In large doses, dextromethorphan is abused to achieve similar highs as PCP and ketamine.
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Investigators went to the factory and found import records for the dextromethorphan it contained.
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The heart drug helps increase and maintain levels of the dextromethorphan in the bloodstream.
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The drug, Coricidin, contains active ingredients common to cold medicines such as Chlorpheniramine and Dextromethorphan.
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But a systematic review concluded that dextromethorphan was about as good as honey at reducing cough frequency.
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Another study of 105 children showed that buckwheat honey also outperformed dextromethorphan in suppressing coughs at night.
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In theory, antitussive drugs (like Dextromethorphan, often referred to as DM or DXM) block the body's cough reflex.
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According to New York-based forensic toxicologist Dr. Richard Stripp, the cold medicine Coricidin contains both dextromethorphan and chlorpheniramine.
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Investigators with Orlando police say she died from an overdose of multiple drugs, including Xanax and the cold medicine dextromethorphan.
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Most over-the-counter cold drugs contain dextromethorphan, guaifenesin and/or phenylephrine, so pick your favorite but know what you're taking.
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Code Red doesn't taste like medicine, as there's no bitter, dextromethorphan afterbite; in fact, medicine should strive to taste like Code Red.
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We tested a person who said they'd used ketamine and we found no ketamine in them at all, but found dextromethorphan [cough syrup] instead.
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Dextromethorphan is used in cough syrups and can cause "agitation, ataxia, hypertonic, sedation and may produce dissociative hallucinations at high doses," the new paper says.
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To test their theory, Shuster went to a local store and bought a bottle of Delsym, a cough suppressant containing dextromethorphan, which also blocks NMDA.
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"Our 2007 study was the first to show that honey was more effective than dextromethorphan" — a common cough suppressant — "or no treatment," said Dr. Paul.
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Both codeine and dextromethorphan carry the potential for abuse and have serious side effects that have led to warnings from the Food and Drug Administration.
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In the early 2000s, Dr. Smith combined dextromethorphan — an ingredient in cough syrups such as Robitussin — with quinidine, a drug used to treat irregular heart rhythms.
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The products in question are children's guaifenesin grape liquid (100mg/5 mL) and children's guaifenesin DM cherry liquid (100mg guaifenesin and 5mg dextromethorphan HBr/ 5 ml) sold in 4 oz.
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When abused or taken in high doses, the cough medicine ingredient Dextromethorphan can cause hallucinogenic effects, including "sensations of physical distortion and hallucinations," according to the National Institute on Drug Abuse.
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"Dextromethorphan is a dissociative anesthetic that is designed to be an anesthetic, and can cause out of body experiences and one can lose their ability to sense pain," Stripp explains to PEOPLE.
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Over the past three years, clinicians at several universities have begun experimenting with hallucination-inducing doses of the drug dextromethorphan (DXM), a common ingredient in several over-the-counter cough medicine brands.
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Meanwhile, a product called Diamond CBD Vape Additive was found to contain dextromethorphan, while Liquid Gold Jungle Juice, Liquid Gold Strawberry, and also the Diamond CBD Vape Additive contained the synthetic marijuana.
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As this Reactions video points out, most over-the-counter cough syrup does contain active ingredients (such as dextromethorphan (DMX) and guaifenesin) that are supposed to stave off coughs caused by illness or allergies.
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Thumbs up: Soothing throats A study of 139 children found that honey did a better job of easing nighttime coughs and improving sleep than both the popular cough suppressant dextromethorphan and the antihistamine diphenhydramine (Benadryl).
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There's no consistent evidence showing that over-the-counter cough medicines that contain compounds such as dextromethorphan (Robitussin) are worth taking, since their benefits are unclear but their risks, including the potential for them to be abused, are well-known.
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Various drugs already exist that target the same type of glutamate receptors, called NMDA receptors, that ketamine tweaks, including nitrous oxide, the "laughing gas" dentists use to reduce anxiety and pain, and dextromethorphan, a decongestant found in over-the-counter cold medicines.
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There's still a lot we don't know about why this happens, but at least part of the explanation could be rooted in how these products work: Many common daytime and nighttime meds contain dextromethorphan (a cough suppressant) and some type of pain reliever (like acetaminophen).
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They found one with dextromethorphan, or DXM, used in over-the counter cough medications and considered addictive when abused; and four with a synthetic cannabinoid, sometimes called Spice, that can cause anxiety, psychosis, tachycardia and death, according to a study last year in Forensic Science International.
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In its pure form, dextromethorphan occurs as a white powder. Dextromethorphan is also used recreationally. When exceeding approved dosages, dextromethorphan acts as a dissociative hallucinogen. It has multiple mechanisms of action, including actions as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist.
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Main metabolic pathways of dextromethorphan degradation, which are catalyzed by cytochrome P450 monooxygenases (CYP3A4 and CYP2D6) and UDP-glucuronosyl-transferase (UGT). The first pass through the hepatic portal vein results in some of the drug being metabolized by O-demethylation into an active metabolite of dextromethorphan called dextrorphan, the 3-hydroxy derivative of dextromethorphan. The therapeutic activity of dextromethorphan is believed to be caused by both the drug and this metabolite. Dextromethorphan also undergoes N-demethylation (to 3-methoxymorphinan or MEM), and partial conjugation with glucuronic acid and sulfate ions.
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N-demethylation is primarily accomplished by CYP3A4, contributing to at least 90% of the MEM formed as a primary metabolite of dextromethorphan. A number of other CYP enzymes are implicated as minor pathways of dextromethorphan metabolism. CYP2B6 is more effective than CYP3A4 at N-demethylation of dextromethorphan, but since the average individual has a much lower CYP2B6 content in the liver compared to CYP3A4, most N-demethylation of dextromethorphan is catalyzed by CYP3A4.
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In 2010, the FDA approved the combination drug dextromethorphan/quinidine for the treatment of pseudobulbar affect (uncontrollable laughing/crying). Dextromethorphan is the actual therapeutic agent in the combination; quinidine merely serves to inhibit the enzymatic degradation of dextromethorphan and thereby increase its circulating concentrations via inhibition of CYP2D6. In 2013, a randomized clinical trial found that dextromethorphan may reduce the overall discomfort and duration of withdrawal symptoms associated with opioid use disorder. When combined with clonidine, dextromethorphan reduced the overall time needed for withdrawal symptoms to peak by 24 hours while reducing severity of symptoms compared to clonidine alone.
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Some findings even suggest that dextromethorphan can actually counter the dopamine-increasing effect caused by morphine. Due to these conflicting results, the actual effect of dextromethorphan on dopamine levels remains undetermined.
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Dextromethorphan/quinidine (trade name Nuedexta) is a codrug containing dextromethorphan and the class I antiarrhythmic agent quinidine. It is the first FDA-approved drug for the treatment of pseudobulbar affect (PBA).
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The active ingredient, dextromethorphan (metabolized to dextrorphan), is surrounded by an edible plastic called polistirex. When the Delsym arrives in the stomach, an initial amount of dextromethorphan is immediately released into the bloodstream while the rest is surrounded by a plastic that is slowly dissolved by stomach acid. After the polistirex is dissolved sufficiently, more dextromethorphan is released.
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Dextromethorphan's hallucinogenic and dissociative effects can be attributed largely to dextrorphan (DXO), a metabolite produced when dextromethorphan is metabolized by the body. Both dextrorphan and dextromethorphan are NMDA receptor antagonists, like the dissociative hallucinogenic drugs ketamine and PCP, although dextrorphan is more potent than its "parent molecule" dextromethorphan. As NMDA receptor antagonists, dextrorphan and dextromethorphan inhibit the excitatory amino acid and neurotransmitter glutamate in the brain. This can effectively slow, or even shut down certain neural pathways, preventing areas of the brain from communicating with each other.
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Because dextromethorphan can trigger a histamine release (allergic reaction), atopic children, who are especially susceptible to allergic reactions, should be administered dextromethorphan only if absolutely necessary, and only under the strict supervision of a healthcare professional.
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Misuse of multisymptom cold medications, rather than using a cough suppressant whose sole active ingredient is dextromethorphan, carries significant risk of fatality or serious illness. Multisymptom cold medicines contain other active ingredients, such as paracetamol (acetaminophen), chlorpheniramine, and phenylephrine, any of which can cause permanent bodily damage such as kidney failure, or even death, if taken on the generally accepted recreational dosing scale of dextromethorphan. Sorbitol, an artificial sweetener found in many cough syrups containing dextromethorphan, can also have negative side effects, including diarrhea and nausea when taken at recreational dosages of dextromethorphan. Guaifenesin, an expectorant commonly accompanying dextromethorphan in cough preparations, can cause unpleasant symptoms including vomiting, nausea, kidney stones, and headache.
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Dextromethorphan is commonly available as the monohydrated hydrobromide salt, however some newer extended- release formulations contain dextromethorphan bound to an ion-exchange resin based on polystyrene sulfonic acid. Dextromethorphan's specific rotation in water is +27.6° (20 °C, Sodium D-line).
