Talk:Dextromethorphan

Removed dubious historical info
I just removed the claim that the FDA "approved dextromethorphan as a prescription antitussive drug on September 24, 1954" their citation for this fact does not contain the date September 24, 1954 and I cannot find an authoritative source to support it, I suspect all other instances of this date being used in DXM histories online are simply repeating misinformation from this wiki.

ref name="cesar">

Proposed split of Recreational use section to new article
Proposing split of "Recreational use" section to new article. This is a large and controversial issue that is a highly notable topic unto itself. Section has grown too large for, and beyond the relevance of, this article. Note: A separate article on Recreational use once existed (see here), but was merged into this article (on 10 Feb 2007, see AfD here).  Equazcion •✗/C • 23:55, 27 December 2007 (UTC)


 * Yes, there's no doubt - it's rising in popularity and it's worth having an entire article. --Soonlaypale (talk) 21:27, 24 December 2007 (UTC)


 * 100% yes, though maybe might be seen as a pro-drug article by some --PA1412 (talk) 20:30, 6 March 2008 (UTC)

Recreational use should be moved under "Uses" where it belongs. To have it up front signals a violation of neutrality. Avoid emotionally or politically-biased and non-scientific terms such as "abuse." This entry should not encourage nor discourage its use but remain purely descriptive. A separate article for DXM's non-FDA approved use might fall under a general category along with other disassociates, but does not warrant an entire article on DXM "recreational uses" nor would that be appropriate. The phrase "recreational use" connotes intent of the user and should be stricken in favor of more denotative description of reported effects at varying levels of "overdose." drkull (talk) 07:11, 26 February 2011 (UTC)

Chemistry
Much of the information in the Chemistry section of this article is either incorrect or problematic.


 * Dextromethorphan isn't the methyl ester of anything; it is a methyl ether.


 * It seems to me that levorphanol is levorotatory by definition, so the use of "d-levorphanol" is confusing at best, and probably incorrect. In any case, it's the L- stereoisomer, not the D- one, that's the narcotic analgesic.  I suspect that much of this was copied inaccurately from this NIH page, which is itself somewhat confusingly worded.


 * The data on solubilities, appearance, and specific rotation seem a little bit problematic to me simply because no sources are given for any of them, and because it is sometimes unclear whether they refer to dextromethorphan as the free base or as the hydrobromide salt, but I'll leave it all in there more or less as is for now.


 * Finally, I saw above that someone requested synthesis information in the Chemistry section, and I am working on getting together some sources on that topic, which I plan on using to add a synthesis subsection in the future.

In any case, just letting everyone know that I am going to try to fix up that section. If anyone has a problem with the way I did it, by all means make your thoughts known. --SilenceIsPoetry (talk) 09:36, 29 December 2007 (UTC)


 * Guh?


 * Your scrutiny is appreciated, even if I don't understand exactly what you're saying, which is probably why the Chemistry section is in the state it's in as I've been generally leaving it alone -- it's a bit beyond me. So I appreciate having someone paying attention who knows this stuff. Thanks for any help you can provide there!  Equazcion •✗/C • 11:37, 29 December 2007 (UTC)

Pharmacokinetics: DXM is active by itself
The article currently says:

"Dextromethorphan is rapidly absorbed from the gastrointestinal tract and converted into an active metabolite within 15 to 60 minutes of ingestion"

that is somehow confusing, because someone reading it may think that DXM is a complete pro-drug which needs to be converted to its metabolite in order to have an effect, it is wrong as DXM itself is active. This fact is even mentioned in "Clinical pharmacology" section but I think every section should be correct and clear.

Any ideas? Arman4 (talk) 18:41, 16 January 2008 (UTC)


 * Your completely right, Dextrorphan is apparently responsible for the stoning body high, while DXM is responsible for the mental effects. Try this by taking a small dose (2nd plat) and allowing yourself to get halfway in comeup, then take a higher dose of DXM, you'll notice a strong mental effect as the amount of Dxm to Do is increased (Dxm:Do). --68.45.219.63 (talk) 18:26, 6 March 2008 (UTC)


 * NMDA receptor antagonism is responsible for the mental effect, and dextrorphan is the more potent NMDA receptor antagonist, so dextrorphan is more responsible for the mental effect. But the original poster is correct that DXM itself is also active, especially as an antitussive, for which it is the more potent agent.  Equazcion •✗/C • 18:30, 6 Mar 2008 (UTC)


