dextromethorphan and Drug-Overdose

Tens of thousands of ED visits each year are related to synthetic psychoactive drug intoxication. Signs, symptoms, and treatment of toxicity with synthetic cathinones, synthetic cannabinoids, or dextromethorphan overlap greatly and can be challenging. This article describes signs and symptoms of psychoactive drug abuse and how to properly manage these symptoms.

Topics: Alkaloids; Cannabinoids; Dextromethorphan; Drug Overdose; Humans; Psychotropic Drugs

The aim of this review was to describe a patient with serotonin toxicity after an overdose of dextromethorphan and chlorphenamine and to perform a systematic literature review exploring whether dextromethorphan and chlorphenamine may be equally contributory in the development of serotonin toxicity in overdose. A Medline literature review was undertaken to identify cases of serotonin toxicity due to dextromethorphan and/or chlorphenamine. Case reports were included if they included information on the ingested dose or plasma concentrations of dextromethorphan and/or chlorphenamine, information about co-ingestions and detailed clinical information to evaluate for serotonin toxicity. Cases were reviewed by two toxicologists and serotonin toxicity, defined by the Hunter criteria, was diagnosed when appropriate. The literature was then reviewed to evaluate whether chlorphenamine may be a serotonergic agent. One hundred and fifty-five articles of dextromethorphan or chlorphenamine poisoning were identified. There were 23 case reports of dextromethorphan, of which 18 were excluded for lack of serotonin toxicity. No cases were identified in which serotonin toxicity could be solely attributed to chlorphenamine. This left six cases of dextrometorphane and/or chlorphenamine overdose, including our own, in which serotonin toxicity could be diagnosed based on the presented clinical information. In three of the six eligible cases dextromethorphan and chlorphenamine were the only overdosed drugs. There is substantial evidence from the literature that chlorphenamine is a similarly potent serotonin re-uptake inhibitor when compared with dextrometorphan. Chlorphenamine is a serotonergic medication and combinations of chlorphenamine and dextromethorphan may be dangerous in overdose due to an increased risk of serotonin toxicity.

Topics: Antitussive Agents; Chlorpheniramine; Dextromethorphan; Drug Overdose; Humans; Male; Serotonin Agents; Suicide, Attempted; Young Adult

Over-the-counter cough and cold medicines are widely prescribed by general pediatricians in order to relieve cough and other symptoms in the setting of upper respiratory infections. This article will review the pharmacologic components found in over-the-counter cough medicines, the data concerning their use and efficacy in children, the increasing trend of abuse of these medications, and their potential toxicity.. There is an overall paucity of data evaluating the use of over-the-counter cough medicines in children as well as a lack of evidence for their efficacy. The articles cited will review the efficacy of over-the-counter cough medicines, the emerging trend of abuse of certain preparations such as dextromethorphan, and specific cases of morbidity and even mortality.. According to the limited data that exist, there is not any evidence that over-the-counter cough and cold medicines are effective in children. In otherwise healthy children without chronic complicating factors such as asthma, the symptoms of acute upper respiratory infections are generally mild and self-limited. Pediatricians must weigh the benefits against the potential risks of recommending over-the-counter cough medicines and should be prepared to educate parents about the expected natural course of their child's illness and the likelihood that these medications will be minimally effective in relieving symptoms, if at all.

Topics: Antitussive Agents; Child; Dextromethorphan; Drug Overdose; Humans; Infant; Nasal Decongestants; Nonprescription Drugs; Phenylpropanolamine

The incidence of serious pediatric morbidity and mortality has fortunately declined over the past two decades due to better prevention efforts, the development of regionalized poison information programs, and advances in the emergency management and critical care of poisoned patients. Still, children continue to explore and often ingest many substances they discover in their world. Some of these children will become patients who present to the emergency department, requiring a coordinated approach to the seriously or even critically ill poisoned child by physicians who can access specialized resources to manage a vast spectrum of potential toxins. This article summarized one such approach, emphasizing initial attention to life support priorities, followed by a detailed evaluation process using readily available clinical and laboratory data. Management strategies including decontamination, urgent antidotal therapy, initiation of excretion enhancement, and optimal supportive care were reviewed. Several specific intoxications were illustrated briefly in an attempt to facilitate pattern recognition of characteristic pediatric exposures.