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Kentucky House Bill 24 states that a person, "other than a medical facility, medical practitioner, pharmacist, pharmacy intern, pharmacy technician, or pharmacy licensed" is prohibited to possess more than one gram of pure dextromethorphan or a dextromethorphan that has been extracted from other medications. A person under the age or 18 is prohibited from purchasing a product containing dextromethorphan and are prohibited to use false identification in the pursuit of purchase. No person is allowed to purchase a dextromethorphan containing product with the intent to provide it to a person under the age of 18. The provider of a dextromethorphan containing product must acquire proof of age if they believe that the potential purchaser is below the age of 18.
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As of August, 2017, the sale of products containing dextromethorphan to minors is prohibited.
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Flanging (speeding up or slowing down) of sensory input is also a characteristic effect of recreational use. Also, a marked difference is seen between dextromethorphan hydrobromide, contained in most cough suppressant preparations, and dextromethorphan polistirex, contained in the brand name preparation Delsym. Polistirex is a polymer that is bonded to the dextromethorphan that requires more time for the stomach to digest it, as it requires that an ion exchange reaction take place prior to its dissolution into the blood. Because of this, dextromethorphan polistirex takes considerably longer to absorb, resulting in more gradual and longer lasting effects reminiscent of time-release pills.
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Hours after dextromethorphan therapy, (in humans) the metabolites (+)-3-hydroxy-N- methylmorphinan, (+)-3-morphinan, and traces of the unchanged drug are detectable in the urine. A major metabolic catalyst involved is the cytochrome P450 enzyme known as 2D6, or CYP2D6. A significant portion of the population has a functional deficiency in this enzyme and are known as poor CYP2D6 metabolizers. O-demethylation of dextromethorphan to dextrorphan contributes to at least 80% of the dextrorphan formed during dextromethorphan metabolism. As CYP2D6 is a major metabolic pathway in the inactivation of dextromethorphan, the duration of action and effects of dextromethorphan can be increased by as much as three times in such poor metabolizers. In one study on 252 Americans, 84.3% were found to be "fast" (extensive) metabolizers, 6.8% to be "intermediate" metabolizers, and 8.8% were "slow" metabolizers of dextromethorphan. A number of alleles for CYP2D6 are known, including several completely inactive variants. The distribution of alleles is uneven amongst ethnic groups.
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As of September 1, 2019, purchasers of dextromethorphan in Texas must be 18 years old.
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Dextromethorphan has not been shown to cause vacuolization in animals, also known as Olney's lesions, despite early speculation that it might, due to similarities with ketamine. In rats, oral administration of dextromethorphan did not cause vacuolization in laboratory tests. Oral administration of dextromethorphan repeatedly during adolescence, however, has been shown to impair learning in those rats during adulthood. The occurrence of Olney's lesions in humans, however, has not been proven or disproven.
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Buckley's DM, which contained dextromethorphan, is no longer produced for sale in Canada as of 2016.
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New Jersey Assembly Bill 622 states that a person will not directly or indirectly sell or offer to sell any product containing any amount of dextromethorphan to a person under the age of 18. The bill then goes on to state the defenses a provider of dextromethorphan could use in the event that they are in violation of the bill. If the person purchasing the dextromethorphan provided false identification to the time of purchase, then the provider would not be held liable for violating this bill. Also, if the person purchasing the dextromethorphan product could be presumed to be of the legal age, then the purchaser will not be held liable.
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The average dose necessary for effective antitussive therapy is between 10 and 45 mg, depending on the individual. The International Society for the Study of Cough recommends "an adequate first dose of medication is 60 mg in the adult and repeat dosing should be infrequent rather than qds recommended." Dextromethorphan has an elimination half-life of approximately 4 hours in individuals with an extensive metabolizer phenotype; this is increased to approximately 13 hours when dextromethorphan is given in combination with quinidine. The duration of action after oral administration is about three to eight hours for dextromethorphan hydrobromide, and 10 to 12 hours for dextromethorphan polistirex.
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Dextromethorphan is an opioid-based cough suppressant found in several cold medications. Several U.S. states have begun regulating who, and under what circumstances, can purchase dextromethorphan containing products. Not all states have regulations documented at this time but this page contains all the states that have documentation.
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Following oral administration, dextromethorphan is rapidly absorbed from the gastrointestinal tract, where it enters the bloodstream and crosses the blood–brain barrier. At therapeutic doses, dextromethorphan acts centrally (meaning that it acts on the brain) as opposed to locally (on the respiratory tract). It elevates the threshold for coughing, without inhibiting ciliary activity. Dextromethorphan is rapidly absorbed from the gastrointestinal tract and converted into the active metabolite dextrorphan in the liver by the cytochrome P450 enzyme CYP2D6.
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Arkansas does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Connecticut does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Iowa does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Maine does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Minnesota does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Mississippi does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Missouri does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Montana does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Ohio does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Vermont does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Hawaii does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Idaho does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Illinois does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Indiana does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Kansas does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Michigan does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Nebraska does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Oklahoma does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Pennsylvania does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Utah does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Wyoming does not have any documented regulation pertaining to the purchase of dextromethorphan available, at this time.
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Side effects of dextromethorphan at normal therapeutic doses can include: A rare side effect is respiratory depression.
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Alabama Code Title 20. Food, Drugs, and Cosmetics § 20-2-2 only mentions dextromethorphan in relation to the fact that it is not defined as an opioid for the sake of regulation in this state. Alabama does not have any provisions about the regulation of dextromethorphan at this time.
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It is a building block for many drugs, including dextromethorphan, amiloride, sulfadimethoxine, and allopurinol, and also for Peldesine.
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New Mexico does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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North Dakota does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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Rhode Island does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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South Carolina does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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West Virginia does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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New Hampshire does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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North Carolina does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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South Dakota does not have any documented regulation pertaining to the purchase of dextromethorphan available at this time.
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There are anecdotal reports of the recreational use of over-the-counter drugs in several countries, being readily available from local pharmacies without a prescription. The effects, beginning around 45 to 120 minutes after consumption, are similar to dextromethorphan and alcohol intoxication. Unlike dextromethorphan, noscapine is not an NMDA receptor antagonist.
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Recreational use of Coricidin for the dissociative (hallucinogenic) effect of its dextromethorphan is hazardous because it also contains chlorpheniramine.
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The Federal Analog Act does not apply to dextromethorphan because a new drug application has been filed for it.
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Some retailers also give out printed recommendations about the potential for abuse with the purchase of products containing dextromethorphan.
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In such use, it is less effective than codeine and more effective than dextromethorphan in inhibiting the tussive stimulus.
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Arizona House Bill 2086 states that it is prohibited for any commercial entity knowingly or willingly sell or trade a dextromethorphan-containing product to a person under the age of 18. Inversely, it is prohibited for a person under the age of 18 to purchase any amount of dextromethorphan. Identification of age is required for purchase unless the purchaser outwardly appears to be above the age of 25. Other than identification of age, the bill does not require any additional provisions to control the purchase of dextromethorphan.
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Dextromethorphan gel capsules Over-the-counter preparations containing dextromethorphan have been used in manners inconsistent with their labeling, often as a recreational drug. At doses much higher than medically recommended, dextromethorphan and its major metabolite, dextrorphan, acts as an NMDA receptor antagonist, which produces dissociative hallucinogenic states somewhat similar to ketamine and phencyclidine. It may produce distortions of the visual field – feelings of dissociation, distorted bodily perception, excitement, and a loss of sense of time. Some users report stimulant-like euphoria, particularly in response to music.
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Antitussive preparations containing dextromethorphan are legal to purchase from pharmacies in most countries, with some exceptions being UAE, France, Sweden, Estonia, and Latvia. In Russia, dextromethorphan (commonly sold under the brand names Tussin+ and Glycodin) is a Schedule III controlled substance and is placed in the same list as benzodiazepines and the majority of barbiturates.
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The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), as well as those resulting from inhaled particle irritants. However, controlled studies have found the symptomatic effectiveness of dextromethorphan similar to placebo.
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Adverse effects of dextromethorphan in overdose at doses 3 to 10 times the recommended therapeutic dose: At doses 15 to 75 times the recommended therapeutic dose: Episodic acute psychosis can occur when high doses of dextromethorphan taken for recreational use, and an abundance of psychiatric symptoms can result, including dissociation and other PCP-like symptoms.
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Dextrorphan (DXO) is a psychoactive drug of the morphinan class which acts as an antitussive or cough suppressant and dissociative hallucinogen. It is the dextrorotatory-stereoisomer of racemorphan, the levo-half being levorphanol. Dextrorphan is produced by O-demethylation of dextromethorphan by CYP2D6. Dextrorphan is an NMDA antagonist and contributes to the psychoactive effects of dextromethorphan.
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A large number of medications are potent inhibitors of CYP2D6. Some types of medications known to inhibit CYP2D6 include certain SSRIs and tricyclic antidepressants, some antipsychotics, and the commonly available antihistamine diphenhydramine. Therefore, the potential of interactions exists between dextromethorphan and medications that inhibit this enzyme, particularly in slow metabolizers. Dextromethorphan is also metabolized by CYP3A4.
