From: [d x m] at [froggy.frognet.net] (Max Tussin) Newsgroups: rec.drugs.psychedelic,alt.drugs Subject: Dextromethorphan FAQ Part 02/06 Date: 7 Apr 1996 23:25:37 -0400 Keywords: DXM DM Robitussin Tussin Dextromethorphan Sigma NMDA P450 X-URL: http://www.frognet.net/dxm/dxm.html It is most commonly available in cough syrups, though some syrups contain other ingredients which can make you sick (or dead) if you take too much of them. It is also available in gelcaps and in some places in capsules. DXM can also be extracted from cough medicines, and the extract can be taken orally, injected subcutaneously, intraperitoneally, intramuscuarly, or intravenously. It can probably also be snorted or used rectally (though why one would want to I don't know). Smoking doesn't seem very effective. Some drugstores keep track of people who frequently buy DXM-containing cough preparations, especially if they buy multiple bottles at once or tend not to buy other things at the same time. This is less common in larger supermarket/drug stores. In some cities where DXM use has become popular (and come to public attention), sales have been restricted to adults. In Utah in the 1980's, DXM was placed behind the counter due to recreational use. .............................................................................. Drinking Cough Syrup DXM is widely available in cough syrups, both brand-name (such as Robitussin[tm] or Vicks Formula 44[tm]) and store brands. Most DXM- containing cough syrups also contain one or more of the following other active ingredients: nasal decongestants, antihistamines, acetaminophen, or guaifenesin (see Section 2.7). As a rule, you want to avoid all of them. Generally speaking, DXM cough syrups all taste nasty. This is for two reasons: to cover up the (even nastier) taste of DXM itself, and to prevent recreational use. The generics tend to be less thick, and thus more drinkable, than the brand names. Some people prefer to mix the DXM with sodas; others find this only makes an already unpleasant task even more unpleasant. Your Mileage May Vary. Most people who have used DXM cough syrups recreationally seem to prefer to take it on a mostly empty stomach, possibly with crackers or some other source of carbohydrates. I generally feel that you should avoid slamming your kidneys and pancreas with a lot of glucose at once; thus I think some crackers or chips beforehand would be advisable. Greasy food should be avoided both before and after taking DXM. Most people report that if carbonated drinks are ingested, they should be clear (e.g., 7-Up[tm]). .............................................................................. Gelcaps and Capsules There are "gelcaps" (liquid or gel filled capsules) available that contain DXM, but they tend to be brand-name only. One brand containing only DXM is Drixoral Cough Liquid Caps[tm]. They come in boxes of 10 or 20 gel capsules, each containing 30mg of DXM. The gel capsule itself is red colored; the liquid inside is actually clear (and tastes very, very bad). The capsules are somewhat large, and difficult if not impossible to take without liquid to wash them down. This brand also comes with a $0.50 or $1.00 manufacturer's coupon inside, which some have taken to calling Drixoral[tm] Dollars (after Camel Bucks[tm], a fake currency coupon in Camel[tm] cigarettes which could be collected and "spent" on various stuff). Note that Drixoral also makes several other liquid and capsule products, all of which contain undesirable active ingredients besides DXM. Absorption from the gelcaps takes some time, and can be sped up by cracking open each gelcap in your mouth before it is swallowed. Note, however, that the liquid inside is apt to spurt out, and it tastes bad. Really, really bad - sour and bitter and cloying all at once with a stickiness that won't go away. However, if you can stand it, you can become used to it after the first few gelcaps. You can also crack open the gelcaps and try to collect the liquid, but it tends to go everywhere. Contac CoughCaps[tm] are available in Canada, and are capsule formula- tions of DXM. I have not personally seen them. In several countries, there are over-the-counter tablet or capsule DXM pills containing 30mg per tablet/capsule; one example is Romilar[tm]. Thus far I know they are available in some areas of southeast Asia and in Saudi Arabia. .............................................................................. Pharmaceutical and Chemical Suppliers DXM is not scheduled in the USA (or most other parts of the world), and consequently should be available via pharmaceutical chemical suppliers. For example, Sigma Chemical