Risks of Mixing Dextromethorphan and Alcohol

Feeling sick is no fun. The stuffy sinuses, the runny nose, the headaches, the chills … We know the age-old advice — sleep, drink water, eat chicken soup — but sometimes the misery of a cold or flu just feels like too much. To relieve symptoms and get a good night’s rest, many of us turn to cold medicines to reduce our coughing, clear our sinuses, and knock us out so we can sleep.

But what if you take cold medicine when you’re not sick? Dextromethorphan (DXM), an ingredient in some of the most widely used cold medicines, is becoming increasingly popular as a recreational drug. It’s said to induce hallucinations and happiness, and it’s often mixed with other drugs to enhance their effects. So what happens when you mix dextromethorphan and alcohol? Let’s look at how these two drugs work in the body and talk about why mixing DXM and alcohol makes for a particularly dangerous cocktail.

What Is DXM?

Dextromethorphan, also known as DXM, is a cough suppressant used in many common cough and cold medicines. It works by modifying the way that excitatory neurochemicals behave in the brain and how they travel to the medulla oblongata — the part of your brain that deals with essential subconscious functions like breathing, heartbeat, and sensory input. Not only does it suppress the subconscious cough reflex, but it suppresses the conscious feeling of irritation that causes us to cough when we’re sick.

How Is Dextromethorphan Used?

For cough medicines, dextromethorphan is typically combined with complementary medications such as antihistamines, decongestants, or pain relievers as a formulation to treat multiple symptoms at once.

DXM also affects serotonin — a complex neurochemical best known for its role in mood and cognition. DXM acts as a much weaker version of a common class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) by increasing the amount of serotonin in our bodies. At normal doses, this doesn’t have an immediate effect, but in certain combinations with other antidepressants it has been shown to help treat major depressive disorder.

In recent years, dextromethorphan has also been investigated for its role in treating other psychiatric conditions, such as the pseudobulbar affect and certain symptoms of Alzheimer’s disease. Despite its promise, it is not considered the primary course of treatment for any condition other than coughing.

Is Dextromethorphan “Cough Syrup”?

While DXM is a common ingredient in cough syrups, the two are not synonymous. There are cough medications and even cough suppressants that do not use dextromethorphan, and many cough syrups containing dextromethorphan also contain other therapeutic ingredients. On the other hand, some cough syrups contain DXM as the sole active ingredient. When referring to “dextromethorphan” and “DXM” in this article, we will generally be referring to over-the-counter cough syrups and not to combination drug therapies prescribed by a doctor for psychiatric conditions.

Side Effects of Dextromethorphan

DXM suppresses coughing by reducing the activity of our central nervous system — the part of our brain responsible for breathing, blood pressure, and heart rate. Because it acts on such a critical part of our body, DXM has a wide range of side effects. Let’s look at some of the most common ones.

• Drowsiness
• Dizziness
• Digestive changes
• Rash
• Nausea and vomiting
• Hallucinations

At normal doses, dextromethorphan puts the brakes on our central nervous system. But at higher doses, particularly at those used recreationally, it starts to have some opposite effects.

How Dextromethorphan Is Misused

Since DXM is common and available over-the-counter, it’s easily accessible for the purpose of misuse, particularly among young adults and teenagers who may find it easier to obtain than other substances. Misuse typically involves consuming DXM in quantities far exceeding the recommended therapeutic dose for cough suppression, seeking a psychoactive experience.

• Recreational use for psychoactive effects. At high doses, DXM acts as a dissociative anesthetic and can produce altered sensory perceptions, euphoria, and hallucinations. These effects are the primary reason people recreationally misuse DXM.
• Combination with other substances. DXM is often misused in combination with other substances such as alcohol, marijuana, or antihistamines to enhance its psychoactive effects. This practice significantly increases the risk of dangerous side effects and toxicity.
• “Robotripping” and “Dexing.” These slang terms refer to the act of consuming large amounts of DXM-containing cough syrups or pills. These practices often involve consuming an entire bottle or multiple bottles of cough syrup or a large number of cough suppressant pills, well beyond the recommended dose. This is particularly dangerous due to the presence of other active ingredients in these medications that may pose additional risks on top of the risks associated with DXM itself.

Effects of Dextromethorphan Misuse

Any sort of substance misuse has serious implications for our health, and dextromethorphan is no different.

In the short term, DXM can cause extreme drowsiness and sedation, impairing our dexterity, balance, reaction time, and mental clarity. Users may experience dizziness, confusion, and impaired motor coordination, increasing their risk of falls and injuries. It can also impair our judgment and decision-making abilities and lead to hallucinations, delusions, or a dissociative state.

Perhaps the most alarming acute effect of DXM is the risk of respiratory depression. When misused at doses high enough to produce psychoactive effects, the central nervous system action of DXM can lead to significantly slowed breathing, which can be life-threatening.

Chronic misuse of DXM can lead to long-lasting cognitive impairments affecting memory, concentration, and problem-solving skills. It’s also particularly hard on the liver, an effect compounded by the fact that DXM is often misused in combination with other substances that also affect the liver.