 * Hmmm, thanks for the information Equazcion, I have read from various people the explanation I used. I assume they were wrong then. --68.45.219.63 (talk) 18:58, 6 March 2008 (UTC)

prevents ejaculation?
whenever i take dayquil with this stuff, or tylenol cough etc, i cannot ejaculate for about 4-5 days. i was wondering if anyone has read this anywhere about dxm, and if so could add it to the article. thank you -stuck with a boner 96.227.101.251 (talk) 17:11, 21 January 2008 (UTC)
 * Ha.  Equazcion •✗/C • 17:16, 21 Jan 2008 (UTC)


 * This is a common side effect of DXM, inability to achive orgasm. It will come back after the DXM's active time is over --71.126.110.245 (talk) 04:50, 22 January 2008 (UTC)


 * Dextromethorphan, like all dissociative drugs, reduces physical sensation temporarily. -Muugokszhiion (talk) 23:31, 29 November 2008 (UTC)

Alleged use in drug dependency
I have removed this para from under the Additional Use section of the article. A reference to a patent application is not sufficient citation and this particular application is unproven Plutonium27 (talk) 02:14, 29 January 2008 (UTC) I see mention of Romilar like substances preventing ejaculation but what an erection. In 1968 I experienced the ability to support a dripping wet bath towel and the effect lasted for about 24 hours. Yes I copulated many times but never to my satisfaction only to my partners.

Dextromethorphan Hbr versus Polix
Good edit on under the effects section regarding poli and Hbr, I added this but I am sure I explained it pretty bad. --68.45.219.63 (talk) 18:37, 6 March 2008 (UTC)
 * Thanks :)  Equazcion •✗/C • 02:34, 7 Mar 2008 (UTC)

Should "abuse" be mentioned as "recreational use"?
The term abuse just sounds like a negative term and something that a anti-drug company would say in all of their stories. --PA1412 (talk) 20:37, 6 March 2008 (UTC)
 * The term "abuse", when used to describe the self-administration of a drug, is defined as using it in a manner not in accordance with medical or label recommendations. People who take more cough medicine than they're supposed to according to the label in order to achieve a high are by definition abusing the drug. It isn't necessarily a negative term, though it may sound that way to some people due to its other uses in other contexts.  Equazcion •✗/C • 00:59, 7 Mar 2008 (UTC)


 * Okay, I usually see it as a negative term, perhaps it isn't, but thats what I would commonly hear in articles regarding DXM. --PA1412 (talk) 02:31, 7 March 2008 (UTC)

It should definitley be "recreational use". Remember that this isn't a middle school anti-drug class.--Metalhead94 (talk) 12:17, 30 August 2008 (UTC)


 * Middle-school anti-drug classes have their purpose. Proponents of the euphemism "recreational use" appear to rail against any suggestion that drug abuse is bad. Well, it is bad. Any hint otherwise should be immediately quashed, as there is no excuse for improper drug use. One might be of the opinion that drug abuse is perfectly acceptable, but that opinion will run right up against the moral stand that it's not acceptable, and that's a tough one to get past. —Preceding unsigned comment added by Dks2855 (talk • contribs) 14:17, 14 May 2010 (UTC)
 * The only purpose that middle school anti-drug classes truly serve, when you dissect the problem to it's core, is to spread the state's totally unfounded prohibitionist bias against psychoactive substances. You, my friend, when you are operating on a neutral encyclopedia project and at the same time screaming such biases as "drug abuse is bad" represents a totally uninformed view against that which is not understood. Use of products intended for medical use to achieve psychedelic effects could be described within the literature as 'misuse' at best. But to outright label all informed recreational use as "abuse" would be totally unencyclopedic. This molecule is being studied as a possible treatment for depression, for example.-- Metalhead94 TC 01:09, 8 July 2010 (UTC)


 * Actually Equazcion, according to wiktionary abuse does seem to involve a negative tone - "1. Improper treatment or usage; application to a wrong or bad purpose; misuse; perversion". The other definition of abuse that would apply here is "2. Physical maltreatment; injury" which in my opinion also implies a negative tone. It should be made clear that everyone who uses drugs is not a "drug abuser" and there are such people as "drug users". The term abuse should be replaced with misuse - "1. An incorrect, improper or unlawful use of something", which seems to describe people who use dextromethorphan in anyway other than the recommended in the least biased fashion. If not misuse, I would vote for 'recreational use' for the sake of maintaining WP:NPOV. Best regards.--Astavats (talk) 19:39, 30 August 2008 (UTC)