Company (1-800-325-3010) lists DXM hydrobromide (product D2531) for US $18.20 for 5 grams, US $128.45 for 50 grams. Note that I have no affiliation with Sigma in any way; I just happened to have a copy of their catalog handy when writing this. In theory, it would be fantastically cheap and easy to order DXM this way; in practice, it's possibly difficult, and probably a Very Bad Idea. First off, most chemical companies are wary about selling to individuals (and if you're not a legal adult, forget it). Secondly, there's a significant chance that your order will be reported to the DEA, and although it's not technically illegal, if enough people do this, that may change very quickly. Still, though, if you have the courage or stupidity to try, there's no reason why this shouldn't be a reasonable source. Just use your head. And don't mention the FAQ. .............................................................................. Extracted DXM Ingestion DXM can be extracted (see Section 7.1 and 7.2) and the extracted DXM can be taken orally, either as free base or as salt (the free base should convert to the hydrochloride salt in your stomach). The salt usually available is hydrobromide, but I see no reason why hydro- chloride, or even acetate or citrate, cannot be used. The free base tends to be somewhat alkaline and should be avoided unless combined with food and/or juice (or other acidic beverage). When taken on a mostly empty stomach, the extract is generally absorbed faster than cough syrups, gelcaps, or capsules. Some extraction processes may convert some or all of the DXM into dextrorphan (DXO). Extracted DXM, unlike cough syrups and gelcaps, has no bromide toxicity (see Section 2.7). .............................................................................. Injection and Other Routes DXM hydrobromide is soluble in saline, and I see no reason why other acid salts shouldn't be - though their long-term stability may be doubtful. However, injection is a very dangerous route, especially if the substance in question is not prepared specifically to be injected. Some of the potential risks include: sterile abscesses, torn or collapsed veins, bruising, muscle fiber damage, histamine release, infection (hepatitis B, HIV, etc.), embolism (and possible resulting stroke or cardiac arrest), increased chance of addiction, overdose, and people mistaking you for a junky. True, most of these are unlikely, and if done correctly injection is generally very safe. However, the key word is correctly. If you're still interested, consult a medical text; I'm not going to teach you how to shoot up. A few notes for those brave or stupid enough to still be interested. Intravenous (IV) and intramuscular (IM) injection both seem to produce similar results in animals, and IM injection is almost always safer. DXM can also be injected intraperitoneally (IP), but that evidently requires some skill. Subcutaneous (SC) injection ("skin popping") leads to slower absorption and a great increase in the amount of DXM relative to DXO. All injected drugs should be completely pure, dissolved in the appropriate physiological saline. In the case of SC (and possibly IM) injection, injecting too large a volume of material can lead to a sterile abscess. DXM can also theoretically be snorted, although I don't generally think this is a very smart route; the nasal lining is very tender. DXM free base is probably too alkaline to try this with. It can also probably be used rectally, but somehow the thought of a cough syrup enema doesn't thrill me. Smoking DXM free base has been attempted several times by various people without success. It seems that some of the DXM is destroyed by the heat, and the remaining DXM is extremely harsh on the lungs. Too bad, really, since self-titration is usually easiest with smoking. ------------------------------------------------------------------------------ [2.6] What are some typical DXM-containing commercial preparations? Rather than listing the content of commercial DXM preparations (I gave up since there are so many!), I have decided to list brands and generic equivalents which contain only DXM. All expressions are in metric. 1tsp is approx. 5ml; a 4oz bottle is approx. 120ml, and an 8oz bottle approx. 240ml. All preparations listed contain no other active ingredients besides DXM. 1mg/ml DXM (120mg per 4oz bottle) Vicks Pediatric Formula 44[tm] (Richardson-Vicks). I am not aware of any generic equivalents. Very low DXM content. 1.5mg/ml DXM (180mg per 4oz bottle) Robitussin Pediatric Cough[tm]. Some generic / store-brand equivalents. Most pediatric DXM-only cough preparations run in this range; again a very low DXM content. 