Beyond the physical dangers, DXM presents a high risk of psychological dependence when used to cope with stress or emotions. Due to its dissociative properties and action on serotonin, it can cause anxiety, depression, panic disorder, and even lead to psychosis, characterized by delusional thinking and persistent hallucinations.

There are many dextromethorphan warnings to consider, but the most severe ones have to do with combining DXM and other substances, especially alcohol.

Dextromethorphan and Alcohol: A Dangerous Cocktail

Mixing DXM and alcohol has potentially severe consequences and is never a good idea. In some ways, they amplify each other’s effects, but in other ways, they counteract each other and produce unpredictable and inconsistent results. Oddly enough, you may even find some cough syrup with alcohol content. It has no therapeutic effect, but it’s used as a preservative or as a way to include alcohol-soluble ingredients. The amount of alcohol in a single dose of alcohol-containing cough medicine is not enough to cause any serious interactions, but when used at higher doses (and especially when mixed with alcohol), interactions start to take place. Here are some of the biggest dangers:

• Respiratory risk. The biggest risk of mixing DXM and alcohol is the compounding effect on respiration. Both substances are central nervous system depressants and using them together can lead to dangerously slowed breathing, or, in extreme cases, complete respiratory arrest.
• Enhanced intoxication. Alcohol and DXM individually impair judgment and motor coordination. When combined, these impairments are magnified, increasing the risk of accidents, injuries, and poor decisions.
• Neurochemical chaos. DXM and alcohol work on many of the same brain chemicals. When combined, they can amplify each other’s effects on neurochemicals like NDMA (responsible for the dissociative effects of both alcohol and DXM) and serotonin, which regulate our mood.
• Serotonin Syndrome. Both alcohol and DXM can increase the brain’s serotonin levels. When mixed, the result could lead to serotonin syndrome, a dangerous and life-threatening condition resulting from an extreme excess of serotonin in the bloodstream. Mixing dextromethorphan and medications for depression and anxiety — like SSRIs, SNRIs, and MAOIs — is particularly dangerous, especially considering the way alcohol affects serotonin.
• Extra stress on the liver. Mixing DXM with alcohol can lead to greater toxicity as both substances are metabolized by the liver. This puts excessive strain on the liver and increases the risk of liver damage or acute liver failure.
• Mental distress. The combination of altered mental states due to high doses of DXM and the depressive effects of alcohol can lead to dissociation, severe anxiety, panic attacks, and paranoia.
• Cognitive impairment. Chronic use of both substances in combination can result in long-term cognitive deficits, affecting memory, concentration, and problem-solving skills.

Clearly, mixing DXM and alcohol comes with a host of risks, most of them serious. Misusing either substance alone can be dangerous enough, but taking them together amplifies this risk and reinforces addictive behaviors.

Hidden Interactions in Cough Syrups

Another important thing to consider is the interaction between alcohol and other medications present in cough syrups in particular. Many cough medications contain acetaminophen, also known as APAP or by its brand name, Tylenol. Acetaminophen and alcohol are extremely dangerous to mix since they strongly compete for processing in the liver. Cough syrups can also contain certain allergy medications, all of which interact with alcohol metabolism and may magnify some of alcohol’s most negative health impacts.

Drinking Alcohol While Sick

Beyond medication interactions, drinking alcohol while sick is not a good idea. Even if we use dextromethorphan for completely innocent reasons, like suppressing a cough, it’s best to give our body a rest while getting over any sort of illness. Alcohol puts strain on our body and weakens our immune system while its diuretic effects increase our risk of dehydration. If you’re sick, just skip the sip!

Staying Safe

• Read medicine labels carefully. Identify whether your medications contain dextromethorphan. Be careful if you’re taking cough syrups and pay close attention to the active ingredients in your psychiatric medications so you can avoid the many possible dextromethorphan interactions with common medications.
• Monitor usage. Keep track of your medications and the amounts you’re taking, and be careful to stay within recommended therapeutic doses. Consider tracking your alcohol consumption with Reframe to stay on top of your drinking.
• Avoid mixing medications and alcohol. To give your medications the best chance at being effective, it’s best to just avoid mixing alcohol and medication entirely. Be especially careful of mixing alcohol with antipsychotics, antidepressants, antibiotics, and supplements. If you’re using DXM and plan to drink anyway, consult with a healthcare provider or pharmacist about how to reduce your risk of side effects.
• Recognize signs of misuse. If you’re considering mixing dextromethorphan and alcohol, ask yourself whether this is an indication of a larger substance misuse pattern. Consider seeking professional help or using Reframe to track your alcohol consumption as you start examining the reasons we turn to substances like alcohol.
• Seek alternatives. There are many cough medications that don’t contain dextromethorphan. Likewise, alcohol is never a good way to cope with life’s stresses, and there are many healthier ways to maximize happiness and enjoyment in life.

Conclusion

Dextromethorphan misuse is dangerous, and it can lead to long-lasting health effects — much like alcohol can. When we consider the complexities of DXM and its interactions, especially with alcohol, we unravel a narrative filled with potential risks and unintended consequences. While DXM can be a valuable medicinal tool, mixing DXM and alcohol opens the door to a wide range of health hazards. By understanding the risks, recognizing the signs of misuse, and taking proactive steps for safe use, we can ensure that DXM serves its intended purpose without compromising our health and safety.