Mention...
Perhaps it should be mentioned the physical risk under Risks associated with abuse, such as falling and similar. --71.126.120.40 (talk) 00:21, 19 March 2008 (UTC)
 * Well... Falling is not necessary and I never heard anything about anyone falling down and getting hurt under the influence of DXM.
 * Falling is not the risk of DXM... It's the risk of unaware walking. You can fall even if you sober, so I don't see any connection.
 * Finally, if falling is the result of taking DXM than it could be said that death is the result of life... I hope I made it clear - there is just no sense in blaming drugs for something they can't be blamed for. 85.89.184.212 (talk) 18:27, 22 December 2009 (UTC)

Once again
Recreational use and medical use of dextromethorphan should be split into two separate sections. The rec section is becoming far too large for relevance to anything to do with the medical uses. It is a noteworthy topic of recent media attention and debate. --C6541 (talk) 21:17, 25 March 2008 (UTC)
 * Done.  Equazcion •✗/C • 22:09, 25 Mar 2008 (UTC)

antitussive effect??
Just recently I read a debate in a medical journal on whether or not Dextromethorphan cough medicine is relevant at for treating cough. The MD's were pondering on this because of the abuse potential. So I was wondering whether there are any experimental double-blinded placebo controled experiments on the supposed antitussive effects? Couldn't find any. 80.221.34.239 (talk) 05:23, 9 May 2008 (UTC)

I find it unlikely my self that dextromethorphan is reliable in controlling coughs, it affects NMDA, Sigma 1 and 2, serotonin and nicotinic receptors which have nothing to do with coughs as far as I know C6541 (talk) 06:58, 10 May 2008 (UTC)


 * Slash that, after a recent recreational use during a nasty dry cough, the cough was alleviated. It seems it doesn't work for wet coughs alone (productive coughs; bringing up phlegm), hence why an expectorant is probably added to certain preperations. Still opioids are much more effective at alleviating coughs, they should make a preperation with codeine + an anti-histamine to prevent itching and recreational use, that would help a lot, especially me as I get viral episodes a lot. But I'll see if I can or can't find anything regarding dextromethorphan + placebo studies regarding antitussive effects. Regards, C6541 (talk) 03:47, 23 October 2008 (UTC)


 * It's not the cough itself that DXM interacts with. It's the reflex. Or rather, your body's system of reflexes in general. NMDA receptors really mean glutamate, which is fundamentally responsible for your nervous system working at all. Take that away, and your reflexes go with it, including the cough reflex. That disconnected, dissociated, wonderfully numb feeling you get from recreational use is just an extreme version of the slight disconnection you get from a small medical dose. The more you take, the more your reflexes are deactivated -- from the need to scratch an itch, to the need to bite your nails, to -- with extreme doses -- the need to shift your weight to keep your balance. With a medical dose, which is tiny in comparison, you only feel the slightest disconnection, which lucky for Robitussin happens to include the deadening of that need to cough when a tickle is detected in your throat.  Equazcion •✗/C • 00:41, 20 Dec 2008 (UTC)

Changed section title 'Abuse' to 'Non-medical use', agree?
I changed the section title that lead to the main article called Non-medical use of dextromethorphan from Abuse which implies something negative to Non-medical use, which seems to be accepted as NPOV. Recreational use may be viewed as some as supporting drug use, but Non-medical just means a use besides for a medical condition, in this case a cough or a cold. Any one agree or disagree? Regards, C6541 (talk) 03:51, 23 October 2008 (UTC)


 * "Recreational use" and "non-medical use" are both NPOV. "Abuse" is POV. -Muugokszhiion (talk) 23:28, 29 November 2008 (UTC)


 * Abuse sounds POV to the average person because there's a stigma attached to it. It really just means "intentional incorrect usage". When you take a drug whose FDA-approved label shows the correct usage, including a specified maximum dosage, and you purposely exceed it, you are therefore intentionally using the drug incorrectly. It is abuse, by definition, despite the added "naughty" stigma attached to the word.


 * "Non-medical use" is, in my opinion, excessively... liberal. If DXM were just an herb or vitamin whose correct use was the subject of opinion, then "abuse" would be POV. But in this case, there is no use other than medical use. The only way to get DXM is by purchasing a cough suppressant preparation, and so, the only way to make use of it recreationally is to use the cough suppressant in a manner other than as a cough suppressant. Merely calling it "non-medical use" implies that people have an equal choice between using the substance medically or non-medically, each of which carry equal weight; similar to, for example, baby powder, or vinegar, or hydrogen peroxide (use it to clean a wound or to remove blood stains from clothes, whichever you choose). This is just not the case for DXM. DXM is currently produced as nothing but a cough suppressant -- not as a generic substance to be used as the purchaser wishes.


