OTC medicines treat a variety of illnesses and their symptoms including pain, coughs and colds, diarrhea, constipation, acne, and others. Some OTC medicines have active ingredients with the potential for misuse at higher-than-recommended dosages. Pseudoephedrine, a nasal decongestant found in many OTC cold medicines, can be used to make methamphetamine. For this reason, products containing pseudoephedrine are sold "behind the counter" nationwide.
A prescription is not needed in most states, but in states that do require a prescription, there are limits on how much a person can buy each month. In some states, only people 18 years of age or older can buy pseudoephedrine. The most common sources of abused DXM are "extra-strength" cough syrup, tablets and gel capsules. DXM may be swallowed in its original form or may be mixed with soda for flavor, called "robo-tripping" or "skittling. These medicines are often misused in combination with other drugs, such as alcohol and marijuana.
Loperamide is an anti-diarrheal that is available in tablet, capsule, or liquid form. When misusing loperamide, people swallow large quantities of the medicine. It is unclear how often this drug is misused. DXM is an opioid without effects on pain reduction and does not act on the opioid receptors.
When taken in large doses, DXM causes a depressant effect and sometimes a hallucinogenic effect, similar to PCP and ketamine. Repeatedly seeking to experience that feeling can lead to addiction-a chronic relapsing brain condition characterized by inability to stop using a drug despite damaging consequences to a person's life and health.
Loperamide is an opioid designed not to enter the brain. However, when taken in large amounts and combined with other substances, it may cause the drug to act in a similar way to other opioids. Other opioids, such as certain prescription pain relievers and heroin, bind to and activate opioid receptors in many areas of the brain, especially those involved in feelings of pain and pleasure. Opioid receptors are also located in the brain stem, which controls important processes, such as blood pressure, arousal, and breathing.
At high doses, a person may have hallucinations or feelings of physical distortion, extreme panic, paranoia, anxiety, and aggression.
Loperamide In the short-term, loperamide is sometimes misused to lessen cravings and withdrawal symptoms; however, it can cause euphoria, similar to other opioids. Loperamide misuse can also lead to fainting, stomach pain, constipation, eye changes, and loss of consciousness. It can cause the heart to beat erratically or rapidly, or cause kidney problems. These effects may increase if taken with other medicines that interact with loperamide.
Other effects have not been well studied and reports are mixed, but the physical consequences of loperamide misuse can be severe. Yes, a person can overdose on cold medicines containing DXM or loperamide.
An overdose occurs when a person uses enough of the drug to produce a life-threatening reaction or death Read more on our Intentional vs. Unintentional Overdose Deaths webpage. As with other opioids, when people overdose on DXM or loperamide, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia.
Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage and death. Dextromethorphan comes alone and in combination with antihistamines, cough suppressants, and decongestants.
Ask your doctor or pharmacist for advice on which product is best for your symptoms. Check nonprescription cough and cold product labels carefully before using 2 or more products at the same time. These products may contain the same active ingredient s and taking them together could cause you to receive an overdose. This is especially important if you will be giving cough and cold medications to a child. Nonprescription cough and cold combination products, including products that contain dextromethorphan, can cause serious side effects or death in young children.
Do not give these products to children younger than 4 years of age. If you give these products to children years of age, use caution and follow the package directions carefully. If you are giving dextromethorphan or a combination product that contains dextromethorphan to a child, read the package label carefully to be sure that it is the right product for a child of that age.
Do not give dextromethorphan products that are made for adults to children. Before you give a dextromethorphan product to a child, check the package label to find out how much medication the child should receive. Give the dose that matches the child's age on the chart. Ask the child's doctor if you don't know how much medication to give the child.
If you are taking the liquid, do not use a household spoon to measure your dose. Use the measuring spoon or cup that came with the medication or use a spoon made especially for measuring medication. If you are taking the chewable tablets you can allow them to melt in your mouth or you can chew them before swallowing. If you are taking the extended-release suspension, shake the bottle well before each use to mix the medication evenly.
Stop taking dextromethorphan and call your doctor if your cough does not get better within 7 days, if your cough goes away and comes back, or if your cough occurs with a fever, rash, or headache. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Dextromethorphan is usually taken as needed. If your doctor has told you to take dextromethorphan regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Dextromethorphan may cause other side effects. Call your doctor if you experience any unusual problems while you are taking this medication.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.
However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach.
In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.
You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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