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Dextromethorphan should not be taken with monoamine oxidase inhibitors due to the potential for serotonin syndrome, which is a potentially life-threatening condition that can occur rapidly, due to a buildup of an excessive amount of serotonin in the body. Patients who are taking dextromethorphan should exercise caution when drinking grapefruit juice or eating grapefruit, as compounds in grapefruit affect a number of drugs, including dextromethorphan, through the inhibition of the cytochrome P450 system in the liver, and can lead to excessive accumulation of the drug which both increases and prolongs effects. Grapefruit and grapefruit juices (especially white grapefruit juice, but also including other citrus fruits such as bergamot and lime, as well as a number of noncitrus fruits) generally are recommended to be avoided while using dextromethorphan and numerous other medications.
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Combining dextromethorphan with other serotonergic drugs could possibly cause serotonin toxicity, an excess of serotonergic activity in the CNS and peripheral nervous system.
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Alaska House Bill No. 125 placed regulations on who can sell and who can buy products that contain any level of dextromethorphan. The provider must check the identification of a person wishing to purchase dextromethorphan-containing products to verify that the purchaser is 18 years of age or older. There is a stipulation that identification is not required if the provider could reasonably assume that the purchaser is 25 years of age or older based on appearance. A person under 18 years of age may purchase a product containing dextromethorphan if they have a prescription for said product from a licensed practitioner.
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Delaware House Bill 329 states that no commercial entity shall provide a product containing dextromethorphan to a person under the age of 18 and that a person under the age of 18 shall not purchase a product containing dextromethorphan. Providers are required to acquire identification of age from any on they presume to be under the age of 25. This bill does not place regulation on whether the commercial entity is required to place any barrier on access to the product beyond identification. The stipulations of age are not required when the dextromethorphan containing produce it purchased with a valid prescription.
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Cough medicine containing dextromethorphan in gel cap form Dextromethorphan, or DXM, a common active ingredient found in many over-the-counter cough suppressant cold medicines, is used as a recreational drug and entheogen for its dissociative effects. It has almost no psychoactive effects at medically recommended doses. However, dextromethorphan has powerful dissociative properties when administered in doses well above those considered therapeutic for cough suppression. Recreational use of DXM is sometimes referred to in slang form as "robo-tripping", whose prefix derives from the Robitussin brand name, or "Triple Cs", which derives from the Coricidin brand.
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Virginia Senate Bill 213 states that no pharmacy or retail entity shall provide a dextromethorphan containing product to a person under the age of 18. It is also prohibited for a person under the age of 18 to purchase dextromethorphan. The retail entity providing the dextromethorphan is required to obtain identification that the purchaser is above the age of 18 at the time of purchase unless the purchaser can be presumed to be above the age of 25 based on appearance. If a provider is found in violation of this bill, the provider will receive a notice of noncompliance and then a $25 civil penalty for each subsequent violation.
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Wisconsin Assembly Bill 681 states that a provider is prohibited from providing a dextromethorphan containing product to a person under the age of 18 and a person under the age of 18 is prohibited to purchase a dextromethorphan containing product. This part of the bill does not apply to a person under the age of 18 purchasing a dextromethorphan containing product pursuant to a prescription. A provider is required to obtain proof of age from a purchaser who, based on appearance, could be presumed to be under the age of 25. A person in violation of this bill is subject to a fine of $250 for each violation.
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Vicks 44E Pediatric (or 44E) is an oral combination therapy for breathing difficulties. Active ingredients are dextromethorphan and guaifenesin a cough suppressant and an expectorant, respectively.
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Maryland Senate Bill 939 states that a person is prohibited to purchase a dextromethorphan containing product unless the potential purchaser provides government issued photographic identification proving age of at least 18 years and signs a receipt documenting the date and time of the transaction, the name and address of the purchaser, and the amount of product purchased. Each establishment that provides dextromethorphan containing products is required to maintain records of purchase and post signs describing the restriction of dextromethorphan and the health reasons behind the restriction. A person is prohibited to purchase more than 3.6 grams of dextromethorphan containing products within a 30-day period unless it is in pursuant to a valid prescription. Any person found in violation of this bill is guilty of a misdemeanor and subject to a fine of $1000, or imprisonment of not more than one year, or both the fine and the imprisonment.
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A number of types of cough medicine are frequently abused. This includes those containing dextromethorphan and codeine. Abuse may result in hallucinations, loss of consciousness and death.
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Teens tend to have a higher likelihood to use dextromethorphan-related drugs as they are easier to access, and an easier way to cope with psychiatric disorders.
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Combining dextromethorphan with other substances can compound risks. Central nervous system (CNS) stimulants such as amphetamine and/or cocaine can cause a dangerous rise in blood pressure and heart rate. CNS depressants such as ethanol (drinking alcohol) will have a combined depressant effect, which can cause a decreased respiratory rate. Combining dextromethorphan with other CYP2D6 substrates can cause both drugs to build to dangerous levels in the bloodstream.
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Dextromethorphan is a medication most often used as a cough suppressant in over-the-counter cold and cough medicines. It is sold in syrup, tablet, spray, and lozenge forms. It is in the morphinan class of medications with sedative, dissociative, and stimulant properties (at lower doses). Dextromethorphan possesses only a minimal degree of the mu-opioid receptor activity typical of morphinan compounds and exerts its therapeutic effects through several other receptors.
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Dextromethorphan had been thought to cause Olney's lesions when administered intravenously; however, this was later proven inconclusive, due to lack of research on humans. Tests were performed on rats, giving them 50 mg or more every day for as long as a month. Neurotoxic changes, including vacuolation, have been observed in posterior cingulate and retrosplenial cortices of rats administered other NMDA receptor antagonists such as PCP, but not with dextromethorphan.
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Dextromethorphan is the dextrorotatory enantiomer of levomethorphan, which is the methyl ether of levorphanol, both opioid analgesics. It is named according to IUPAC rules as (+)-3-methoxy-17-methyl-9α,13α,14α-morphinan. As its pure form, dextromethorphan occurs as an odorless, opalescent white powder. It is freely soluble in chloroform and insoluble in water; the hydrobromide salt is water-soluble up to 1.5 g/100 mL at 25 °C.
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Drugs of this class are unlikely candidates for pharmacological prevention of addiction because these drugs themselves are used recreationally. Examples of NMDAR antagonists are ketamine, dextromethorphan (DXM), phencyclidine (PCP).
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Dextrorphan has a notably longer elimination half-life than its parent compound, and therefore has a tendency to accumulate in the blood after repeated administration of normally dosed dextromethorphan formulations.
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If the D ring is "below" the core (dextrorotatory), the analgesic and euphoric properties are eliminated or are dramatically reduced, but the cough-suppressant property is retained, as in dextromethorphan.
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Contraindications include prior treatment (within the past 5–6 weeks, depending on the dose) with MAOIs such as phenelzine and tranylcypromine, due to the potential for serotonin syndrome. Its use should also be avoided in those with known hypersensitivities to fluoxetine or any of the other ingredients in the formulation used. Its use in those concurrently receiving pimozide or thioridazine is also advised against. In some cases, use of dextromethorphan-containing cold and cough medications with fluoxetine is advised against, due to fluoxetine increasing serotonin levels, as well as the fact that fluoxetine is a cytochrome P450 2D6 inhibitor, which causes dextromethorphan to not be metabolized at a normal rate, thus increasing the risk of serotonin syndrome and other potential side effects of dextromethorphan.
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William E. White, author of the "DXM FAQ", has compiled informal research from correspondence with dextromethorphan users suggesting that heavy abuse may result in various deficits corresponding to the brain areas affected by Olney's lesions; these include loss of episodic memory, decline in ability to learn, abnormalities in some aspects of visual processing, and deficits of abstract language comprehension. In 2004, however, White retracted the article in which he made these claims. A formal survey of dextromethorphan users showed that more than half of users reported experience of these withdrawal symptoms individually for the first week after long-term/addictive dextromethorphan use: fatigue, apathy, flashbacks, and constipation. Over a quarter reported insomnia, nightmares, anhedonia, impaired memory, attention deficit, and decreased libido.
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In many documented cases, dextromethorphan has produced psychological dependence in people who used it recreationally. However, it does not produce physical addiction, according to the WHO Committee on Drug Dependence. It is considered less addictive than the other common weak opiate cough suppressant, codeine. Since dextromethorphan also acts as a serotonin reuptake inhibitor, users report that regular recreational use over a long period of time can cause withdrawal symptoms similar to those of antidepressant discontinuation syndrome.
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Psychoactive drugs can often induce a state of temporary dissociation. Substances with dissociative properties include ketamine, nitrous oxide, alcohol, tiletamine, amphetamine, dextromethorphan, MK-801, PCP, methoxetamine, salvia, muscimol, atropine, ibogaine, and minocycline.
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Dextromethorphan/quinidine is also under investigation for the treatment of a variety of other neurological and neuropsychiatric conditions besides pseudobulbar affect, such as agitation associated with Alzheimer's disease and major depressive disorder.
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Georgia House Bill 739 states that a person is prohibited from selling or transferring possession of a dextromethorphan containing product to a person under the age of 18. This bill also notes that a business that sells dextromethorphan containing products should label that the product is prohibited to be purchased by a person under the age of 18. If a person is found in violation of this bill, they are guilty of a misdemeanor. This bill took effect in 2007.