 * In this case, abuse is the more appropriate, and the more technically correct word.  Equazcion •✗/C • 03:39, 1 Dec 2008 (UTC)


 * "Recreational use" is not, in my opinion, NPOV. Look up recreation; the first synonym used in Wikipedia is "fun." Does that not sound positive, in the same way as "abuse" sounds negative? —Preceding unsigned comment added by Dks2855 (talk • contribs) 14:22, 14 May 2010 (UTC)


 * Agree on non-medicinal as well. If LSD-25 or MDMA were used in medical practice (more so than research level) then I would feel the use would be classified as non-medicinal as a catch-all for spiritual, recreational, or other. If there is, as mentioned previously, a "stigmata attached to" "abuse" then it really should be avoided as to not offend anyone.--Astavats (talk) 00:42, 8 January 2009 (UTC)


 * Mmmm I disagree there. Wikipedia doesn't sacrifice accuracy for political correctness, generally. Offending people is the least very least of our concern, if at all.  Equazcion •✗/C • 00:57, 8 Jan 2009 (UTC)

Inconsistent Molecular Structure Orientation
I apologize as I am basically copy my post on the DXO discussion page. I just want to make sure someone sees this.

I'm not good with graphics or I would correct this. It's not so much a problem, but the molcular structures for DXO and DXM are oriented completely differently from one and another. This makes it very difficult for someone to see the structural similarities/differences. It would be nice if they could be oriented the same way. --Jmcclare (talk) 20:46, 3 January 2009 (UTC)

Additionally, it would be nice if the structures were oriented similarly to morphine for likewise reasons. The DXO molecule is already oriented like the morphine molecule. --Jmcclare (talk) 23:31, 3 January 2009 (UTC)

Do we really need...
... "fever" "hypertension" and "Can include increases in: temperature and blood pressure" separately?? Isn't that pretty much a given with one or the other. Someone with more medical sophistication can pick either one, but both are certainly redundant. Rachaella (talk) 23:42, 7 January 2009 (UTC)


 * The list of side-effects comes directly from the source: http://www.nhtsa.dot.gov/PEOPLE/injury/research/job185drugs/dextromethorphan.htm. Looking there, a lot of the listed effects are actually only in the case of overdose, so the list is inaccurate in that regard. However things like fever and increased body temp are listed as separate effects, both as overdose symptoms, so I think we need to go with that.  Equazcion •✗/C • 00:25, 8 Jan 2009 (UTC)

"other active ingredients"

 *  Other Active ingredients Most of the over-the-counter cough medications containing dextromethorphan also contain other active ingredients. Active ingredients are chemicals that may have a strong effect on the body or mind. Some of these chemicals may be harmful to take above the recomended dosage. It's extremely important that people using dextromethorphan for recreational purposes pay close attention to the active ingredients list, and only use products containing solely dextromethorphan. Products that exclusively treat cough are less likely to contain the other harmful chemicals. The most common active ingredients found in combination with DXM are: Paracetamol, Aspirin, Chlorpheniramine, Guaifenesin, Phenylephrine, Pseudoephedrine, Sorbitol 

This section was placed under "non-medical use". Two problems with that, one being WP:NOTGUIDE (basically article content can't be in the form of instructions). Also the general info is already available in the main non-medical use of dextromethorphan article, so see that article and maybe edit that to include this info. Thanks :)  Equazcion •✗/C • 07:01, 11 Jan 2009 (UTC)

article split
why is there a separate article for recreational use of dxm? no other drug that can be used recreationally on wikipedia gets the same treatment. in the other articles theres is always a sub section dealing with it rather than a separate article. the reasons stated above dont seem to justify the split. the pharmacology section of the recreational use of dxm could easily be merged with the original article and the "dxm "faq"" is an article off of erowid which doesnt really have a place here, its not a scholarly source. there is also already a side effects section in the original article. what im getting at is that the two are fairly similiar and the info that one article has could easily be added to the other. —Preceding unsigned comment added by 69.206.78.252 (talk) 05:51, 17 April 2010 (UTC)

Binding and Ki values vs. action
Various results of Ki values, e.g. for opioid receptors have been listed as pharmacological actions. Many of them are seemingly spurious binding to non-target protein in vitro. These have to be precisely cited as such, i.e. what receptors, what species etc. to not be confused with pharmacological actions. There is a difference between a binding assay and a pharmacological effect, as is known from immunological detection methods. So I ask for more precise citation. The ref abstract gives no hint of this ref being relevant for the substance. 70.137.131.62 (talk) 11:49, 17 April 2010 (UTC)

