FDA Says Yes to Dextromethorphan Cough Meds, Should It Be No?


Although the Food and Drug Administration (FDA) advisory panel voted against requiring prescriptions for cough medicines that contain dextromethorphan, the debate is not over. Many experts and parents believe the cough medicine ingredient needs to be limited to people age 18 and older.

The Dangers of Dextromethorphan

The FDA documented an estimated 7,988 emergency department visits related to dextromethorphan (DXM) in 2008, a significant increase from 4,634 just four years earlier. Although DXM is found in more than 120 cough formulations and is considered safe and effective when used in recommended doses, it is often abused by young people as a way to get an inexpensive high.

An estimated 10 percent of adolescents in the United States, some as young as nine, report that they have abused over-the-counter medications that contain dextromethorphan. Specifically, some teens and tweens participate in “Robo tripping,” during which they consume large doses of Robitussin (the best-known brand of cough medicine that contains DXM).

While the medicinal dose is about 30 mg, abusers often take 250 to 1,500 mg, which can produce blurry vision, rash, sweating, fever, itching, elevated blood pressure and heart rate, fast, shallow breathing, and an increase in body temperature. It can also cause hallucinations, loss of motor control, and occasionally, death. If DXM is taken along with some classes of antidepressants, the combination can cause a life-threatening condition known as serotonin syndrome, which requires hospitalization.


Limiting Access to Dextromethorphan
Although the Consumer Healthcare Products Association was pleased the FDA did not vote to require prescriptions for DXM, the Association also noted in a statement that “We do, however, recognize the need for continued education to keep any abuse levels low.”

Medications that contain DXM are referred to by abusers as “robo,” “tussin,” “dex,” and “red velvet.” Parents who are concerned about whether their child is involved with DXM should be aware of the lingo and how to recognize signs that their child might be abusing the drug. The American Society of Anesthesiologists recently released guidelines for this purpose.

Another related concern for parents is the fact that there are many websites that provide “how-to” abuse information, as well as photographs of the many different products that contain dextromethorphan. These opportunities make it easier for young people to gain access to and abuse the drug.

The door is not yet closed on how dextromethorphan will be handled by the authorities. The FDA usually, but not always, follows the recommendations of the advisory panel. Congress has the power to limit sales of the drug to people younger than 18. Even the Consumer Healthcare Products Association, which is opposed to restricting sale of DXM to adults, noted that “We believe that a statutory ban on sales of dextromethorphan medicines to those under 18 would limit abuse.”

ABC News
CHPA statement



Standing alone, DXM has no documented lethal dosage. It is the other medicines and drugs that are consumed while "robo-tripping" that produce the more deadly results.