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Colorado House Bill 18-1307 states that it is unlawful for a store to provide a product containing any amount of dextromethorphan to a person that is under the age of 18. Providers are required to obtain proof that the purchaser is above the age of 18 before the sale unless the provider can reasonably assume that the purchaser is above the age of 18 based on the purchaser's appearance. This bill does not place regulations on whether the store selling dextromethorphan must put the product in a special area in the store, whether access to the dextromethorphan products should be restricted, or whether they store should keep transactions records. If a provider violates these regulations, they are first subject to a written warning and then a fine of $200 for every following offense.
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Florida Senate Bill 938 states that a manufacturer, distributor, or retailer, or its employees and representatives is prohibited to provide a dextromethorphan containing product to a person under the age of 18 and that a person under the age of 18 is prohibited form purchasing a product containing dextromethorphan. The employee or representative involved in the sale of dextromethorphan is required to obtain proof of age of the purchaser if that purchaser could be presumed to be under the age of 25 based on appearance. If a provider is found to be in violation of these regulations, they are subject to a first time written warning and for subsequent violations subject to a civil citation that will each incur a fine of $100. This bill took effect January 1, 2017.
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Any person found to possess more than one gram of pure dextromethorphan without the required credentials is subject to a $1000 fine for the first offense and a $2500 fine for each subsequent offense. A person who is found to be assisting a person under the age of 18 in acquiring a product containing dextromethorphan is subject to a $100 fine for the first offense and a $200 fine for each subsequent offense. A person under the age of 18 who attempts to purchase a product that contains dextromethorphan, and uses false identification to do so, is subject to a $25 fine for the first offense, a $100 fine for the second offense, and a $200 for the third and each subsequent offense. This bill took effect March 19, 2015.
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Coricidin is sometimes used in high doses as a recreational drug because it contains the dissociative dextromethorphan. In this context, Coricidin is referred to as C's, red devils (red D's), Skittles, trips, or triple C's.
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The N-methyl-D-aspartate (NMDA) receptor seems to play a major role in neuropathic pain and in the development of opioid tolerance. Dextromethorphan is an NMDA antagonist at high doses. Experiments in both animals and humans have established that NMDA antagonists such as ketamine and dextromethorphan can alleviate neuropathic pain and reverse opioid tolerance. Unfortunately, only a few NMDA antagonists are clinically available and their use is limited by a very short half life (ketamine), weak activity (memantine) or unacceptable side effects (dextromethorpan).
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At high doses, dextromethorphan is classified as a dissociative general anesthetic and hallucinogen, similar to the controlled substances ketamine and phencyclidine (PCP). Also like those drugs, dextromethorphan is an NMDA receptor antagonist. It generally does not produce withdrawal symptoms characteristic of physical dependence-inducing substances, but cases of psychological dependence have been reported. Due to dextromethorphan's selective serotonin reuptake inhibitor-like action, the sudden cessation of recreational dosing in tolerant individuals can result in mental and physical withdrawal symptoms similar to the withdrawal from SSRIs.
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DXO is an active metabolite of the pharmaceutical drug dextromethorphan (DXM), which, analogously to DXO, is an enantiomer of the racemic mixture racemethorphan along with levomethorphan, the latter of which has similar properties to those of levorphanol.
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Some NMDA receptor antagonists, such as ketamine, dextromethorphan (DXM), phencyclidine (PCP), methoxetamine (MXE), and nitrous oxide (N2O), are recreational drugs used for their dissociative, hallucinogenic, and euphoriant properties. When used recreationally, they are classified as dissociative drugs.
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Tennessee Senate Bill 45 states that it is prohibited that a provider to provide a dextromethorphan containing product to a person under the age of 18. This bill also states that it is prohibited for a person under the age of 18 to purchase a dextromethorphan containing product. These sections do not apply to a person under the age of 18 that is an emancipated minor or if the product was purchased in pursuit to a valid prescription. The provider is required to obtain identification for proof of age or emancipation before completing the sale.
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Intentionally consuming more than the recommended dosage of Delsym may result in euphoria, lack of coordination, hallucinations, apathy, feelings of dissociation, and disorientation. This is due to dextromethorphan as well as its pharmacologically-active metabolite dextrorphan, both dissociative drugs that work as NMDA receptor antagonists the same way nitrous oxide (N2O), ketamine, and phencyclidine (PCP) do. Because of the abuse potential, many pharmacies and large retail chains have begun taking precautions such as restricting sales to those under age 18 and limiting the number of sales of dextromethorphan-containing products per customer.
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A single case study suggests that the antidote to dextromethorphan overdose is naloxone, administered intravenously. In addition to producing PCP-like mental effects, high doses may cause a false-positive result for PCP and opiates in some drug tests.
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The combination medicine dextromethorphan/bupropion is in clinical trials by Axsome Therapeutics for major depressive disorder, with fast track designation granted by the FDA in 2017. The combination showed positive results in phase 2 and phase 3 clinical trials.
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His screen name is "Kraft Singles". Michael is addicted to Robitussin cough syrup, which contains the dissociative drug dextromethorphan. ; Karla : A coder, coworker, and girlfriend of Daniel. Karla's relationship with her family is tense, and she actively avoids contact with them.
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Louisianan House Bill 514 states that a person under the age of 18 is prohibited to purchase, or attempt to purchase, any nonprescription products that contain dextromethorphan. This bill also states that a provider is prohibited to sell a product that contains dextromethorphan to a person under the age of 18 unless said purchaser has a valid prescription for the product. This bill also requires that identification is provided at the time of purchase and that the identification is issued by either a state or the United States government, such as a license or passport. This bill took effect August 1, 2014.
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Since pseudobulbar palsy is a syndrome associated with other diseases, treating the underlying disease may eventually reduce the symptoms of pseudobulbar palsy. Possible pharmacological interventions for pseudobulbar affect include the tricyclic antidepressants, serotonin reuptake inhibitors, and a novel approach utilizing dextromethorphan and quinidine sulfate. Nuedexta is an FDA approved medication for pseudobulbar affect. Dextromethorphan, an N-methyl-D-aspartate receptor antagonist, inhibits glutamatergic transmission in the regions of the brainstem and cerebellum, which are hypothesized to be involved in pseudobulbar symptoms, and acts as a sigma ligand, binding to the sigma-1 receptors that mediate the emotional motor expression.
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A person's assessment of pain intensity from standard experimental stimuli prior to surgery is correlated with the intensity of their post-surgery pain. Pain intensity immediately post-surgery is correlated with pain intensity on release from hospital, and correlated with the likelihood of experiencing chronic post- surgery pain. Different medications such as pregabalin, acetaminophen, naproxen and dextromethorphan have been tried in studies about preemptive analgesia.Amiri, Hamid Reza et al. “Multi-Modal Preemptive Analgesia With Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan in Radical Neck Dissection Surgery: A Randomized Clinical Trial.” Anesthesiology and Pain Medicine 6.4 (2016): e33526. PMC. Web.
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Washington Second Substitute House Bill 2163 states that a provider of a dextromethorphan containing product is required to obtain proof of age from a purchaser unless the provider can assume that the purchaser is about the age of 25 based on appearance. It is prohibited for a provider to provide a dextromethorphan containing product to a person under the age of 18 and it is prohibited for a person under the age of 18 to purchase a dextromethorphan containing product. These provisions do not apply to a person under the age of 18 who is emancipated, and provides proof of emancipation at the time of purchase, or to a person under the age of 18 who is actively enrolled in the military, and can provide their military identification card at the time of purchase. A provider or purchaser found in violation of this bill is subject to a written warning from law enforcement for the first offense and is guilty of a class 1 civil infraction.
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Dextromethorphan and its major metabolite, dextrorphan, also block the NMDA glutamate receptor at high doses, which produces effects similar to other dissociative anesthetics such as ketamine, nitrous oxide, and phencyclidine. It was patented in 1949 and approved for medical use in 1953.
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Vicks 44M Pediatric (or 44M) is an oral combination therapy for breathing difficulties. Active ingredients include dextromethorphan, pseudoephedrine and chlorpheniramine. The combination of antihistamine, de-congestant and cough suppressant is designed to relieve the symptoms of several minor breathing complaints, such as the common cold.
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A treatment of sodium benzoate, which binds to glycine and forms hippurate, and dextromethorphan, which weakly inhibits the N-methyl-D-aspartate receptors that glycine acts on has been shown to improve outcomes in select cases where the disorder is present in attenuated form.
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Nevada Senate Bill 159 states that it is prohibited to provide a dextromethorphan containing product to a person under the age of 18. A person under the age of 18 is prohibited from purchasing a product that contains dextromethorphan unless they have a valid prescription. The provider is required to obtain identification for proof of age unless the provider can presume that the purchaser is above the age of 18 by the purchaser's appearance. If a provider is found to be in violation of they are subject to a warning for the first offense and a civil penalty of $50 for each subsequent violation.
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Dextromethorphan was excluded from the Controlled Substances Act (CSA) of 1970 and was specifically excluded from the Single Convention on Narcotic Drugs. As of 2010, it was still excluded from U.S. Schedules of Controlled Substances; however, officials have warned that it could still be added if increased abuse warrants its scheduling. The motivation behind its exclusion from the CSA was that under the CSA, all optical isomers of listed Schedule II opiates are automatically Schedule II substances. Since dextromethorphan is an optical isomer of the Schedule II opiate levomethorphan (but does not act like an opiate), an exemption was necessary to keep it an uncontrolled substance.