2mg/ml DXM (240mg per 4oz bottle) Benylin Cough Syrup[tm]. Note: Benylin DM[tm] should be avoided due to inactive ingredients which cause severe diarrhea. Some generic / store-brand equivalents. Not terribly common in comparison to 3mg/ml brands. Several DXM plus guaifenesin products (e.g., Robitussin DM[tm]) are 2mg/ml. Guaifenesin in high doses tends to induce vomiting. 3mg/ml DXM (360mg per 4oz bottle) Vicks Formula 44[tm], and generic equivalents. Make sure to avoid other formulae, such as Vicks Formula 44D[tm]. Robitussin Maximum Strength Cough[tm], and generics. Avoid Robitussin Maximum Strength Cough and Cold[tm] which has other ingredients. 15mg/capsule or tablet Evidently, Romilar[tm] is available in 15mg tablets or capsules. I have not personally seen them. 30mg/capsule or tablet Drixoral Cough Liquid Caps[tm] and generics (there aren't many). These are available in packages of 10 or 20 capsules (300mg or 600mg total DXM content per package). Contac CoughCaps[tm], available in Canada. Romilar[tm], available in some areas of the world (and possibly by prescription elsewhere). Also available in 15mg/tablet. ------------------------------------------------------------------------------ [2.7] What should I know about other drug ingredients? There are five main classes of active ingredients that are present in OTC DXM-containing products: decongestants, antihistamines, guaifenesin, analgesics, and alcohol. Each will be discussed in turn, followed by "inactive" ingredients. With the exception of alcohol, all should be avoided, although for differing reasons. Additionally, some of the dyes and other "inactive" ingredients may cause some people trouble. .............................................................................. Decongestants There are three nasal decongestants that are used in OTC cough formulas in the USA: PPA, pseudoephedrine, and phenyleprine (the latter is almost always found with antihistamines). PPA is also known as phenylpropanolamine (from which the acronym PPA is derived), norephedrine, and the IUPAC name [alpha-(1-aminoethyl)benzyl alcohol]. Pseudoephedrine, known as the brand name Sudafed[tm], has the IUPAC name [(+)alpha-(1-methylamino)benzyl alcohol]. Phenyleprine is [(-)-3-hydroxy-alpha-(methylaminomethyl)benzyl alcohol] (1-2). These decongestants belong to a class of chemicals known as the phenethylamines; this class also includes methamphetamine, MDMA (ecstasy), MDA, etc., and tend to be DEA scheduled. Decongestants are not scheduled by the DEA (this is USA laws) because they do not have significant psychostimulant activity. Ephedrine, which is similar to pseudoephedrine, and is (or was, depending on your state) available throughout truck stops and mail-order pharmaceutical companies in the USA, does have mild stimulant properties; thus its popularity as a form of "legal speed". All of these drugs stimulate the sympathetic nervous system (the "fight or flight" system) and are thus called sympathomimetics. What nasal decongestants do share with the more potent amphetamines is the peripheral activity common to sympathomimetics, such as vaso- constriction (constriction of blood vessels) and decreased nasal secretions (the good side), and - with larger doses - insomnia, hypertension, heart rhythm abnormalities, hemorrhaging, stroke, or death (the bad side) (8). Note that these are extreme reactions, and that individual tolerance to sympathomimetics tends to vary considerably. Tolerance can build quickly, and a fatal dose for one person may have only a mild effect on another person. Because of the potential danger of hypertension, exceeding the recommended dose of DXM and decongestant containing preparations may be asking for trouble. Most people can probably handle it in smaller recreational doses, but the peripheral "speediness" can be distinctly unpleasant. Anyone with high blood pressure or the like has no business taking large quantities of decongestants. Try to avoid these drugs. .............................................................................. Antihistamines The antihistamines operate by blocking histamine receptors (see Section 6 for an explanation of receptors). Peripherally, this has the effect of reducing the symptoms of histamine activity (stuffy and runny nose, itchy eyes, hives, rashes, etc.) associated with infections and allergies. In the CNS, histamine is partially responsible for wakefulness, and antihistamines that cross the blood-brain barrier will cause sleepiness. In fact, most OTC "sleeping pills" in the USA are really just antihistamines (although melatonin is making inroads as an alternative). There