dextromethorphan and Alcoholism

Alcohol withdrawal syndrome is associated with increased central N-methyl-D-aspartate (NMDA) glutamate transmission. Medications that reduce glutamate release or block NMDA overactivation have shown efficacy for treating alcohol withdrawal syndrome. Dextromethorphan (DXM), a widely used antitussive drug, is a low-affinity, noncompetitive NMDA antagonist with potential neuroprotective properties. This study, using a randomized, double-blind, placebo-controlled study design, examined the benefit of DXM in the management of acute alcohol withdrawal. Alcohol-dependent patients admitted for detoxification treatment and experiencing moderate alcohol withdrawal, as measured by a score greater than 10 on the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), were randomly assigned to receive either DXM 360 mg/d or an identical placebo for 7 days in a double-blind manner. All subjects received a concurrent dose of lorazepam 2 mg along with the initial administration of DXM or placebo and were given additional lorazepam (1 mg) as a rescue medication according to the symptom-triggered detoxification protocol. Outcome measures consisted of the mean total dose of lorazepam received, the sequential scores on the CIWA-Ar, and craving assessed by the Obsessive-Compulsive Drinking Scale. Forty subjects completed the study, 18 in the DXM group and 22 in the placebo group. We found that compared with placebo, DXM use was not associated with lower lorazepam doses to control alcohol withdrawal symptoms. The progression in CIWA-Ar and Obsessive-Compulsive Drinking Scale scores was also comparable between the 2 groups. Our preliminary results do not support the efficacy of high-dose DXM in reducing the need of benzodiazepines to treat withdrawal symptoms in alcohol-dependent patients.

Topics: Adult; Alcohol Abstinence; Alcohol Drinking; Alcoholism; Brain; Dextromethorphan; Double-Blind Method; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Humans; Lorazepam; Middle Aged; Psychiatric Status Rating Scales; Receptors, N-Methyl-D-Aspartate; Substance Withdrawal Syndrome; Taiwan; Time Factors; Treatment Failure

Topics: Alcohol Drinking; Alcoholism; Behavior, Addictive; Dextromethorphan; Dextrorphan; Double-Blind Method; Ethanol; Excitatory Amino Acid Antagonists; Humans; Ketamine; Male; Receptors, N-Methyl-D-Aspartate; Recurrence; Up-Regulation

Glutamatergic NMDA receptors are believed to play a major role in the pathophysiology of numerous neuropsychiatric disorders including substance use and schizophrenia. Neuropharmacological studies measuring subjective response, psychopathology and biological parameters are helpful in studying pathophysiology of these disorders. We report preliminary data of a placebo-controlled double-blind challenge study in recently detoxified alcoholics (n = 20) and healthy controls (n = 10) using the non-competitive NMDA antagonist dextromethorphan. Findings suggest that dextrometorphan can produce ethanol-like subjective effects in both alcoholics and controls and induce a mild form of craving in alcoholics only. The results of this study give further support to the hypothesis of glutamatergic NMDA receptors mediating much of ethanol's psychotropic effects. Possible clinical implications of these findings are discussed.

Topics: Adult; Alcoholism; Dextromethorphan; Double-Blind Method; Excitatory Amino Acid Antagonists; Humans; Hydrocortisone; Male; Middle Aged; Neurosecretory Systems; Prolactin; Receptors, N-Methyl-D-Aspartate; Substance Withdrawal Syndrome

Topics: Alcoholism; Antitussive Agents; Dextromethorphan; Electrocardiography; Emergency Service, Hospital; Female; Heart Arrest; Humans; Hypokalemia; Middle Aged; Recurrence; Syncope; Tachycardia, Ventricular; Torsades de Pointes

The N-methyl-D-aspartate (NMDA) antagonist dextromethorphan has been available in pharmacies without a prescription since 1954 as an antitussive agent. There is an alarming increase in reports of its abuse. Dextromethorphan is avidly taken, mainly by young people, as a psychoactive drug. The currently available data yield incomplete information about the extent of the problem and its significance for addiction medicine in Germany.. We report the case of a 44-year-old man who became dependent on dextromethorphan through years of abuse, buying the substance for himself without a prescription in German pharmacies. He told us he had taken it regularly for six years. He had become dependent on dextromethorphan, ultimately taking it in a dose of 1800 mg daily. This led him to overt neglect of his work and leisure activities. A urine sample taken on admission to the hospital was found to contain dextromethorphan. During inpatient detoxification, he developed an vegetative withdrawal syndrome consisting of craving, diaphoresis, nausea, hypertension, and tachycardia. He was treated on our ward for three weeks, and a stay in a residential detoxification facility was planned thereafter.. Dextromethorphan is a psychotropic substance that carries a potential for abuse and dependence. On the basis of the currently available data, its reclassification as a prescription drug should be considered.

Topics: Adult; Alcoholism; Antitussive Agents; Cross-Sectional Studies; Dextromethorphan; Dose-Response Relationship, Drug; Excitatory Amino Acid Antagonists; Humans; Male; Patient Admission; Rehabilitation Centers; Substance Abuse Detection; Substance Withdrawal Syndrome; Substance-Related Disorders; Temperance

Coricidin HBP, a cold medication containing dextromethorphan, has become a popular agent abused among adolescents. This retrospective chart review examines the potential psychiatric manifestations of Coricidin HBP misuse and patterns of use among patients treated in an inpatient child and adolescent psychiatric unit. Coricidin HBP use was documented in 47 patient. The data revealed that Coricidin HBP use was associated with: (a) predominantly depressive symptomatology; (b) transient substance-induced psychosis; (c) cardiac toxicity; and (d) greater quantities used per episode by Caucasians. Clinicians treating adolescents need to be aware of the abuse potential and psychiatric manifestations of this dextromethorphan-containing product.

Topics: Acetaminophen; Adolescent; Age Factors; Alcoholism; California; Child; Chlorpheniramine; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Dextromethorphan; Dose-Response Relationship, Drug; Drug Combinations; Drug Overdose; Female; Heart Block; Hospitalization; Humans; Male; Mental Disorders; Phenylpropanolamine; Psychiatric Department, Hospital; Psychoses, Substance-Induced; Retrospective Studies; Sex Factors; Substance-Related Disorders; Suicide, Attempted; Tachycardia, Ventricular

Topics: Adult; Alcoholism; Antitussive Agents; Dextromethorphan; Diagnosis, Dual (Psychiatry); Humans; Male; Schizophrenia, Paranoid; Substance-Related Disorders

Acetaminophen, a commonly used medication, is present in many over-the-counter remedies. In recent years, its potential to cause severe liver injury has been increasingly appreciated. Chronic abusers of alcohol may be particularly susceptible to hepatotoxicity from acetaminophen. We report two cases of unintentional liver injury associated with ingestion of Nyquil, a liquid cold remedy containing acetaminophen and 25% alcohol.

Topics: Acetaminophen; Adult; Alcoholism; Chemical and Drug Induced Liver Injury; Dextromethorphan; Doxylamine; Drug Combinations; Ephedrine; Female; Humans; Levorphanol; Liver; Male; Middle Aged; Necrosis; Nonprescription Drugs; Promethazine; Pseudoephedrine; Pyridines

Topics: Acetaminophen; Adult; Alcoholism; Chemical and Drug Induced Liver Injury; Dextromethorphan; Doxylamine; Drug Combinations; Ephedrine; Humans; Hypnotics and Sedatives; Levorphanol; Male; Nonprescription Drugs; Promethazine; Pseudoephedrine; Pyridines