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Anabolic steroids, including testosterone and human chorionic gonadotropin are Schedule 3 on the California Uniform Controlled Substances Act. On August 31, 2011, California Legislature passed SB 514, which banned the sale of dextromethorphan (DXM), the active ingredient in most over-the-counter cough medicines, to minors.
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After giving the cocktail, the concentrations of the drugs and their metabolites in plasma (for midazolam and omeprazole) and urine (for caffeine and dextromethorphan) are determined at various times. By analysing these concentrations, it is possible to determine the activity (i.e. the phenotype) of the relevant enzyme.
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Any provider who knowingly and willfully provides a product containing dextromethorphan to a person who does not meet these requirements is subject to a fine. The first violation has a fine of $150 and each subsequent fine is $250. This Bill took effect May 1, 2016.
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The bill also states that a retail clerk who fails to identify the age of the purchaser would not be found guilty unless the retail clerk was a willful participant in an ongoing conspiracy to sell dextromethorphan to minors. This bill took effect January 1, 2012.
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However, Paregoric was characterized as "a needlessly complex pharmacopeial mixture... of a former day" by a 1966 study. In the 21st century its two main uses have been largely supplanted by minimally psychoactive cough-suppressant drugs (such as dextromethorphan) and non-psychoactive antidiarrheal drugs (such as loperamide).
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Lozenges may contain benzocaine, an anaesthetic, or eucalyptus oil. Non- menthol throat lozenges generally use either zinc gluconate glycine or pectin as an oral demulcent. Several brands of throat lozenges contain dextromethorphan. Other varieties such as Halls contain menthol, peppermint oil and/or spearmint as their active ingredient(s).
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These provisions do not apply to a person with a valid prescription purchasing a product containing dextromethorphan. A person who violates the provisions of the bill will be subject to a first time warning and subsequent penalties of fifty dollars for additional offenses. This Bill took effect April 24, 2014.
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Zipeprol is a centrally acting cough suppressant developed in France in the 1970s.Patent It is not a morphinan derivative (in contrast to codeine and dextromethorphan). Zipeprol acts as a local anaesthetic and has mucolytic, antihistamine and anticholinergic properties. It is sold with several brand names such as Zinolta and Respilene.
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The active ingredient in Tylenol is paracetamol, a widely used over-the-counter analgesic (pain reliever) and antipyretic (fever reducer). Formulations with additional active ingredients intended to target specific applications are sold under the Tylenol brand. These can include codeine as co-codamol, dextromethorphan, methocarbamol, guaifenesin, pseudoephedrine, caffeine, diphenhydramine, chlorpheniramine and phenylephrine.
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Cholesterol-24 hydroxylase is easily inhibited by many drugs due to its broad substrate specificity. It has been shown to metabolize Bufuralol, progesterone, Dextromethorphan, methoxyresorufin, cortisol, Diclofenac, Phenacetin, and testosterone. The ability for inhibition by various xenobiotics makes this enzyme a prime candidate for drug therapy for AD or other brain injuries.
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Coricidin, Coricidin 'D' (decongestant), or Coricidin HBP (for high blood pressure), is the name of a drug marketed by Schering-Plough that contains dextromethorphan (a cough suppressant) and chlorpheniramine maleate (an antihistamine). It is now owned by Bayer. Varieties of Coricidin may also contain acetaminophen (an analgesic/antipyretic) and guaifenesin (an expectorant).
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No legal distinction currently exists in the United States between medical and recreational use, sale, or purchase. Some states and store chains have implemented restrictions, such as requiring signatures for DXM sale, limiting quantities allowable for purchase, and requiring that purchasers be over the age of majority in their state. The sale of dextromethorphan in its pure powder form may incur penalties, although no explicit law exists prohibiting its sale or possession, other than in Illinois. Cases of individuals being sentenced to time in prison and other penalties for selling pure dextromethorphan in this form have been reported, because of the incidental violation of more general laws for the sale of legitimate drugs – such as resale of a medication without proper warning labels.
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Coricidin, Coricidin D, or Coricidin HBP, is the brand name of a combination of dextromethorphan and chlorpheniramine maleate (an antihistamine). Varieties may also contain acetaminophen and guaifenesin. Codral is a brand name manufactured by Johnson & Johnson and sold primarily in Australia and New Zealand. Codral is the highest-selling cold and flu medication in Australia.
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Similarly, a 2012 Dutch guideline regarding the treatment of acute cough does not recommend its use. (The opioid analogue dextromethorphan, long claimed to be as effective a cough suppressant as codeine, has similarly demonstrated little benefit in several recent studies.) Low dose morphine may help chronic cough but its use is limited by side effects.
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The Maricopa County Medical Examiner found Gotbaum accidentally strangled herself and ruled her death an accident. The report states she was acutely intoxicated on alcohol and prescription medication at the time of her death. These medicines included the antidepressants Citalopram and Duloxetine, as well as the antitussive Dextromethorphan and the antihistamines Diphenhydramine and Chlorpheniramine. Her blood alcohol content was .
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According to a recent meta-analysis, there is only one small study that has shown that a combination of dextromethorphan and quinidine alleviates symptoms of easy laughing and crying (pseudobulbar affect) in patients with amyotrophic lateral sclerosis and multiple sclerosis. Although intravenous quinidine is sometimes used to treat Plasmodium falciparum malaria, the future availability of this agent is uncertain.
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In 2009, Canada restricted the use of over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits. The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries.Eccles p. 246 Intranasal corticosteroids have not been found to be useful.
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The Benylin logo. Benylin is a brand name owned by Johnson & Johnson for a range of cough, cold and flu medications. Some Benylin products also contain codeine, which is used to treat pain, cough and diarrhea. The flagship cough syrup and cold care brand is marketed in several countries as Benylin DM, for its active ingredient, dextromethorphan.
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California bill S.B. 514 states that a manufacturer, wholesaler, retailer, or other person is prohibited from selling or transferring a specified substance to a person under the age of 18, except as specified. Although this bill extended to the drugs ephedrine and pseudoephedrine, it was used as a starting point for building the bill for dextromethorphan. This bill provided that any infraction of a provider in an over-the-counter sale who willfully and knowingly supply, deliver, or give possession of a non-prescription drug that contains dextromethorphan to a person under the age of 18 would incur a fine of $250.The bill also mentions that proof that identification at the time of purchase was demanded by the provider can be used as a defense in criminal prosecution.
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People who are taking meperidine, tramadol, methadone, propoxyphene, dextromethorphan, St. John’s wort, cyclobenzaprine, or another MAO inhibitor should not take rasagiline. The FDA drug label carries a warning of the risk of serotonin syndrome when rasagiline is used with antidepressants or with meperidine. However the risk appears to be low, based on a multicenter retrospective study in 1504 people, which looked for serotonin syndrome in people with PD who were treated with rasagiline plus antidepressants, rasagiline without antidepressants, or antidepressants plus Parkinson's drugs other than either rasagiline or selegiline; no cases were identified. There is a risk of psychosis or bizarre behavior if rasagiline is used with dextromethorphan and there is a risk of non-selective MAO inhibition and hypertensive crisis if rasagiline is used with other MAO inhibitors.
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Levomethorphan (INN, BAN) is an opioid analgesic of the morphinan family that has never been marketed. It is the L-stereoisomer of racemethorphan (methorphan). The effects of the two isomers of the racemethorphan are quite different, with dextromethorphan (DXM) being an antitussive at low doses and a dissociative hallucinogen at much higher doses. Levomethorphan is about five times stronger than morphine.
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In clinical pharmacology, a potentiator is a drug, herb, or chemical that intensifies the effects of a given drug. For example, hydroxyzine or dextromethorphan is used to get more pain relief and anxiolysis out of an equal dose of an opioid medication. The potentiation can take place at any part of the liberation, absorption, distribution, metabolism and elimination of the drug.
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Dextromethorphan usually provides its recreational effects in a non- linear fashion, so that they are experienced in significantly varied stages. These stages are commonly referred to as "plateaus". These plateaus are numbered from one to four, with the first having the mildest effects to fourth being the most intense. Each plateau is said to come with different related effects and experiences.
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Nitrous oxide, a common anesthetic for humans (especially in dentistry), has also been shown to cause vacuolization in rats' brains, but caused no irreversible lesions. Dextromethorphan, a common antitussive often found in cough medicines, has been shown to cause vacuolization in rats' brains when administered at doses of 75 mg/kg. However, oral administration of dextromethorphan hydrobromide (DXM HBr) to female rats in single doses as high as 120 mg/kg did not result in detectable neurotoxic changes at 4–6 hours or 24–26 hours post-dose (female rats are more sensitive to NMDA antagonist neurotoxicity). The same researchers also found no evidence of neurotoxic changes in retrosplenial or cingulate cortices of male rats orally administered up to 400 mg/(kg day) DXM HBr or female rats orally administered 120 mg/(kg day) DXM HBr, both for 30 days.