are antihistamines that do not cross the blood- brain barrier (e.g., Seldane[tm]) but these are prescription in the USA. High doses of antihistamines can result in dizziness, impairment of concentration, extreme sedation (or, paradoxically, insomnia), headache, heart palpitations, dry mouth, gastric discomfort, delusions, and abnormally high blood pressure. Doses of 30-60mg/kg have been fatal in very young children; most adults, however, are very unlikely to overdose on antihistamines. Death, when it does occur, is from cardiovascular collapse or respiratory arrest (8). High doses of prescription antihistamines are much more dangerous; do not mix DXM with prescription antihistamines! The danger of an antihistamine overdose is very low when using a DXM-containing product recreationally. However, you will most likely experience some unpleasant symptoms, such as sleepiness, dry mouth, heart palpitations, etc. For this reason, I recommend against products containing antihistamines. .............................................................................. Guaifenesin Guaifenesin (gwye-FEN-a-sin) [3-(2-methoxyphenoxy)-1,2-propanediol] is an expectorant; it increases the production of respiratory tract fluids, thus making phlegm less viscous and easier to cough up. Guaifenesin has been shown effective as an expectorant, but is of no use as a cough suppressant. It is often combined with dextrometh- orphan. Guaifenesin should not be used for chronic coughs or coughs accompanied by excessive phlegm (1-2). High doses of guaifenesin tend to induce emesis (i.e., you puke). Other effects from high guaifenesin doses are not well known, but probably not serious. However, as most people do not enjoy vomiting, I would recommend avoiding guaifenesin-containing products. .............................................................................. Analgesics Acetaminophen (called paracetamol in the UK) is the most common analgesic (painkiller) present in cough suppressant formulas. It is closely related to the NSAIDs (non-steroidal anti-inflammatory drugs) of which aspirin and ibuprofen are the two most common examples. Unlike the OTC NSAIDs, however, acetaminophen/paracetamol does not tend to irritate the stomach, and thus its inclusion in cough syrups. An acetaminophen overdose is VERY DANGEROUS. Normally, acetaminophen is metabolized (broken down) in the body by two separate pathways, both of which lead to harmless metabolites. However, these two pathways can only metabolize so much before saturating. At that point, the remaining acetaminophen is metabolized by a cytochrome P450 liver enzyme. The metabolite via the P450 pathway is toxic to the liver (2,8). Furthermore, this doesn't happen right away; it can take 16 hours before any signs of liver damage show up. This delayed toxic effect has been responsible for the rather painful deaths of some people who (accidentally or not) overdose on acetaminophen, and then think they are fine when no immediate problems occur. There is an antidote (acetylcystine), but it must be administered within the first 12 to 16 hours. The toxic dose of acetaminophen can be as low as 50mg/kg; for a 60kg person this is only six acetaminophen tablets. This is unlikely but possible. DO NOT UNDER ANY CIRCUMSTANCES USE RECREATIONALLY ANY DXM PRODUCT WHICH ALSO CONTAINS ACETAMINOPHEN / PARACETAMOL! As for aspirin and ibuprofen, the other two most common OTC pain- killers, both tend to irritate the stomach at high doses. I recommend against them, especially if you have an irritable stomach. Never take large doses of aspirin or ibuprofen if you have an ulcer. .............................................................................. Alcohol Most cough syrups contain some alcohol, to act as a carrier and to numb the throat. With a few exceptions (such as Nyquil[tm]), the amount of alcohol is not usually very great. While alcohol does not, in general, mix well with DXM as a recreational drug, the amount in cough syrups should not cause trouble unless you are specifically sensitive to, or attempting to avoid, alcohol. There are alcohol- free preparations available; many gelcaps are alcohol-free. .............................................................................. Food Coloring / Dyes Some of the dyes used in cough formulas may give some people allergic reactions. Most notable among these is tartrazine (FD&C Yellow #5). Generally, these dyes are not a problem unless you take a lot of them (which recreational DXM use may involve). If you think you may be allergic to a dye, switch to a different brand (or more accurately, a different color). It is also a good idea to keep an