Topics: Acetaminophen; Alcoholic Intoxication; Astemizole; Child; Child, Preschool; Clonidine; Cocaine; Critical Care; Dextromethorphan; Drug Overdose; Female; Humans; Hydrocarbons; Infant; Insecticides; Iron; Male; Organophosphorus Compounds; Poisoning

Dextromethorphan, the d-isomer of the opiate agonist levorphanol, has none of the analgesic or sedative effects associated with the opiates and is approved for over-the-counter use as an antitussive. It is available, in various combinations with other medications, in nonprescription cough suppressant and common cold formulations, and its availability in the United States is not controlled. In this paper we have reported two cases of recreational use of dextromethorphan-containing cough syrup by two unrelated teenage boys. Despite the safety of this medication when used at the recommended dosage, there have been cases of "recreational" use of dextromethorphan as well as death by overdose. Although usually thought to be nonaddictive, dextromethorphan produces a substance dependence syndrome, and physicians should be aware of its abuse potential, particularly by youths.

Topics: Adolescent; Alcohol Drinking; Comorbidity; Dextromethorphan; Drug and Narcotic Control; Drug Combinations; Drug Overdose; Humans; Male; Marijuana Abuse; Nonprescription Drugs; Substance-Related Disorders

Dextromethorphan, a common ingredient in cough syrups, has rarely been described to cause toxicity. The authors describe an unusual case of a known asthmatic presenting with somnolence, who appeared to be in end-stage respiratory failure. Her partial response to routine naloxone, 1 mg, was surprising. However, additional naloxone was required to completely normalize the patient's mental status. The authors suggest naloxone be administered in doses of 0.4 mg or more intravenously in suspected dextromethorphan overdose.

Topics: Adolescent; Adult; Antidotes; Antitussive Agents; Child, Preschool; Dextromethorphan; Drug Overdose; Female; Humans; Infant; Male; Naloxone; Poisoning

Topics: Antidepressive Agents; Antidepressive Agents, Second-Generation; Bupropion; Dextromethorphan; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Humans

Dextromethorphan polistirex is an extended-release formulation of dextromethorphan hydrobromide, marketed as Delsym® (Reckitt; Parsippany, NJ), with a duration of action roughly two to three times that of the standard formulation. The polistirex binder is responsible for the prolonged duration of action by slowing the release of active ingredient; the liberated dextromethorphan has unchanged pharmacokinetics and clinical effects. A 23-month-old male presented following a 900 mg (71.4 mg/kg) dextromethorphan polistirex ingestion 90 min prior. On arrival, he was unresponsive, tachycardic, and hypertensive with mydriasis, roving eye movements, rotary nystagmus, and opisthotonos. Approximately 90 min after arrival, he required intubation for airway protection. The blood dextromethorphan concentration from 75 min after arrival was 110 ng/mL (10-40 ng/ml therapeutic). He was extubated approximately 13 h after arrival and discharged that day. Most pediatric dextromethorphan overdoses produce mild symptoms that are not considered to be life-threatening. Life threatening overdoses are rare. The toxic dextromethorphan dose and blood concentration as well as the toxicokinetics of the polistirex formulation are not well defined. Our case suggests that a blood dextromethorphan concentration exceeding 100 ng/mL can be toxic in this age group, however further study is needed.

Topics: Child; Child, Preschool; Delayed-Action Preparations; Dextromethorphan; Drug Overdose; Excipients; Humans; Infant; Male; Nystagmus, Pathologic

A 47 year old woman presented to the emergency department for an intentional overdose of an over the counter cough suppressant. She had been seen multiple times over the last several months with the same presentation. Her work up revealed a significantly elevated chloride level (125 mmol/L, normal 98-107) as well as an anion gap of 1. She denied any other co-ingestions, including other over the counter medications or alcohol, and was otherwise asymptomatic. She was given fluids and supportive care. Ultimately, a significantly elevated bromide level was noted on a send out lab. She was diagnosed with chronic bromide toxicity (bromism) from recurrent over the counter Robitussin HBr use, which was the source of her hyperchloremia and decreased anion gap.