Side effects
i think that any pharmacological article here should be written primarily for someone seeking info on the drug's therapeutic use, rather than its illicit recreational use. from that perspective,most of your 'side effects' are more properly seen as overdose symptoms. it's easy to miss that perspective when the treatise you cite is from the national highway traffic safety administration (!?), not exactly a front rank pharmacological journal.Toyokuni3 (talk) 16:34, 29 April 2010 (UTC)
 * Eh since when is use of DXM illicit? C6541 (T↔C)  17:47, 13 May 2010 (UTC)

you want to bet i can't find one or more laws that taking 75 times the therapeutic dose for a cheap high contravenes?Toyokuni3 (talk) 20:48, 13 May 2010 (UTC)


 * Please do provide a reference to such a law.


 * Laws have nothing to do with what information we provide, methamphetamine is a prescription drug and go read that article, most of it is so called "illicit" side effects. The side effects section clearly states what side effects are typical of "overdoses". C6541 (T↔C)  15:26, 19 May 2010 (UTC)

uses
The subject of whether cough suppressants are actually effective is discussed primarily in the Wikipedia article Cough medicine. The material here was overweight, and I reduced it and moved it to the right section. The use of alternative medicines for cough is irrelevant to the present topic; I removed that material and it should not be reinserted.  DGG ( talk ) 00:40, 17 June 2010 (UTC)

NMDA antagonist neurotoxicity
Someone had written: However the only side effect the rats showed was a change in personality. The following reference was offered (without ref tags): " /  I removed it given that Carliss et al. (2007) found that dextromethorphan did not lead to vacuolation or other neurotoxic changes.

One final note: please make sure to actually read papers before citing them. Prior to my edit, it appeared as though Olney et al. (1989) were cited as the source of evidence supporting the assertion that rats only showed changes in peronality and Olney's paper says no such thing.

"nonselective serotonin reuptake inhibitor"
A reuptake inhibitor either selectively inhibits reuptake of one neurotransmitter, or it inhibits reuptake of several, and thus would not be called selective. The phrase "nonselective serotonin reuptake inhibitor" is an oxymoron. I'd like to remove the term "nonselective". —Preceding unsigned comment added by 71.79.30.121 (talk) 11:34, 3 February 2011 (UTC)

Possible benefits for Multiple Sclerosis
The following is an article from the Sacramento Bee date July 8, 2011

A drug used in over-the-counter cough medicine may treat symptoms of multiple sclerosis -- offering inexpensive therapy for a disease with few treatment options, according to UC Davis researchers.

In tests using mice, the drug, dextromethorphan, was found to significantly reduce the loss of myelin, the fatty sheath surrounding nerve fibers in the central nervous system. It also minimized the development of paralysis during MS attacks.

The finding provides an opportunity to pursue a new treatment strategy "with a drug that is widely available, inexpensive and known to be safe," said Wenbin Deng, principal investigator of the study and a UC Davis assistant professor.

MS affects about 400,000 people in the United States and 2.5 million worldwide. It is caused by cells of the immune system attacking the myelin.

Symptoms of the disease vary and often involve periods of motor problems, including paralysis of a limb or poor coordination. It may either go away or become permanent.

As the disease progresses, it causes increased disability and has no known cure, according to a UC Davis Health System press release.

Researchers induced mice to have moderate or severe MS and treated them with either very low or high doses of dextromethorphan. Investigators found that very low amounts given to mice with moderate disease signficantly reduced the loss of myelin and the development of paralysis during acute attacks. High doses didn't help at all.

"Finding that a chemical like dextromethorphan might be useful for treating multiple sclerosis is especially significant because we already know it is safe," said David E. Pleasure, director of research at the Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California in Sacramento and one of the authors of the study. "Normally, a possible new treatment must first undergo years of clinical trials to prove this."

Source: The Sacramento Bee Copyright © The Sacramento Bee 2011 (07/08/11) — Preceding unsigned comment added by Leonkingcpa (talk • contribs) 17:37, 13 July 2011 (UTC)

International History
As a Canadian child of the 60s and 70s, I had no access to an efficient antitussive. I spent my 20 first years of life coughing 6 months a year. Coughing for me was no longer a symptom but a problem in of itself. I would be very curious to know when Dextromethorphan made it to Canadian markets. I hope someone can provide this sort of information. I only found out about Dextromethorphan in 2000! I now use it 2-3 times a year, in strip form (now only available for children in Canada) or liquid. It has changed my life. I usually use it as a solo ingredient, without all the other cold/flu medications. It allows me to cough a couple of times, just enough to move the phlegm, and completely prevents me from having coughing fits. It's one of the only completely efficient drugs I've ever used in my life. I really wish I had known about it sooner, or that my parents could have known about it. I would find it very interesting to read how this product evolved in Canada. Thank you. — Preceding unsigned comment added by 207.189.245.231 (talk) 00:07, 3 September 2011 (UTC)

wow keren — Preceding unsigned comment added by 180.254.254.228 (talk) 01:31, 26 February 2015 (UTC)