antihistamine (not a prescription or non-drowsy one!) nearby in case an allergic reaction does occur. .............................................................................. Bromide Ions DXM is usually ingested as a hydrobromide salt. Large amounts of bromide ions can cause sedation and eventually lead to bromism (bromide poisoning), which affects (among other things) the skin and nervous system. I don't think this is terribly relevant for users of DXM (recreational or not); however it is one more reason to avoid prolonged high-dose use. You can avoid bromide ions by converting the DXM to free base and/or hydrochloride salt (see Section 7.6). Some physicians do believe that prolonged heavy use of DXM may lead to bromism (147). .............................................................................. Other "Inactive" Ingredients Cough syrups tend to contain several thickening and sweetening agents. Glucose, sucrose, invert sugar, and fructose are all commonly used as sweetening agents. Obviously, a person with blood sugar problems (diabetes or hypoglycemia) should not take large amounts of these syrups. Thickening agents are not usually a problem. Occasionally people will look on cough syrup labels and see propylene glycol or polyethylene glycol, and (thinking about ethylene glycol, i.e., antifreeze) worry about toxicity. Propylene glycol (a thickening and emulsifying agent) is not toxic, even though ethylene glycol is. The same goes for polyethylene glycol (PEG) - it's also nontoxic. About the worst you will get from any of these is an upset stomach. One general note - keep in mind that your body does eventually have to use or excrete whatever you eat and drink. Drinking huge amounts of sugars and thickening agents can put a fair amount of load on the kidneys, and should definitely be avoided if you have kidney problems already. There is anecdotal evidence that regular high-dose use of DXM cough syrups (without eating much) has led to kidney damage due to the glucose load. I cannot confirm this but I can't disprove it either. ------------------------------------------------------------------------------ [2.8] Why are so many DXM preparations in liquid form? Cough preparations are in liquid form for two reasons. First and foremost, most people have the (mistaken) belief that in order for a cough suppressant formula to work, it must coat the throat. This is complete bunk. If consumers were a bit smarter, we wouldn't have to gag down cough syrup. There are, in fact, gel-capsule cough suppressants on the market, and I expect that tablet or capsule dextromethorphan will eventually be common. Second, tablet-form DXM preparations have been kept from the market in an attempt to prevent their recreational use. ------------------------------------------------------------------------------ [2.9] Is recreational use of DXM illegal? Possibly. There may be laws making it a crime to use OTC medicines in any way other than directed on the label. Not that this stops people from using ephedrine (a bronchodilator) as a stimulant. Nor are you likely to get caught and/or prosecuted; the authorities are much too busy infringing upon our civil rights looking for the illegal drugs. But, remember - I SPECIFICALLY instruct you NOT to use any medicine in a manner inconsistent with its labeling. Furthermore, suggesting to someone that they use DXM as a recreational drug could also be violating a law - against prescribing drugs as a layperson. Again, it's not likely to happen, but it is possible. DXM is a prescription drug in Sweden (9). It is prescription and scheduled in western Australia unless combined with other active ingredients. It may become prescription in other countries. In drug stores in some areas it is kept behind the counter, and must be requested. ------------------------------------------------------------------------------ [2.10] Other (medical) uses for DXM Dextromethorphan is commonly used to determine cytochrome P450-2D6 activity (10-11). Cytochrome P450-2D6, or debrisoquine 4-hydroxylase, is a liver enzyme which converts DXM into dextrorphan, and is extensively involved in the metabolism of other drugs. About 5-10% of Caucasians seem to lack P450-2D6 entirely (12-15); in the remaining individuals, its activity can vary significantly due to minor genetic variance (15-18). By looking at the metabolites of DXM, a physician can determine P450-2D6 efficiency, and adjust drug dosage to match. One area in which DXM (as well as other NMDA blockers; see 5.3 - NMDA Receptors) shows great promise is in the prevention of brain damage resulting from excitotoxicity (over-stimulation of nerve cells