What is Dextromethorphan Overdose?

• Dextromethorphan (DXM) is a medication that is used in treating cough that develops from common cold or influenza (and not arising from smoking or asthma). It is a cough suppressant in the form of a liquid, lozenge, chewable tablet, or dissolving strip
• Dextromethorphan Overdose is the accidental or intentional intake of the medication in dosage higher than prescribed values
• The condition is diagnosed based upon the clinical history, combination of signs and symptoms, and additional tests (that may include, in some cases, radiological studies and laboratory tests)

Dextromethorphan Overdose may be also referred to as the following:

• DXM Overdose
• Orange Crush Overdose
• Red Devils Overdose
• Robo Overdose
• Triple C's Overdose

What are the Causes of Dextromethorphan Overdose?

• Dextromethorphan Overdose is caused by intake of dextromethorphan containing drug in dosage that is higher than prescribed
• This intake could be accidental, or in some cases intentional, to bring self-harm
• It is sold as over-the-counter cough medication under brand names Robitussin DM, Triaminic DM, Rondec DM, Benylin DM, Drixoral, St. Joseph Cough Suppressant, Coricidin, Alka-Seltzer Plus Cold and Cough, NyQuil, DayQuil, TheraFlu, Tylenol Cold, and Dimetapp DM among others
• In the form of a recreational drug, it may be sold under street names Orange crush, Triple Cs, Red Devils, Skittles, Dex, etc.
• Even though legally sold for purchase, Dextromethorphan is a drug of abuse as it can be intoxicating and habit-forming

Note: The drug can interact with other prescribed or non-prescribed medications in the body. Such interactions may enhance the therapeutic effects of the drug or other medications being taken, resulting in undesired side effects (such as an overdose).

What are the Signs and Symptoms of Dextromethorphan Overdose?

The signs and symptoms of Dextromethorphan Overdose can vary from one individual to another. It may be mild in some and severe in others. Several systems of the body, such as the vascular system, nervous system, respiratory system, and ENT may be affected.

The signs and symptoms of DXM Overdose may include

• Nausea and vomiting
• Twitching of the muscles
• Muscle spasms, particularly affecting the stomach and intestines
• Constipation
• Breathing difficulties; absence of breathing or shallow breathing
• Bluish-colored skin, particularly in the lips and underneath the nails
• Feeling dizzy or drowsy, hallucinations
• Increased heartbeat and palpitations
• Increased or decreased blood pressure (hypertension or hypotension respectively)
• Confusion and increased nervousness/unsteadiness
• Seizures
• Vision abnormalities including blurred vision 
• Increase in body temperature
• Acid buildup in body fluids
• Hyperexcitability
• Excessive sleepiness
• Coma

How is First Aid administered for Dextromethorphan Overdose?

First Aid tips for Dextromethorphan Overdose:

• Call 911 or your local emergency help number immediately
• Call the Poison Control Center at 1-800-222-1222 (or your local poison control center) for further instructions
• Provide them with information such as dosage, type of drug taken, strength and time of ingestion of medication, age, weight and general health status of affected individual
• Confirm that the airways are protected; also, ensure breathing and the presence of pulse
• Stay with the affected individual until medical help arrives
• Avoid any home remedies, which may only worsen the condition
• Take individual to emergency room (ER) for further treatment
• Always try to take the medication strip/bottle/container to the ER

The emergency medical health professional might perform the following steps towards treating the condition:

• Conduct blood and urine tests, obtain an electrocardiogram (ECG), and undertake imaging scans, as needed
• Gastric lavage for elimination of drug from the stomach (irrigation using special solutions)
• Medically manage symptoms, such as seizures
• Provide breathing support, if necessary
• Administer suitable medicine to counter the effects of the ingested drug
• Administer activated charcoal to avoid absorbance of drug in the body
• Administer laxatives for elimination of drug from the body
• Administer fluids by an intravenous drip line

Who should administer First Aid for Dextromethorphan Overdose?

First aid for Dextromethorphan Overdose is administered by healthcare professionals.

• The individual who overdosed, or someone near, should call 911 for emergency assistance (or the local emergency number)
• They should also call the poison control center at 1-800-222-1222 (or the local poison control center) and follow instructions

What is the Prognosis of Dextromethorphan Overdose?

• The prognosis of Dextromethorphan Overdose is dependent on the amount of drug consumed, time between overdose and treatment, severity of the presenting symptoms, as well as general health status of the patient
• If the individual can recover from the symptoms with appropriate medication and early support, the outcome is generally good
• In a majority of cases, the symptoms are mild, and an early recovery is noted with suitable (generally minimal) treatment
• Although, many teenagers are reported to abuse dextromethorphan (sold as a recreational drug on streets) and deaths have been reported following large overdoses

In general, overdoses are common situations in the emergency departments. A majority of the cases are often not fatal when appropriate treatment is given.

How can Dextromethorphan Overdose be Prevented?

Dextromethorphan Overdose can be prevented by:

• Always taking the right dose of medication at recommended times
• Avoiding drugs that might interact with dextromethorphan
• Talking to your healthcare provider if recommended dose of Dextromethorphan does not provide adequate relief
• DO NOT continue to take medications beyond the prescribed dose duration before checking with and obtaining permission of the consulting physician
• Refraining from self-medication
• Avoiding alcohol while taking any medication
• DO NOT recommend or share medications you are taking with others who may have similar or near similar health conditions
• Exercising caution while taking multiple drugs with Dextromethorphan
• Keeping medications out of reach of children in child-proof containers
• For older individuals and those who tend to be forgetful, medications should be stored in single dose containers with time labels, to avoid multiple dosage
• Monitor intake of this drug especially in patients, who have depression or harbor suicidal thoughts and behavior

It is important to give your healthcare provider a complete list of prescription and non-prescription medications that are being currently taken. This will help them in assessing the possible drug interactions within various medications and help avoid/prevent accidental or unintentional toxic drug effects.

What are certain Crucial Steps to be followed?

• Call 911 (or your local emergency number) for emergency assistance, if symptoms are life-threatening
• Call Poison Control Center at 1-800-222-1222 (or the local poison control center) and follow the recommend steps
• It would be helpful if the following information is readily available:
  • Type, dosage and time of administration of medication
  • Age and weight of the individual
  • And, the overall health status of the individual