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Sinomenine or cocculine is an alkaloid found in the root of the climbing plant Sinomenium acutum which is native to Japan and China. The plant is traditionally used in herbal medicine in these countries for rheumatism and arthritis. However, its analgesic action against other kinds of pain is limited. Sinomenine is a morphinan derivative, related to opioids such as levorphanol and the non-opioid cough suppressant dextromethorphan.
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Dextromethorphan hydrobromide affects the signals in the brain that trigger the cough reflex. It is used as a cough suppressant, although it can sometimes be used, medicinally, as a pain reliever, and is also used as a recreational drug. Quinidine sulfate affects the way the heart beats, and is generally used in people with certain heart rhythm disorders. It is also used to treat malaria.
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For chronic and acute coughs, a Cochrane review found no strong evidence for or against the use of honey. For treating children, the systematic review concluded with moderate to low evidence that honey probably helps more than no treatment, diphenhydramine, and placebo at giving relief from coughing. Honey does not appear to work better than dextromethorphan at relieving coughing in children. Another reviewer agrees with these conclusions.
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Oregon Senate Bill 743 states that a provider is prohibited to provide a dextromethorphan containing product to a person under the age of 18 and an individual under the age of 18 is prohibited to purchase a dextromethorphan containing product. The provider is required to obtain identification for proof of age unless the provider can reasonable presume, based on the purchaser's appearance, that the purchaser is 25 years of age or older. Any provider found to be in violation of this bill is subject to a warning from law enforcement for the first violation, a fine of $150 for the second violation, and a fine of $250 for the third violation and each subsequent violation. Any purchaser found to be in violation of this bill is subject to a warning from law enforcement for the first violation and a fine of $50 for the second violation and each subsequent violation.
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Dextrallorphan (DXA) is an opioid derivative chemical of the morphinan class that is used in scientific research. It acts as a σ1 receptor agonist and NMDA receptor antagonist. It has no significant affinity for the σ2, μ-opioid, or δ-opioid receptor, or for the serotonin or norepinephrine transporter. As an NMDA receptor antagonist, in vivo, it is approximately twice as potent as dextromethorphan, and five-fold less potent than dextrorphan.
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No interactions have been described at usual doses. It is possible that pentoxyverine can increase the potency of sedative drugs like benzodiazepines, some anticonvulsants and antidepressants, and alcohol. Likewise, some consumer informations warn patients from taking the drug in combination with or up to two weeks after monoamine oxidase inhibitors, which are known to cause potentially fatal reactions in combination with the (chemically only distantly related) antitussive dextromethorphan.
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The antihistamine is helpful in cases where allergy or common cold is the reason for the cough; it is also a potentiator of opioids, allowing enhanced suppression of cough, analgesia, and other effects from a given quantity of the drug by itself. In various places in the world, cough and cold preparations containing codeine and chlorphenamine are available. In the drug Coricidin, chlorphenamine is combined with the cough suppressant dextromethorphan.
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The penalty for trafficking or manufacturing the substance is a $5,000,000 (HKD) fine and life imprisonment. Possession of the substance for consumption, without a licence from the Department of Health, is illegal and carries a $1,000,000 (HKD) fine or 7 years imprisonment. ; Japan : In Japan, dihydrocodeine is available without a prescription; used in cough medicines such as New Bron Solution-ACE. Dihydrocodeine is used as an antitussive in many products as a Dextromethorphan alternative.
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In severe cases body temperature can increase to greater than . Complications may include seizures and extensive muscle breakdown. Serotonin syndrome is typically caused by the use of two or more serotonergic medications or drugs. This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
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Honey may be a minimally effective cough treatment. A Cochrane review found the evidence to recommend for or against its use in children to be weak. In light of this they found it was better than no treatment, placebo, and diphenhydramine but not better than dextromethorphan for relieving cough symptoms. Honey's use as a cough treatment has been linked on several occasions to infantile botulism and accordingly should not be used in children less than one year old.
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In an older commercial from 1986, Tylenol emphasized that it is the drug that American hospitals trust the most. In this ad, Susan Sullivan told the consumer that Tylenol was a drug that could be trusted by Americans since many doctors also trusted it; she went on to state that doctors prescribed Tylenol four times more often than other leading pain relieving drugs combined. A form that contains dextromethorphan, pseudoephedrine, acetaminophen, and chlorpheniramine, is sold as Cotylenol.
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New York Senate Bill S696B states that no provider shall sell a dextromethorphan containing product to a person under the age of 18 without a valid prescription. Providers are required to obtain identification of age for anyone who looks to be under the age of 25 based on appearance. Any provider found to be in violation of this bill is subject to a fine of $250 for each violation. This bill took effect January 23, 2014.
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Taking SAM at the same time as some drugs may increase the risk of serotonin syndrome, a potentially dangerous condition caused by having too much serotonin. These drugs include dextromethorphan (Robitussin), meperidine (Demerol), pentazocine (Talwin), and tramadol (Ultram). SAM may also interact with antidepressant medications increasing the potential for their side effects and reduce the effectiveness of levodopa for Parkinson's disease. People who have bipolar disorder should not use SAM because it increases the risk of manic episodes.
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3-Hydroxymorphinan (3-HM), or morphinan-3-ol, is a psychoactive drug of the morphinan family. It is the racemic counterpart to norlevorphanol. The dextrorotatory stereoisomer of the compound is an active metabolite of dextromethorphan, dextrorphan, and 3-methoxymorphinan, and similarly to them has potent neuroprotective and neurotrophic effects on LTS- and MPTP-treated dopaminergic neurons of the nigrostriatal pathway, but notably without producing any neuropsychotoxic side effects (e.g., dissociation or hallucinations) or having any anticonvulsant actions.
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Elements of the morphine structure have been used to create completely synthetic drugs such as the morphinan family (levorphanol, dextromethorphan and others) and other groups that have many members with morphine-like qualities. The modification of morphine and the aforementioned synthetics has also given rise to non- narcotic drugs with other uses such as emetics, stimulants, antitussives, anticholinergics, muscle relaxants, local anaesthetics, general anaesthetics, and others. As well, morphine-derived agonist–antagonist drugs have also been developed.
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Taking tenoxicam with other drugs can increase the chance of side effects or alter the therapeutic effect of tenoxicam or the other drug, depending on the combination. Drug types the tenoxicam may interact with include: other analgesic NSAIDs, salicylates such as aspirin, antacids, anticoagulants, cardiac glycosides, ciclosporin, quinolone antibiotics, lithium therapy, diuretics and anti-hypertensives, methotrexate, oral anti-diabetics, colestyramine, dextromethorphan, mifepristone, corticosteroids, anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs), tacrolimus, zidovudine, and gold/penicillamine.
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Benzonatate was first made available in the U.S. in 1958 as a prescription medication for the treatment of cough in individuals over the age of 10. There are a variety of prescription opiate-based cough relievers, such as dextromethorphan and codeine, but have unwanted side effects and potential of abuse and diversion. However, benzonatate is currently the only prescription non-opioid antitussive and its usage has been rapidly increasing. The exact reasons of this increase are unclear.
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The development of a potentially life-threatening serotonin syndrome (also more recently classified as "serotonin toxicity") may occur with venlafaxine treatment, particularly with concomitant use of serotonergic drugs, including but not limited to SSRIs and SNRIs, many hallucinogens such as tryptamines and phenethylamines (e.g., LSD/LSA, DMT, MDMA, mescaline), dextromethorphan (DXM), tramadol, tapentadol, pethidine (meperidine) and triptans and with drugs that impair metabolism of serotonin (including MAOIs). Serotonin syndrome symptoms may include mental status changes (e.g. agitation, hallucinations, coma), autonomic instability (e.g.
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NMDA receptor dysfunction has been proposed as a mechanism in psychosis. This theory is reinforced by the fact that dissociative NMDA receptor antagonists such as ketamine, PCP and dextromethorphan (at large overdoses) induce a psychotic state. The symptoms of dissociative intoxication are also considered to mirror the symptoms of schizophrenia, including negative symptoms. NMDA receptor antagonism, in addition to producing symptoms reminiscent of psychosis, mimics the neurophysiological aspects, such as reduction in the amplitude of P50, P300, and MMN evoked potentials.
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Examples of antagonists, or more appropriately named receptor channel blockers, of the NMDA receptor are APV, amantadine, dextromethorphan (DXM), ketamine, magnesium, tiletamine, phencyclidine (PCP), riluzole, memantine, methoxetamine (MXE), methoxphenidine (MXP) and kynurenic acid. While dizocilpine is generally considered to be the prototypical NMDA receptor blocker and is the most common agent used in research, animal studies have demonstrated some amount of neurotoxicity, which may or may not also occur in humans. These compounds are commonly referred to as NMDA receptor antagonists.
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Inversely, dextromethorphan, a cough suppressor, is best taken orally because it needs to be metabolised by the liver into dextrorphan in order to be effective. This latter principle is that of most prodrugs. The use of suppositories is a way to bypass partially the portal vein: the upper 1/3 of the rectum is drained into the portal vein while the lower 2/3 are drained into the internal iliac vein that goes directly in the inferior vena cava (thus bypassing the liver).