Topics: Bromides; Dextromethorphan; Drug Overdose; Female; Humans; Middle Aged; Substance-Related Disorders

Dextromethorphan is the most common over-the-counter (OTC) antitussive medication. We sought to characterize adverse events associated with dextromethorphan in children <12 years old from a surveillance program of OTC cough/cold medication exposures.. This is a retrospective case series of oral exposures to dextromethorphan with ≥1 adverse event from multiple U.S. sources (National Poison Data System, FDA Adverse Event Reporting System, manufacturer safety reports, news/media, medical literature) reported between 2008 and 2014. An expert panel determined the relationship between exposure and adverse events, estimated dose ingested, intent of exposure, and identified contributing factors to exposure.. 1716 cases contained ≥1 adverse event deemed at least potentially related to dextromethorphan; 1417 were single product exposures. 773/1417 (55%) involved only one single-ingredient dextromethorphan product (dextromethorphan-only). Among dextromethorphan-only cases, 3% followed ingestion of a therapeutic dose; 78% followed an overdose. 69% involved unsupervised self-administration and 60% occurred in children <4 years old. No deaths or pathologic dysrhythmias occurred. Central nervous system [e.g., ataxia (N = 420)] and autonomic symptoms [e.g., tachycardia (N = 224)] were the most common adverse events. Flushing and/or urticarial rash occurred in 18.1% of patients. Dystonia occurred in 5.4%.. No fatalities were identified in this multifaceted surveillance program following a dextromethorphan-only ingestion. Adverse events were predominantly associated with overdose, most commonly affecting the central nervous and autonomic systems.

Topics: Antitussive Agents; Autonomic Nervous System Diseases; Central Nervous System Diseases; Child; Child, Preschool; Dextromethorphan; Drug Overdose; Female; Humans; Infant; Male; Nonprescription Drugs; Retrospective Studies

An enantioselective CE-based determination of methorphan and its main metabolites in blood is described. Enantiomeric separations were carried out in 50cm×50μm (ID) uncoated fused silica capillaries, using a background electrolyte composed of 150mM sodium phosphate pH 4.4 added with 5mM 2-(hydroxypropyl)-β-cyclodextrin and methanol 20% (v/v), at a constant voltage of 25kV. Sample injections were performed under field amplified sample stacking conditions. Detection was by recording UV absorbance at the wavelength of 200nm. Linearity of response was assessed within a concentration range from 25 to 500ng/mL for dextrometorhan, levomethorphan and their main metabolites (namely dextrorphan and levorphanol, respectively). Folcodine was used as internal standard. Under these conditions, the limit of quantification resulted 25ng/mL for each one of the analytes. The intra-day and inter-day precision, in terms of coefficient of variation (CV) were below 3.7% and 14.9 % for migration times and peak areas, respectively. The present method was successfully applied to the analysis of post-mortem blood samples from ten subjects died for heroin overdoses. Among the samples "positive" for methorphan (n=4), the d-enantiomer was found in concentrations ranging from 214 to 1282ng/mL. The concentration of its main metabolite dextrorphan in the same samples ranged from 49 to 389ng/mL.

Topics: Dextromethorphan; Drug Overdose; Electrophoresis, Capillary; Heroin; Humans; Limit of Detection; Linear Models; Reproducibility of Results; Stereoisomerism

Topics: Adolescent; Antitussive Agents; Dextromethorphan; Drug Overdose; Humans; Male

Dextromethorphan (DXM) is a derivative of codeine with an antitussive properties. Acute poisonings with this drug are related to serious, often life-threatening clinical symptoms. In the last decade the number of DXM poisonings increased and the problem was particularly noticeable among adolescents. The aim of this study was to analyze selected demographic and clinical parameters of patients who were hospitalized due to DXM poisoning in Pomeranian Centre of Toxicology between 2009-2011. The study included 170 individuals which was 2.7% of all admissions in this period. In 2009 and 2010, the proportion of patients poisoned with DXM did not exceed 1.5%, while in the years 2011- 2013 it tripled and reached up to 3.5%. The age of patients ranged from 12 to 42 (mean 18) years. Women were more frequently hospitalized. The dose of ingested DXM ranged from 150 to 2700 (mean 588.7) mg. The analysis revealed that the dose of ingested DXM was increasing with the age of patients.