to the point of cell death) and other types of nerve cell damage (19). DXM may reduce or eliminate the brain damage resulting from conditions such as fever, hypoxia (lack of oxygen) (20), ischemia (cutoff of blood to brain cells) (21-22), physical injury (23), infection (such as poliomyelitis, encephalitis, and meningitis), stroke, seizure, drug toxicity (24-25), and withdrawal from long-term dependence upon certain drugs (notably alcohol, barbiturates, and benzodiazepines such as Valium[tm]) (26-29). In the case of infection (and in particular poliomyelitis), it has been demonstrated that the damage to the CNS often occurs not from the infection, but from the body's own defenses, and notably from a chemical called quinolinic acid (a metabolite of tryptophan) (30,31). Quinolinic acid is a very potent agonist (activator) at excitatory amino acid receptors, of which NMDA is one type; DXM prevents quinolinic acid from activating NMDA receptors. (Incidentally, the function of quinolinic acid - if it has any - is not currently known; it may be involved in the immune response). As for physical trauma, hypoxia, seizure, stroke, etc., there are several experiments which indicate that the majority of the damage again comes from excitotoxicity at excitatory amino acid receptors. While DXM has shown somewhat less success there (possibly due to other factors being involved), it still has potential. DXM is currently being evaluated as an anticonvulsant (32,33). The animal data are somewhat conflicting, but the most accurate model of epileptic seizures (called kindling) responds well to DXM. Preliminary studies in humans indicates that even very low levels of DXM may help prevent seizures. This effect is not, as was originally thought, due to NMDA receptors; instead, it is probably due to sigma receptors or voltage-gated ion channels (32). Interestingly, DXM produces different side-effects in kindled (seizure-susceptible) animals than in non-kindled animals (this may be due to uncoupling of NMDA receptors). It is possible that humans susceptible to seizure may experience different effects from recreational DXM use. Another new area where DXM has potential is in combating the withdrawal symptoms of opiate addiction. DXM plus diazepam (Valium[tm]) was more effective at combating the symptoms of heroin withdrawal (goose flesh, tremors, dilated pupils, joint ache, etc.) than chlorpromazine (Thorazine[tm]) plus diazepam (34). This is most likely due to DXM's ability to block NMDA receptors. A further study (134) verified this, and found that adding tizanidine (an alpha-2 adrenergic agonist) to DXM was better yet. DXM has shown some potential for treating some of the problems associated with mental retardation (35). It may also be of use in treating Parkinson's disease (36). DXM may be useful in conjunction with opiates for alleviation of both acute and chronic pain (37). It may even be useful in fighting lung cancer (38). ------------------------------------------------------------------------------ [2.11] Drug Interactions DXM should not be used (either recreationally or at normal dosage levels) by people who are taking a monoamine oxidase inhibitor (MAOI, rhymes with "wowee") - either a prescription MAOI or a recreational one such as harmaline. Note that there is considerable confusion among drug users about what is and isn't a MAOI. MAOIs include a few drugs prescribed for depression and Parkinson's disease, and a few rare recreational drugs derived from exotic plant sources (harmine and harmaline, from Syrian Rue and Yag, for example). Prozacú, MDMA, cheese, beer, Seldane[tm], etc., are not MAOIs - they are things to avoid when taking a MAOI. If you are taking a prescription MAOI you will almost certainly know, as your physician will have (hopefully!) told you to avoid eating aged cheeses. Combining DXM and a MAOI has been fatal (3). Fluoxetine (Prozac[tm]) is a cytochrome P450-2D6 inhibitor (39), and will change the characteristics of a DXM trip somewhat (increasing the ratio of DXM to DXO). Other P450-2D6 inhibiting drugs will probably do the same; see Appendix 1. The duration of the trip may be greatly extended by P450-2D6 inhibitors; some users have reported effects lasting 12 to 24 hours past the normal duration. The potency of DXM may also be enhanced via other mechanisms by fluoxetine (40). DXM should not be taken (recreationally or at normal dosage levels) with the prescription antihistamine terfenadine (Seldane[tm]). This combination has been fatal (41). Terfenadine has been implicated in other drug interactions, incidentally. The reason for this interaction seems to be that terfenadine, which is