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Both the oral and patch forms come with strong warnings against combining selegiline with drugs that could produce serotonin syndrome, such as SSRIs and the cough medicine dextromethorphan. Selegiline in combination with the opioid analgesic pethidine is not recommended, as it can lead to severe adverse effects. Several other synthetic opioids such as tramadol and methadone, as well as various triptans, are contraindicated due to potential for serotonin syndrome. Birth control pills containing ethinylestradiol and a progestin increase the bioavailability of selegiline by 10- to 20-fold.
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Pseudoephedrine is a sympathomimetic drug of the phenethylamine and amphetamine chemical classes. It may be used as a nasal/sinus decongestant, as a stimulant, or as a wakefulness-promoting agent. The salts pseudoephedrine hydrochloride and pseudoephedrine sulfate are found in many over-the-counter preparations, either as a single ingredient or (more commonly) in combination with antihistamines, guaifenesin, dextromethorphan, and/or paracetamol (acetaminophen) or another NSAID (such as aspirin or ibuprofen). It is also used as a precursor chemical in the illegal production of methamphetamine.
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In the autumn of 2003 he was diagnosed with Head and neck cancer. During several months of chemo- and radiation- therapy he wrote a semi-biographical novel titled RUNAWAY JESUS, which recounted his experiments with the drug dextromethorphan hydrobromide (DXM), followed by What's so Wrong with Love and Peace- Adventures in the European Underground 1965-67. Both available as E-books at Amazon, iTunes, etc. He survived the Head and neck cancer, but in 2007 was diagnosed with bladder cancer, which was treated with two bladder resections.
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Black market ecstasy pills are frequently found to contain other drugs in place of or in addition to methylenedioxymethylamphetamine (MDMA). Since the slang term "ecstasy" usually refers only to MDMA, any pill which contains other compounds may be considered adulterated. 3,4-Methylenedioxyamphetamine (MDA), methylenedioxyethamphetamine (MDEA), amphetamine, methylamphetamine, benzylpiperazine (BZP), trifluoromethylphenylpiperazine (TFMPP), caffeine, ephedrine, pseudoephedrine, and dextromethorphan (DXM) are all commonly found in pills being sold as ecstasy. Less common drugs in ecstasy include diphenhydramine, acetaminophen, 5-MeO-DiPT, 2C-B, procaine, and phencyclidine (PCP).
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The function of these receptors is poorly understood. Activation of σ–receptors by an agonist ligand may induce hallucinogenic effects and also may be responsible for the paradoxical convulsions sometimes seen in opiate overdose. Drugs known to be σ–agonists include cocaine, morphine/diacetylmorphine, opipramol, PCP, fluvoxamine, methamphetamine, dextromethorphan, and the herbal antidepressant berberine. However the exact role of σ–receptors is difficult to establish as many σ–agonists also bind to other targets such as the κ-opioid receptor and the NMDA glutamate receptor.
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Typically, the base for lean has been prescription cold medicine, specifically cough syrup, one that contains both promethazine and codeine, but over-the-counter cold medicine that lists dextromethorphan as the active ingredient has also been used, as it can produce similar effects and eliminate the need for a doctor's visit. To create a drinkable mixture, the cough syrup is combined with Sprite, Mountain Dew, or grape-flavored Fanta and is typically served in a foam cup. A hard candy, usually a Jolly Rancher, may be added to give the mixture a sweeter flavor.
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Ramelteon has been evaluated for potential drug interactions with the following medications and showed no significant effects: omeprazole, theophylline, dextromethorphan, and midazolam, digoxin and warfarin. There were no clinically meaningful effects when ramelteon was coadministered with any of these drugs. A drug interaction study showed that there were no clinically meaningful effects or an increase in adverse events when ramelteon and the SSRI Prozac (fluoxetine) were coadministered. When coadministered with ramelteon, fluvoxamine (strong CYP1A2 inhibitor) increased AUC approximately 190-fold, and the Cmax increased approximately 70-fold, compared to ramelteon administered alone.
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The authors of this study suggested that this increase is unlikely to be of clinical concern. Caution should be used when taking cough medicine containing dextromethorphan (DXM) as serotonin syndrome has been reported. Bupropion has been found to significantly increase citalopram plasma concentration and systemic exposure; the interaction with escitalopram had not been studied, but some monographs warned of the potential interaction. Escitalopram can also prolong the QT interval and hence it is not recommended in patients that are concurrently on other medications that also have the ability to prolong the QT interval.
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Most of the time, irregular coughing is caused by a respiratory tract infection but can also be triggered by choking, smoking, air pollution, asthma, gastroesophageal reflux disease, post-nasal drip, chronic bronchitis, lung tumors, heart failure and medications such as angiotensin-converting-enzyme inhibitors (ACE inhibitors). Treatment should target the cause; for example, smoking cessation or discontinuing ACE inhibitors. Cough suppressants such as codeine or dextromethorphan are frequently prescribed, but have been demonstrated to have little effect. Other treatment options may target airway inflammation or may promote mucus expectoration.
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As an example, the ratio of dextromethorphan (a drug that is mainly metabolized by CYP2D6) to its major metabolite dextrorphan increased approximately 35-fold when it was administered to people being treated with 300 mg/day bupropion, indicative of a major drug interaction with a common over-the-counter medicine. Bupropion lowers the threshold for epileptic seizures, and therefore can potentially interact with other medications that also lower it, such as carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline, systemic corticosteroids (e.g., prednisone), and some tricyclic antidepressants (e.g., clomipramine).
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The precise mechanisms underlying opioid- induced hyperalgesia are poorly understood. The sensitization of pronociceptive pathways in response to opioid treatment appears to involve several pathways. Research thus far has primarily implicated the abnormal activation of NMDA receptors in the central nervous system, and long-term potentiation of synapses between nociceptive C fibers and neurons in the spinal dorsal horn. One possible strategy for treating hyperalgesia involves blocking activation of these receptors with NMDA receptor antagonists such as ketamine, dextromethorphan, or methadone (which has NMDAR antagonist properties in addition to being an opioid analgesic).
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Toohil sponsored a measure enacted in 2018 that banned the sale of over-the-counter cough medicines containing dextromethorphan to minors in Pennsylvania. In 2019, legislation she sponsored was enacted specifying that civil confidentiality agreements do not cover communications with law enforcement. The proposal was one of the recommendations made by the 40th Statewide Investigating Grand Jury that examined clergy sex abuse in Pennsylvania's Roman Catholic dioceses. Toohil also sponsored an adoption reform law regarding the witnessing of an adoption consent agreement for an incarcerated parent in Pennsylvania.
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Rolapitant moderately inhibits the liver enzyme CYP2D6. Blood plasma concentrations of the CYP2D6 substrate dextromethorphan have increased threefold when combined with rolapitant; and increased concentrations of other substrates are expected. The drug also inhibits the transporter proteins ABCG2 (breast cancer resistance protein, BCRP) and P-glycoprotein (P-gp), which has been shown to increase plasma concentrations of the ABCG2 substrate sulfasalazine twofold and the P-gp substrate digoxin by 70%. Strong inducers of the liver enzyme CYP3A4 decrease the area under the curve of rolapitant and its active metabolite (called M19); for rifampicin, this effect was almost 90% in a study.
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This leaves the user feeling dissociated or disconnected, experienced as brain fog or derealization. Dextromethorphan's euphoric effects have sometimes been attributed to an increase in dopamine levels, since such an increase generally correlates with pleasurable responses to drugs, as is observed with some clinical antidepressants, as well as some recreational drugs. However, the effects of dextrorphan and dextromethorphan, and other NMDA receptor antagonists, on dopamine levels is a disputed subject. Studies show that the NMDA receptor antagonists ketamine and PCP do raise dopamine levels, although other studies show that another NMDA receptor antagonist, dizocilpine, has no effect on dopamine levels.
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Tylenol PM contains diphenhydramine in addition to acetaminophen for the purpose of inducing sleep and reducing pain and/or fever. Promethazine is marketed by the brand name Phenergan for use against allergy symptoms and motion sickness in the US, where a prescription for promethazine is required. It is also available in the form of a syrup either alone or in combination with one or more of several other active ingredients including codeine and dextromethorphan, for the treatment of allergy symptoms, cough, or cold, among other uses. In Canada, promethazine is available as an over the counter anti- histamine by the name of Histantil.
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Ketamine, a synthetic general anesthetic and one of the best-known NMDAR antagonists. Antagonists of the NMDA receptor are used as anesthetics for animals and sometimes humans, and are often used as recreational drugs due to their hallucinogenic properties, in addition to their unique effects at elevated dosages such as dissociation. When certain NMDA receptor antagonists are given to rodents in large doses, they can cause a form of brain damage called Olney's lesions. NMDA receptor antagonists that have been shown to induce Olney's lesions include ketamine, phencyclidine, and dextrorphan (a metabolite of dextromethorphan), as well as some NMDA receptor antagonists used only in research environments.
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It does not alleviate coughing to the same extent as dextromethorphan but it shortens the cough duration better than placebo and salbutamol. A trial of antibiotics or inhaled corticosteroids may be tried in children with a chronic cough in an attempt to treat protracted bacterial bronchitis or asthma respectively. There is insufficient evidence to recommend treating children who have a cough that is not related to a specific condition with inhaled anti-cholinergics. Because coughing can spread disease through infectious aerosol droplets, it is recommended to cover one's mouth and nose with the forearm, the inside of the elbow, a tissue or a handkerchief while coughing.