Topics: Adolescent; Adult; Age Distribution; Child; Dextromethorphan; Drug Overdose; Female; Hospitalization; Humans; Incidence; Male; Poisoning; Poland; Recreation; Young Adult

Deaths from overdose of acetaminophen (APAP) combination medications are reported, yet the individual ingredients are not well examined as individual putative causes of death.. To examine the individual contribution of APAP or other ingredient(s) to fatalities resulting from ingestion of APAP combination products reported to poison centers.. A search in the United States (US) National Poison Data System between 1 January 2000 and 31 December 2009 (10 years) was conducted. Only fatal cases determined by American Association of Poison Control Centers Fatality Review team to be caused by ingestion of one or more APAP combination products were included. The fatality abstract narrative for each case was obtained. Each narrative abstract was rated independently by four reviewers and putative cause of death was determined to be APAP, 'other ingredient' or 'unable to determine'. Fleiss' Kappa test was utilized to assess interrater agreement.. Three hundred and thirty-seven deaths met inclusion criteria: 204 were due to suicides, 96 were the result of nonmedical use, 3 were from a therapeutic error, 1 resulted from an unsupervised pediatric ingestion, and 33 were due to unknown reason for exposure. The overall putative cause of death was APAP in 60.8%, other ingredients in 29.7%, and unable to determine in 9.5% of fatalities. APAP was responsible for the fatality in 79.2% of deaths resulting from nonmedical use of APAP combination products. Fleiss Kappa was 0.74, indicating substantial interrater agreement.. The most common putative cause of death in fatal overdoses involving APAP combination products reported to US poison centers is the APAP component.

Topics: Acetaminophen; Adolescent; Adult; Aged; Aged, 80 and over; Aspirin; Databases, Factual; Dextromethorphan; Diphenhydramine; Dose-Response Relationship, Drug; Drug Combinations; Drug Overdose; Female; Humans; Male; Middle Aged; Poison Control Centers; Retrospective Studies; United States; Young Adult

The purpose of the present study is to determine the role of lidocaine, caffeine and dextromethorphan, used as adulterant substances, in five cases of drug overdose which have come to our attention. Taking into account the pharmacological mechanism, blood concentration and route of administration (intravenous) we evaluated the hypothesis that these substances could act with a synergistic effect - or at least additive - with the illicit drugs on the central nervous system and cardiovascular system.

Topics: Adult; Anesthetics, Local; Antitussive Agents; Bile; Brain Chemistry; Caffeine; Central Nervous System Stimulants; Citalopram; Codeine; Dextromethorphan; Drug Contamination; Drug Overdose; Drug Users; Female; Forensic Pathology; Forensic Toxicology; Gastrointestinal Contents; Humans; Illicit Drugs; Kidney; Lidocaine; Liver; Lung; Male; Methadone; Morphine; Morphine Derivatives; Narcotics; Pyrrolidines; Selective Serotonin Reuptake Inhibitors; Substance-Related Disorders; Vitreous Body

Topics: Adult; Antitussive Agents; Dextromethorphan; Drug Overdose; Humans; Long QT Syndrome; Male

Topics: Adolescent; Antitussive Agents; Dextromethorphan; Diagnosis, Differential; Drug Overdose; Female; Fluid Therapy; Humans; Male; Substance-Related Disorders; Young Adult

Topics: Acetaminophen; Adolescent; Child; Dextromethorphan; Drug Overdose; Female; Humans; Illicit Drugs; Liver; Male; Substance-Related Disorders; Tablets

Each year consumers purchase about 95 million units of over-the-counter medications for pediatric use, an unsafe application that can cause life-threatening effects. Despite a warning from the Food and Drug Administration, many parents or caregivers continue to administer these remedies to children. This report describes the case of a 4-month-old infant presenting to the emergency department with acute life-threatening intoxication including altered mental status, impaired coordination of movements, as well as a positive urine drug test for phencyclidine and an elevated serum ethanol level. Further evaluation uncovered that the actual reason for all clinical symptoms and laboratory test results was over-the-counter cough syrup.

Topics: Cough; Dextromethorphan; Drug Overdose; Humans; Infant; Male; Nonprescription Drugs

We report the first case of serotonin syndrome caused by overdose of dextromethorphan in Japan. A 34-year-old woman with schizophrenia received a dextromethorphan (Medicon) for a catarrhal symptom from two individual departments of the university hospital by chance. The daily amount of dextromethorphan was up to 180 mg for several days in addition to other regular antipsychotic drugs including risperidone, amitriptyline and levomepromazine. Finally, she was found in deep comatose state (GCS coma scale: E1V1M1) and the trachea was intubated in the emergency room. After admission to intensive care unit, the consciousness gradually improved; however, she was confused and agitated. The situation was normalized within next 24 hours and she was weaned from the mechanical ventilation next day. Serotonin syndrome demonstrates various signs and might be overlooked in an emergency room. Dextromethorphan is considered as a safe antitussive drug; however, the unexpected interaction should be suspected during chronic medical treatment.

