Cough Syrup Psychosis

Authors: Alfred Amaladoss, Simon O'Brien

Published: January 01, 2011 | Views: 0

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Over-the-counter medications are widely accessible and used. Cough suppressant syrups contain dextromethorphan (DM), which has the potential to be abused, with resultant psychiatric symptoms. This case report describes a young woman presenting with psychotic mania secondary to DM abuse. We also describe the treatment of this toxidrome and include the results of a literature search on this topic. The recognition of cough syrup as an agent of abuse and its toxidrome is important. This will facilitate early diagnostic clarification and promote efficient treatment strategies.

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  1. Bem JL, Peck R. Dextromethorphan. An overview of safety issues. Drug Saf 1992;3:190-9, .
  2. Miller SC. Dextromethorphan psychosis, dependence and physical withdrawal. Addict Biol 2005;10:325-7, .
  3. The Vaults of Erowid. Available at: (accessed October, 2010). ;:, .
  4. Swartz RH. Adolescent abuse of dextromethorphan. Clin Pediatr (Phila) 2005;45:565-8, .
  5. Franklin PH, Murray TF. High affinity[H] dextrorphan binding in rat brain is localized to a noncompetitive antagonist site of the activated N-methyl-D-aspartate receptor-cation channel. Mol Pharmacol 1992;41:134-46, .
  6. Whittemore ER, Ilyin VI, Woodward RM. Antagonism of N-methyl-D-aspartate receptors by [sigma] site ligands: potency, subtype-selectively and mechanism of inhibition. J Pharmacol Exp Ther 1997;282:326-38, .
  7. Gonzalez GM, Werling LL. Release of [H]dopamine from guinea pig striatal slices is modulated by sigma 1 receptor agonists. Naunyn Scmiedebergs Arch Pharmacol 1997;356:455-61, .
  8. Yamamoto H, Yamamoto T, Sagi N, et al. Sigma ligands indirectly modulate the NMDA receptor-ion channel complex on intact neuronal cells via sigma 1 site. J Neurosci 1995;15:731-6, .
  9. Meoni P, Tortella FC, Bowery NG. An autoradiographic study of dextromethorphan high-affinity binding sites in rat brain: sodium-dependency and colocalization with paroxetine. Br J Pharmacol 1997;120:1255-62, .
  10. Schadel M, Sellers E. Psychosis with Vicks Formula 44D. Can Med Assoc J 1992;147:843-4, .
  11. Dickerson DL, Schaepper MA, Peterson MD, et al. Coricidin HBP abuse: patient characteristics and psychiatric manifestations as recorded in an inpatient psychiatric unit. J Addict Dis 2008;1:25-32, .
  12. Price LH, Lebel J. Dextromethorphan-induced psychosis. Am J Psychiatry 2000;157:, .