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The activity of the NMDA receptor is affected by many psychoactive drugs such as phencyclidine (PCP), alcohol (ethanol) and dextromethorphan (DXM). The anaesthetic and analgesic effects of the drugs ketamine and nitrous oxide are partially due to their effects on NMDA receptor activity. Since 1989 memantine has been recognized to be an uncompetitive antagonist of the N-methyl-D-aspartate receptor (NMDA receptor), entering the channel of the receptor after it has been activated and thereby blocking the flow of ions. The NMDA receptor channels play an important role in synaptic plasticity and synapse formation underlying memory, learning and formation of neural networks during development in the central nervous system (CNS).
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Temporary binocular diplopia can be caused by alcohol intoxication or head injuries, such as concussion (if temporary double vision does not resolve quickly, one should see an optometrist or ophthalmologist immediately). It can also be a side effect of benzodiazepines or opioids, particularly if used in larger doses for recreation, the antiepileptic drugs phenytoin and zonisamide, and the anticonvulsant drug lamotrigine, as well as the hypnotic drug zolpidem and the dissociative drugs ketamine and dextromethorphan. Temporary diplopia can also be caused by tired or strained eye muscles. If diplopia appears with other symptoms such as fatigue and acute or chronic pain, the patient should see an ophthalmologist immediately.
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The drug phencyclidine (more commonly known as PCP) antagonizes glutamic acid non-competitively at the NMDA receptor. For the same reasons, dextromethorphan and ketamine also have strong dissociative and hallucinogenic effects. Acute infusion of the drug LY354740 (also known as eglumegad, an agonist of the metabotropic glutamate receptors 2 and 3) resulted in a marked diminution of yohimbine-induced stress response in bonnet macaques (Macaca radiata); chronic oral administration of LY354740 in those animals led to markedly reduced baseline cortisol levels (approximately 50 percent) in comparison to untreated control subjects. LY354740 has also been demonstrated to act on the metabotropic glutamate receptor 3 (GRM3) of human adrenocortical cells, downregulating aldosterone synthase, CYP11B1, and the production of adrenal steroids (i.e.
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Pseudoephedrine (PSE) is a sympathomimetic drug of the phenethylamine and amphetamine chemical classes. It may be used as a nasal/sinus decongestant, as a stimulant, or as a wakefulness-promoting agent in higher doses. It was first characterized in 1889, by the German chemists Ladenburg and Oelschlägel, who used a sample that had been isolated from Ephedra vulgaris by the Merck pharmaceutical corporation of Darmstadt, Germany. The salts pseudoephedrine hydrochloride and pseudoephedrine sulfate are found in many over-the-counter preparations, either as a single ingredient or (more commonly) in a fixed-dose combination with one or more additional active ingredients such as antihistamines, guaifenesin, dextromethorphan, paracetamol (acetaminophen) or an NSAID (such as aspirin or ibuprofen).
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Dimetapp is a brand of over-the-counter cold and allergy medicines manufactured by Pfizer (formerly Wyeth). At one point, Dimetapp as a household word referred to a single combination preparation marketed to relieve symptoms of the common cold, containing brompheniramine (an antihistamine) and phenylephrine (decongestant replacing the formerly used pseudoephedrine, which itself replaced phenylpropanolamine). Variants were created, including Dimetapp DM with the addition of dextromethorphan (an antitussive or cough suppressant). Dimetapp Elixir and Colour Free Elixir are intended to relieve nasal congestion, runny nose, itchy watery eyes and sneezing, whereas Dimetapp DM and Dimetapp DM Colour Free Elixir are intended for colds with dry coughs and also to treat whooping cough.
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In the same study, withdrawal symptoms ranged from physical symptoms such as nausea, diarrhea, and muscle spasms to psychological symptoms such as restlessness, anxiety, and anger but lasted less than 3 days for most subjects. However, the results from this study may be obfuscated by the occasional addition of other substances in the mitragynine preparation such as dextromethorphan and benzodiazepines, which could contribute to the withdrawal symptoms. In an animal study, mitragynine withdrawal symptoms were observed following 14 days of mitragynine i.p. injections in mice and included displays of anxiety, teeth chattering, and piloerection, all of which are characteristic signs of opioid withdrawal in mice and are comparable to morphine withdrawal symptoms.
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Tramadol can interact with other medications with similar mechanisms of action. Tramadol acts as a serotonin-norephinephrine reuptake inhibitor and thus can interact with other serotonergic medications (selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, tricyclic antidepressants, triptans, cough and cold medications containing dextromethorphan, herbal products containing St. John’s wort, and medications that inhibit the metabolism of serotonin, such as monoamine oxidase inhibitors) and, in combination, may lead to serotonin syndrome. It may also make some serotonergic antagonist anti-emetic medications (ondansetron) less effective. Tramadol also acts as an opioid agonist and thus can increase the risk for side effects when used with other opioid analgesics (such as morphine, pethidine, tapentadol, oxycodone, and fentanyl).
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These drugs are used along with analgesics to modulate and/or modify the action of opioids when used against pain, especially of neuropathic origin. Dextromethorphan has been noted to slow the development of and reverse tolerance to opioids, as well as to exert additional analgesia by acting upon NMDA receptors, as does ketamine. Some analgesics such as methadone and ketobemidone and perhaps piritramide have intrinsic NMDA action. High-alcohol liquor, two forms of which were found in the US Pharmacopoeia up until 1916 and in common use by physicians well into the 1930s, has been used in the past as an agent for dulling pain, due to the CNS depressant effects of ethyl alcohol, a notable example being the American Civil War.
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Dimemorfan (INN) (or dimemorphan) (brand names Astomin, Dastosirr, Tusben), or dimemorfan phosphate (JAN), also known as 3,17-dimethylmorphinan, is an antitussive (cough suppressant) of the morphinan family that is widely used in Japan and is also marketed in Spain and Italy. It was developed by Yamanouchi Pharmaceutical (now Astellas Pharma) and introduced in Japan in 1975. Dimemorfan is an analogue of dextromethorphan (DXM) and its active metabolite dextrorphan (DXO), and similarly to them, acts as a potent agonist of the σ1 receptor (Ki = 151 nM). However, unlike DXM and DXO, it does not act significantly as an NMDA receptor antagonist (Ki = 16,978 nM), and for this reason, lacks dissociative effects, thereby having reduced side effects and abuse potential in comparison.
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As a MAO inhibitor, safinamide can theoretically cause hypertensive crises, serotonin syndrome and other severe side effects when combined with other MAO inhibitors or with drugs that are known to interact with MAO inhibitors, such as pethidine, dextromethorphan, selective serotonin reuptake inhibitors (SSRIs), serotonin–noradrenaline reuptake inhibitors (SNRIs), tricyclic and tetracyclic antidepressants. An interaction with tyramine, a substance found in various foods, could be expected by the same reasoning but has been excluded in studies. Safinamide should not be given with opioids; some fatal reactions have occurred. Another theoretical interaction is with drugs with affinity to the transporter protein ABCG2 (also known as BCRP), such as pitavastatin, pravastatin, ciprofloxacin, methotrexate, and diclofenac; a study with the latter has shown no clinical relevance.
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NMDA receptors have a very important role in modulating long-term excitation and memory formation. NMDA antagonists such as dextromethorphan (DXM, a cough suppressant), ketamine (a dissociative anaesthetic), tiletamine (a veterinary anaesthetic) and ibogaine (from the African tree Tabernanthe iboga) are being studied for their role in decreasing the development of tolerance to opioids and as possible for eliminating addiction/tolerance/withdrawal, possibly by disrupting memory circuitry. Acting as an NMDA antagonist may be one mechanism by which methadone decreases craving for opioids and tolerance, and has been proposed as a possible mechanism for its distinguished efficacy regarding the treatment of neuropathic pain. The dextrorotary form (dextromethadone), which acts as an NMDA receptor antagonist and is devoid of opioid activity, has been shown to produce analgesia in experimental models of chronic pain.
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Drug-induced hallucinations are caused by hallucinogens, dissociatives, and deliriants, including many drugs with anticholinergic actions and certain stimulants, which are known to cause visual and auditory hallucinations. Some psychedelics such as lysergic acid diethylamide (LSD) and psilocybin can cause hallucinations that range in the spectrum of mild to intense. Hallucinations, pseudohallucinations, or intensification of pareidolia, particularly auditory, are known side effects of opioids to different degrees—it may be associated with the absolute degree of agonism or antagonism of especially the kappa opioid receptor, sigma receptors, delta opioid receptor and the NMDA receptors or the overall receptor activation profile as synthetic opioids like those of the pentazocine, levorphanol, fentanyl, pethidine, methadone and some other families are more associated with this side effect than natural opioids like morphine and codeine and semi- synthetics like hydromorphone, amongst which there also appears to be a stronger correlation with the relative analgesic strength. Three opioids, Cyclazocine (a benzormorphan opioid/pentazocine relative) and two levorphanol- related morphinan opioids, Cyclorphan and Dextrorphan are classified as hallucinogens, and Dextromethorphan as a dissociative.
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