Topics: Adult; Antipsychotic Agents; Antitussive Agents; Dextromethorphan; Drug Interactions; Drug Overdose; Excitatory Amino Acid Antagonists; Female; Humans; Serotonin Syndrome

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

Dextromethorphan (DXM) is a common component of combination cold medications that has become a popular drug of abuse for young adults. Abusers of DXM have developed a simple acid-base extraction technique to "free-base," or extract, the DXM from the unwanted guaifenesin, coloring agents, sweeteners, and alcohol that are typically included in combination cold preparations. We report a case of DXM overdose after ingestion of this purified "Crystal Dex" and discuss the "Agent Lemon" and single-phase extraction techniques that are used to free-base the dextromethorphan.

Topics: Adult; Antitussive Agents; Chemical Fractionation; Dextromethorphan; Drug Overdose; Guaifenesin; Humans; Male; Solvents; Substance-Related Disorders

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antitussive Agents; Child, Preschool; Dextromethorphan; Diagnosis, Differential; Dipyrone; Drug Overdose; False Positive Reactions; Female; Humans; Ibuprofen; Immunoassay; Infant, Newborn; Male; Phencyclidine; Seizures

An 18-year-old male developed a severe serotonin syndrome after recreational ingestion of Coricidin HBP (chlorpheniramine 4 mg and dextromethorphan hydrobromide 30 mg). Propofol infusion rapidly normalized his agitation, neuromuscular hyperactivity, and autonomic instability. Confirmatory analysis demonstrated a dextromethorphan serum concentration of 930 ng/mL. Dextromethorphan can produce serotonin syndrome in the absence of another serotonergic drug.

Topics: Acetaminophen; Adolescent; Algorithms; Chlorpheniramine; Dextromethorphan; Drug Combinations; Drug Overdose; Humans; Hypnotics and Sedatives; Infusions, Intravenous; Male; Phenylpropanolamine; Propofol; Serotonin Syndrome; Substance-Related Disorders

Drug testing plays an important role in the provision of information to health authorities on trends in drug abuse. In the Republic of Korea, the testing of urine and postmortem specimens has been used as part of a programme to monitor and control the abuse of non-controlled drugs, i.e., substances that were not originally included in the lists of controlled substances in that country. Zipeprol, dextromethorphan, carisoprodol and nalbuphine are examples of such drugs, which are widely used as medicines. Increasing levels of abuse of these drugs, including abuse that resulted in fatalities, were confirmed in the Republic of Korea by the results of drug testing. Based on the accumulated data from postmortem specimens, the health authorities in the Republic of Korea subsequently introduced controls on these drugs. A significant drop in fatalities related to the abuse of these non-controlled drugs underlined the importance of timely action for improving community health. In the context of drug testing, the analysis of non-controlled and new drugs always presents a scientific challenge, because specific analytical methods for testing for those drugs are not available. In the Republic of Korea, as part of the drug abuse warning programme, it was necessary to establish methods for the detection and quantification in biological fluids of all four non-controlled drugs and their metabolites in order to monitor the trends in drug abuse. The present paper puts forward epidemiological and clinical data on abuse and fatalities associated with zipeprol, dextromethorphan, carisoprodol and nalbuphine, as well as details of the analytical methods developed.

Topics: Adolescent; Adult; Autopsy; Body Fluids; Carisoprodol; Child; Cross-Cultural Comparison; Dextromethorphan; Drug and Narcotic Control; Drug Interactions; Drug Overdose; Female; Humans; Illicit Drugs; Korea; Male; Middle Aged; Nalbuphine; Piperazines; Population Surveillance; Prescription Drugs; Substance Abuse Detection; Substance-Related Disorders; Suicide; Young Adult

Topics: Acetaminophen; Adolescent; Chlorpheniramine; Delirium; Dextromethorphan; Drug Combinations; Drug Overdose; Female; Hallucinations; Humans; Nystagmus, Pathologic; Phenylpropanolamine