Dextromethorphan NOT related to SIDS
Under the Adverse Effects sub-heading, the first bullet point is "Sudden Infant Death Syndrome" referenced by Footnote 17. The article linked to footnote 17 doesn't support a link between DXM and SIDS - it refutes it. I'm going to remove this bullet point. If anyone has real supporting evidence of a link between DXM and SIDS, by all means put the bullet point back in with a new footnote. 125.209.146.230 (talk) 12:55, 3 January 2013 (UTC)

Dextromethorphan and serotonin syndrome
After reading the 2008 article by Schwartz, Pizon, and Brooks, I felt the text which introduced their findings with "research has shown..." was too sweeping a claim, so I have tried to rephrase the statement to make it more in line with the strength of their findings. What the authors do claim is that none of the pre-2008 case studies purporting to link dextromethorphan with serotonin syndrome include objective evidence of the dosages consumed by the patient, for example in the form of serum drug levels. (For what it's worth, up until this paper was published, the same lack of evidence existed in cases documenting recreational use). So I think it's incorrect to say they have "shown" (proven) that therapeutic doses can't cause serotonin syndrome. The authors themselves wrote that "More information is required to confirm our findings" which I think more accurately represents the current state of the literature.

I did a quick follow-up in Google Scholar and nothing immediately jumped out at me as backing up or refuting their conclusions. Perhaps someone more familiar with the area will be able to confirm. Bartleby62 (talk) 00:58, 3 March 2014 (UTC)

food interaction?
The section on food interaction suggests that Dextromethorphan metabolism is modified by p450 inhibition via dietary sources such as grapefruit. While true of some drugs, this is not generally true. The article needs to cite an original source that directly connects to dextromethorphan metabolism,  otherwise it is just speculation.

I would change it, but I'm personally not sure if it does or does not connect--I can't find a clear answer right now. PeterWoolf (talk) 13:51, 4 April 2014 (UTC)

Diabetes
Apparently it increases glucose sensitivity in the pancreas. -- 65.94.43.89 (talk) 07:41, 19 March 2015 (UTC)

What is the Recreational Use?
The section seems to lack some of the reasons as to why people use this. The section talks of what the drug does and goes into more detail of the science behind it. I think there needs to be more on the social reasons for use and propose adding a few citations to help give a broader understanding of uses than just the psychological effects. --Escott25 02:42, 19 April 2016 (UTC) — Preceding unsigned comment added by Escott25 (talk • contribs)

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Antitussive: effective mg/kg dosage for adults?
I am mystified why the recreational abusers of DXM talk about plateaus and mg/kg dosage precision, yet for use as an actual medicine, that sort of precision does not seem to be used at all, as if it is not important. It looks to me like mg/kg dosage precision probably is important as an antitussive, and as such larger adults are probably being far underdosed using DXM for its labeled usage.

Robitussin / Catalent Pharma Solutions has a standard dosage of 30 mg of dextromethorphan HBR for anyone 12 years of age or older for the standard non time release product. Based on my web searching the average body weight of a 12 year old human is about 90 pounds or 40.8 kg. So this works out to an effective dosage of 0.70 mg/kg

https://www.cdc.gov/growthcharts/data/set1/chart03.pdf https://www.cdc.gov/growthcharts/data/set1/chart04.pdf
 * 2 to 20 years: Boys USA Weight-for-age percentiles, Centers for Disease Control, May 30, 2000
 * 2 to 20 years: Girls USA Weight-for-age percentiles, Centers for Disease Control, May 30, 2000

Though the standard dosage may really be more of a "maximum safe dosage for the minimum body weight". If we look at those same CDC charts, the minimum body weight of a 12 year old is about 65 lb / 29.4 kg. That then works out to 1.02 mg/kg.

Speaking personally as a 240 lb / 108.86 kg man, I find that Robitussin softgels do nothing for my coughing unless I at least double the dosage to 60 mg, and I find it most effective at 75mg (5 Robitussin softgels). If I do the math, this works out to 75 mg / 108 kg = 0.69 mg/kg ..... which as you can see is very close to and just slightly under the standard 0.70 mg/kg body-weight compensated dosage for an average sized 12 year old. I do not experience any sort of unusual dissociative effects at this dosage.