Dextromethorphan is an opiod-derived, easily available cough remedy that, when used in large quantities, can have stimulatory effects which mimic that of amphetamine and other psychedelic drugs. Due to its easy availability, dextromethorphan is gaining widespread popularity as a recreational drug among Thai youths. Symptoms of overdose are directly related to its pharmacodynamic and pharmacokinetic properties. Dextromethorphan is metabolized by cytochrome p450 2D6, an isoenzyme that exhibit polymorphism in Asians. The drug is also a serotonin-reuptake inhibitor and has significant interactions with other drugs that exert their effects through the serotonin pathway such as the amphetamines, cocaine, and Lysergic Acid (LSD).. We report here two cases of dextromethorphan overdose that presented to the Pediatric Toxicology Service at Siriraj Hospital, Bangkok, Thailand. Both cases presented with hyper-agitation, confusion, with signs of sympathomimetic overdose. Both patients were treated with supportive care and fully recovered within 24 hours without sequalae.. Although the acute toxicity of dextromethorphan is abated within 24 hours, its pharmacological properties still render it a dangerous drug to use alone or in combination with other drugs.

Topics: Adolescent; Analgesics, Opioid; Child; Dextromethorphan; Drug Overdose; Female; Humans; Substance-Related Disorders; Thailand

Topics: Adolescent; Analgesics, Opioid; Child; Dextromethorphan; Diagnosis, Differential; Drug Overdose; Emergency Medical Technicians; Emergency Treatment; Humans; Substance-Related Disorders; United States

Topics: Acetaminophen; Chlorpheniramine; Dextromethorphan; Drug Combinations; Drug Overdose; Excitatory Amino Acid Antagonists; Humans; N-Methylaspartate; Nonprescription Drugs; Phenylpropanolamine; Receptors, N-Methyl-D-Aspartate; Substance-Related Disorders

A 30-year old woman was presented to the emergency room with marked lethargy and fever. Her physical examination showed an acneiform eruption on the face. Blood biochemistry showed a high chloride level and a negative anion gap. High blood bromide level measurements on an ion-selective electrode was noted later to cause spurious hyperchloremia with a negative anion gap. After receiving saline hydration and diuretic treatment, her serum chloride returned to normal range on hospital day nine. Slow resolution of her mental status occurred over 2 months. Her skin lesions disappeared about 5 months later. In conclusion, in face of an unusual high chloride level and a negative anion gap in a patient of long-term use of over-the-counter (OTC) agents, bromide intoxication should be included in the differential diagnosis.

Topics: Adult; Bromine; Bromisovalum; Dextromethorphan; Drug Overdose; Female; Humans; Male; Nonprescription Drugs; Poisoning; Self Medication

CoricidinHBP (Schering-Plough Health Care Products, Inc, Memphis, TN) is a popular over-the-counter product abused by teenagers for its potent euphoric properties. Clinically significant signs and symptoms after ingestion are usually short-lived and commonly include tachycardia, hypertension, somnolence, and agitation. We report 2 cases of severe toxicity from CoricidinHBP in adolescents that required prolonged hospitalization. The first case demonstrates prolonged anticholinergic complications from a suicidal attempt with CoricidinHBP. The second case demonstrates significant acetaminophen-induced hepatotoxicty from recreational use of CoricidinHBP Maximum Strength Flu. Adolescent abuse of these products is encouraged because of the easily accessible medium of the Internet. The significant morbidity seen in our cases clearly demonstrates the need for vigilance by health care professionals regarding the abuse of over-the-counter products.

Topics: Acetaminophen; Adolescent; Antidepressive Agents; Chemical and Drug Induced Liver Injury; Chlorpheniramine; Depression; Dextromethorphan; Drug Combinations; Drug Overdose; Emergency Medical Services; Female; Humans; Nonprescription Drugs; Phenylpropanolamine; Substance-Related Disorders

Topics: Adult; Antitussive Agents; Cytochrome P-450 Enzyme Inhibitors; Depressive Disorder, Major; Dextromethorphan; Drug Overdose; Female; Fluoxetine; Humans; Lorazepam; Metabolic Clearance Rate; Suicide, Attempted

Coricidin products seemed to be one of the over-the-counter medications being reportedly abused by adolescents, as observed from the Texas Poison Center Network data. This retrospective chart review investigated the occurrence of abuse, developed a patient profile, and defined the clinical effects resulting from the abuse of Coricidin products. Data collected from the Texas Poison Center Network Toxic Exposure Surveillance System database included human exposures between 1998 and 1999, patients > or = 10y old, intentional use or abuse, and single substance ingestion of I of the tablet formulations of Coricidin. Thirty-three cases from 1998 and 59 cases from 1999 were reviewed. Of these cases, 85% met the inclusion criteria. Of the 7 medications searched, only 4 substances were coded for: Coricidin D, Coricidin D (long acting), Coricidin D (cold, flu & sinus) and Coriciding HBP. These contain a combination of dextromethorphan hydrobromide, chlorpheniramine maleate, phenylpropanolamine hydrochloride, and acetaminophen. Of the 78 cases, 63% were male and 38% were female. The mean age was 14.67 years, 77% being between 13 to 17 years old. Eighteen different symptoms were reported: tachycardia 50%, somnolence 24.4%, mydriasis and hypertension 16.7%, agitation 12.8%, disorientation 10.3%, slurred speech 9%, ataxia 6.4%, vomiting 5.1%, dry mouth and hallucinations 3.9%, tremor 2.6%, and headache, dizziness, syncope, seizure, chest pain, and nystagmus each 1.3%; 12.8% of the calls originated from the school nurse. The incidence of abuse reported increased 60% from 1998 to 1999. This worrisome trend suggests increased abuse of these products.

Topics: Acetaminophen; Adolescent; Adolescent Behavior; Age Factors; Antitussive Agents; Child; Chlorpheniramine; Databases, Factual; Dextromethorphan; Drug Combinations; Drug Overdose; Female; Humans; Incidence; Male; Medical Records; Nonprescription Drugs; Phenylpropanolamine; Population Surveillance; Retrospective Studies; Texas

Topics: Adolescent; Adult; Dextromethorphan; Drug Overdose; Female; Humans; Korea; Male; Methamphetamine; Piperazines; Substance-Related Disorders

The abuse of zipeprol, an antitussive agent, was found to be most prevalent among young people in Korea. Because abusers take large doses of this drug for its hallucinogenic effects, fatalities from zipeprol overdose abuse have been on the rise since 1991. Since 1991, a total of 69 zipeprol-related deaths have occurred throughout the nation. A demographic study shows that in ninety six percent of cases involving ziperol alone, the victims were in their teens and twenties. The male/female ratio in zipeprol related death was 3.5:1. Most of these zipeprol-associated deaths occurred in the larger cities of Seoul and Inchon. The blood concentration of zipeprol ranged from 0.8 to 38.3 micrograms/mL in single drug involved deaths, while zipeprol varied from 0.1 to 35.3 micrograms/mL in zipeprol and dextromethorphan victims.

Topics: Adolescent; Adult; Age Factors; Antitussive Agents; Calibration; Chromatography, Gas; Dextromethorphan; Drug Overdose; Female; Humans; Indicators and Reagents; Korea; Male; Piperazines; Sex Factors; Substance-Related Disorders

Topics: Acute Disease; Child, Preschool; Dextromethorphan; Drug Overdose; Humans; Male; Psychomotor Disorders

Topics: Adult; Central Nervous System; Clomipramine; Depressive Disorder; Dextromethorphan; Drug Interactions; Drug Overdose; Emergencies; Female; Humans; Phenelzine; Serotonin; Syndrome

A case of fatal self-poisoning with dextromethorphan, an antitussive, and terfanadine, an antihistamine H1, is reported. Both drugs were quantified in several postmortem tissues and fluids using capillary gas chromatography coupled to mass spectrometry. Results are discussed in the light of the existing literature.

Topics: Adult; Dextromethorphan; Drug Overdose; Female; Humans; Liver; Terfenadine

Dextromethorphan-containing cold/cough preparations are frequently prescribed and bought over the counter for use in children. Although generally considered safe, dextromethorphan has been shown to cause CNS side effects, including hyperexcitability, increased muscle tone, and ataxia. Two deaths have been reported with intentional dextromethorphan overdose. A literature review, brief review of pharmacology, and report of two cases of adverse reactions to dextromethorphan-containing preparations are presented.

Topics: Child, Preschool; Cough; Dextromethorphan; Drug Overdose; Emergency Service, Hospital; Female; Humans; Infant, Newborn; Male; Naloxone