For me at 240 lb / 108.86 kg, this is also quite a bit below what appears to be the maximum safe dosage of 110mg (1.02 mg/kg), which would require 7.3 softgels.

Comparing this to the recreational drug use guide (which obviously is not a reliable source but the only source available, so I have to mention it), the first stage of dissociative effects begin at about 1.5 - 2.5 mg/kg. This is in general agreement with my extrapolated maximum safe dosage for a minimum weight 12 year old.


 * Vaults of Erowid: DXM FAQ / Section 5, The DXM Experience, August 2002 https://erowid.org/chemicals/dxm/faq/dxm_experience.shtml

According to the softgel product label, users are warned "not to exceed 8 softgels (120mg) in any 24 hour period", yet at the 0.69 mg/kg antitussive dosage rate, I am using 20 softgels per day to effectively control my cough. No explanation is provided on the product packaging for why 120mg is intended as the maximum dosage per day.

So, if you are an adult and DXM isn't doing anything for your cough at the standard labeled dosage, there is probably a reason for that. It is a mystery to me why the product is allowed to be labeled and dosed to adults in a manner that renders it less effective, to the point of being ineffective, for adults with a body weight that is normally beyond 90 lbs / 40.8 kg.

I am trying to hunt down official numbers and sources for the clinically tested effective mg/kg dosage and maximum standard mg/kg dosage amounts for DXM HBr as an antitussive, but so far I have not found anything. -- Pikonuk (talk) 11:30, 13 January 2017 (UTC)


 * I believe I have found a way to find medically significant documentation regarding mg/kg dosage using Google.
 * "Dextromethorphan" "0.7 mg/kg" -plateau "antitussive" -dogs
 * We do not want any document referring to plateaus because that word is only used by the recreational drug [ab-]users.
 * Dogs come up tens of thousands of times for some reason. Is it used in veterinary, or is this regarding animal studies for humans? I haven't examined this closely yet.


 * Unfortunately there are a variety of ways to write the significant digits of numbers, so medical papers may write dosage numbers in the form of
 * .7 mg/kg
 * .70 mg/kg
 * .700 mg/kg
 * 0.7 mg/kg
 * 0.70 mg/kg
 * 0.700 mg/kg


 * I don't think it is possible to ask Google to do a dynamic numeric range search using significant digits, so individual searches would need to be done, sequentially checking for dosage values from 0.001 mg/kg to about 2.000 mg/kg
 * 9 searches for .1 to .9
 * 99 searches for .01 to .99
 * 999 searches for .001 to .999
 * 9 searches for 0.1 to 0.9
 * 99 searches for 0.01 to 0.99
 * 999 searches for 0.001 to 0.999
 * 10 searches for 1.0 to 1.9
 * 100 searches for 1.00 to 1.99
 * 1000 searches for 1.000 to 1.999


 * So, finding all relevant medical papers on this subject is potentially quite time-consuming. I am not sure I want to be doing 3324 individual web searches.


 * If someone can suggest a better way to find citations using number ranges, I would be interested to hear about it. -- Pikonuk (talk) 17:10, 17 January 2017 (UTC)

Neurotoxicity
I'm not technically competent to edit this article. However, the assertion in this section in this section that something formerly believed was "proven inconclusive" strikes me as odd. I checked, and found that this was changed from "proven not to be true" in this 2010 edit. I'm out of my depth here; Would an editor more technically capable than I please take a look at this? Wtmitchell (talk) (earlier Boracay Bill) 05:42, 20 September 2022 (UTC)


 * It's not my edit so I'm just speculating, but it might have had something to do with the fact that scientific inquiry can't prove a negative. Maybe someone thought more precise wording about inconclusively would be better. 2001:448A:1082:1F97:F5CC:2705:37C3:C671 (talk) 05:00, 30 October 2023 (UTC)

Commercial product placement
My first impression upon reading this article is that it seems strange the introduction obsesses with depression and psychoactive mechanisms. This venerable and ubiquitous OTC agent has been known as a cough suppressant for decades, yet the intro launches into a plug for novel uses associated with a new pharma product right after the first sentence. Psychoactivity and anti depression dominate the intro as if antitussant activity is just an off-label afterthought. Weird... Unless it was edited for hire to promote Auvelity, a product that's only been on the market for a year (as of this entry). The weird thing isn't that the article mentions the indication of depression and the new product of Auvelity, but just the kind of suspicious fact that it appears as if it is the article's primary topic. Wouldn't coverage of the novel use and new product be more appropriately located further down in another section? 2001:448A:1082:1F97:F5CC:2705:37C3:C671 (talk) 04:07, 30 October 2023 (UTC)


 * I don't get that impression. The first paragraph mentions it being used as a cough-suppressant and being part of Auvelity, and it mentions the cough-suppressant part first. The rest of the opening/top section doesn't appear to have anything out of place. The next place the use for depression is mentioned is in the Medical Uses section, in a small 1 sentence subsection mentioning Auvelity; it's also at the bottom of the Medical Uses section, below not only Cough Suppression but also Pseudobulbar affect. Then I don't see it mentioned in the context of depression again anywhere in the article; even in the Pharmacology section, the article is mostly indifferent to how the drug is to be used, but in one instance it mentions an effective antitussive dose (and doesn't mention depression in this section at all). Auvelity is not even mentioned in the Research section. So, it is mentioned twice: once in the top matter but not in a suspicious way, and then once in Medical Uses, also not in a suspicious way. Obviously I could be wrong and this is just my opinion from how I see the article, and I do care about integrity regarding paid editing, but this doesn't look like it to me. Kimen8 (talk) 12:01, 30 October 2023 (UTC)

Drug class
, I see you are having some issue accepting Dissociative drug as the drug class on this article. Drugs can be classified by their chemical structure, as you're trying to do, or by their effect. Your complaint:

"The term morphinan class actually describes dextromethorphan. Dissociative class is a vague and useless term since it neither describes the type of dissociative (anesthetic, hallucinogen, psychology term; what is even being said) and I can find no other antitussives part of this made-up class. This is complete mumbo jumbo."

"Dissociative class" is not too vague nor useless; if you read that article, it describes the class well enough: they are a subclass of hallucinogens, that induce the psychological/physiological effect of dissociation, and at high enough doses are used as anaesthetics. This is all very cut and dry; it is not "made-up" as you seem to think, nor is it "mumbo jumbo". The class is well defined, and the term is commonly used and perfectly descriptive.

That there are no other antitussives in the dissociative class is a meaningless complaint. There is no reason that other antitussives need be dissociatives. To my knowledge, the dissociative effects of DXM are not responsible for its antitussive effects; as such, there is no reason to assume that other antitussive should be in the dissociative class.

For consistency, you should look at practically any pharmaceutical's article: they are going to use the drug class defined by the drug's effect when possible; in some cases both chemical structure and effect are mentioned (specifically in the case of, e.g., "subtituted amphetamine stimulant", or "substituted cathinone stimulant", etc.) when it may be useful to do so.

Please discuss this here; barring any reasonable discussion or convincing rebuttal, I am going to revert your change as it is not an improvement and is inconsistent with other articles. Kimen8 (talk) 08:17, 22 December 2023 (UTC)


 * It’s a morphinan first and foremost, anything beyond that is secondary. Irruptive Creditor (talk) 08:54, 22 December 2023 (UTC)
 * A more proper phrasing would be the following: “Morphinan antitussive and dissociative drug”. Much like the case of cocaine: “Tropane alkaloid and stimulant drug.” Dissociative class would be improper. It would be akin to describing the stimulant methylhexanamine as an alkylamine of the stimulant class. That is utter nonsense, it’s a stimulant of the alkylamine class. Not the other way around. Also, I can’t find any consensus supporting your outlandish claims. Three editors besides myself have edited in the timeframe since I reverted your edit. Not a single one of them reverted my revert or expressed any concern on that matter. Overall, there is zero significant empirical support to be found for any claim that such edit was not an improvement or is inconsistent with any other article. As such, it appears this attempt to talk things out (by you) is little more than a thinly veiled attempt to push a personal prerogative since nobody else seems to care that I called dextromethorphan an antitussive of the morphinan class.  Irruptive Creditor (talk) 09:01, 22 December 2023 (UTC)
 * Stop trying to make mountains out of molehills. Irruptive Creditor (talk) 09:26, 22 December 2023 (UTC)
 * Though your reasoning is faulty, "Morphinan antitussive and dissociative drug" is acceptable as a short description.
 * Also, be sure to read (and enact) WP:AGF, and do not accuse others of . There is no evidence of this, and it is not the case, and accusing editors of not editing in good faith is problematic behavior. Kimen8 (talk) 09:33, 22 December 2023 (UTC)
 * Ok, whatever. Have a great day :) Irruptive Creditor (talk) 09:50, 22 December 2023 (UTC)