normally metabolized by a P450 enzyme, induces heart irregularities when it builds up. DXM may saturate the P450 enzymes that normally metabolize terfenadine. Incidentally, this probably applies to Claritin[tm] and Hismanal[tm] as well; avoid combining them with DXM. Like other psychoactive drugs, DXM should not be used by people who are mentally or emotionally unstable. I tend to believe that NO recreational drug (legal or not) should be used unless the user is in a calm, rational mood, free from anxiety or negative emotions, and is in a controlled setting where s/he will not have to drive. Speaking of which, as DXM is an intoxicating drug, don't drive under the influence. Ever. But I shouldn't have to tell you that, right? High doses of DXM can be very dissociative. While this is not necessarily bad, you should know what you are getting into first. A high-dose DXM trip is not like an LSD trip; it more closely resembles ketamine. You will most likely encounter experiences that you didn't expect, and possibly didn't want. While this is OK for the more committed psychonaut, casual users of hallucinogens might want to think twice before taking a high dose. Prolonged use of DXM, or extended doses of DXM (including the polistirex formulation), may cause problems due to the buildup of DXM (as opposed to DXO), and the resulting activity at sigma receptors (see Section 6). Sigma receptors seem to have a potent modulatory role on neurons, possibly inducing permanent or semi-permanent changes when they are activated for long periods of time (most studies so far indicate over 3 days of high DXM concentrations are required before such changes occur). Furthermore, sigma activity seems to be correlated with delusional thinking, which should probably be avoided, especially in the inexperienced. Some people are allergic to tartrazine (FD&C Yellow #5), which is present in several cough syrups. Sensitivity to tartrazine is rare, but is frequent in people sensitive to aspirin. Avoid tartrazine if you are, or think you might be, allergic to it or to aspirin. Note that, based on anecdotal evidence, I believe that sensitivity to other dyes may develop from chronic use. The large amount of glycerine, glucose syrup, and sugars present in cough syrups can give some people problems ranging from stomach ache to sugar shock. Obviously anyone with diabetes or a family history of blood sugar problems should avoid cough syrups. ------------------------------------------------------------------------------ [2.12] What about other cough suppressants? The only other non-narcotic cough suppressant of which I am aware is a drug called noscapine (42). I have little information on it as of yet; look for more soon. Narcotic cough suppressants include primarily codeine, although any opiate can be used for that purpose (in fact, heroin was originally marketed as a cough suppressant). Opiates have an entirely different set of recreational effects than DXM, however, and are not covered here. ------------------------------------------------------------------------------ [2.13] Can DXM be detected on drug tests? As DXM itself, probably not; nobody bothers to look for it. On the other hand, anecdotal evidence indicates that some people will test positive for opiate use after using recreational DXM(1). Keep this in mind before using DXM if you have to take a drug test. If worse comes to worse, you can always claim you had a bad cold, and ask them to do a test which will discriminate between opiates and DXM. Good luck! ------------ (1) Drug tests aren't particularly good at discriminating between legal and illegal drugs. Nasal decongestants can cause you to test positive for amphetamine use, for example. ============================================================================== [3] THE DXM DRUG EXPERIENCE This section discusses some of the effects you might expect to feel if you were to use DXM recreationally (which, for legal reasons, I recommend against). ------------------------------------------------------------------------------ [3.1] What is the general character of a DXM experience? This is a difficult question to answer, because DXM's effects tend to vary widely depending on the person, their set and setting, other drugs, their physiology, and so on. DXM, probably more than most drugs, tends to exert its (recreational) effects on plateaus, rather than being linearly dose-dependent. Within a given plateau, a given set of effects will occur (at a roughly dose-dependent strength). On the other hand, once the next plateau is reached, the feeling may change entirely. A reasonable analogy is water - it exists in three states (solid, liquid, and gas) which all can exist at varying temperatures (e.g., hot water and cold water), but which have different and characteristics. Importantly, DXM and its metabolite, dextrorphan (DXO), produce different sets of effects. Normally, DXM is converted mostly or entirely into DXO, but with recreational doses, the conversion enzyme (P450-2D6) can saturate, leaving a mixture of DXM and DXO. Furthermore, another of DXM's metabolites - 3-methoxymorphinan - can also block this enzyme, so that taking divided doses leads to more DXM and less DXO than taking a combined dose of the same amount. DXM's effects are in some ways much more subtle than DXO's. Whereas DXO produces a heavy "stoning" or intoxicating effect, DXM is only lightly intoxicating. DXM, however, can alter the thought processes, leading to highly abnormal, psychosis-like mental states. It is possible that DXM, via sigma activation, may induce a mental state similar to that of schizophrenia. Whether or not this is fun to you is, of course, up to you. As to how many plateaus DXM exhibits, this is debatable. I previously listed three; however, some daring (or foolish) individuals have pushed into a qualitatively different level which I call the fourth plateau. Some people will undoubtedly disagree with this classification method, but I think this is the best way to represent DXM's effects. Note that both the third and fourth plateaus have significant dissociative characteristics, much like ketamine. Keep in mind that the effects in different plateaus can be very different. For example, on the first plateau, DXM tends to have a stimulant effect, often quite potent. Upon reaching the second plateau, however, the stimulant effect may no longer be present. The beginning of the end of a DXM trip can come abruptly. Often, the user will know when it's starting to end by noticing the return of normal sensory processing. Coming down from there may take a significant amount of time. The following table can be used as a general guideline for the plateaus. For convenience I give example dosages in gelcaps and 3mg/ml syrup for 75kg and 150lb adults; adjust up or down by the amounts indicated per 10kg or 25lb. Calculating with the mg/kg is more accurate, but it's easy to make mistakes when using non-metric measures. Dosage will vary considerably from person to person, by as much as 5 times! Also, these mg/kg figures should evidently be adjusted down for higher mass (e.g., maybe 6mg/kg to 13mg/kg third plateau for a 150kg adult). Note that kg = pounds * 0.45. o------------------------------------------------------------------------o | Plateau --> | First | Second | Third | Fourth | |================+=============+=============+=============+=============| | Dosage Range | 1.5-2.5 | 2.5-7.5 | 7.5-15 | >15 mg/kg | | (mg/kg) | mg/kg | mg/kg | mg/kg | | |================+=============+=============+=============+=============| | Gelcaps (30mg) | 4 to 6 | 6 to 18 | 18 to 37 | >37 gelcaps | | for 75kg adult | gelcaps | gelcaps | gelcaps | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 1/2 to 1 | 1 to 2.5 | 2.5 to 5 | 5 gelcaps | | 10 kg | gelcap | gelcaps | gelcaps | | |================+=============+=============+=============+=============| | Gelcaps (30mg) | 3 to 5 | 5 to 17 | 17 to 34 | >34 gelcaps | | for 150lb adult| gelcaps | gelcaps | gelcaps | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 1/2 to 1 | 1 to 2.5 | 2.5 to 5.5 | 5.5 gelcaps | | 25 lb | gelcap | gelcaps | gelcaps | | |================+=============+=============+=============+=============| | Syrup (3mg/ml) | 37 to 62 ml | 62 to 187 | 187 to 375 | >375 ml | | for 75kg adult | | ml | ml | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 5 to 8 ml | 8 to 25 ml | 25 to 50 ml | 50 ml | | 10 kg | | | | | |================+=============+=============+=============+=============| | Syrup (3mg/ml) | 2 tbsp to 2 | 2 oz to 5.5 | 5.5oz to 11 | >11oz | | for 150lb adult| oz (.25cup) | oz (2/3cup) | oz (1+1/3c) | | |----------------+-------------+-------------+-------------+-------------| | Adjust per | 1 tsp to | 2 tsp to 1 | 2tbsp to 2 | 2oz | | 25 lb | 2 tsp | oz (1/8cup) | oz (1/4cup) | | o------------------------------------------------------------------------o Table 1: DXM Plateaus and Dosages The specific effects at each plateau will be listed according to the following categories: Sensory, Cognitive, Motor, Memory, and Emotion. ------------------------------------------------------------------------------ [3.2] The First Plateau The first plateau generally occurs around 1.5 to 2.5 mg/kg, but this may vary enormously depending on metabolism and other factors. The first plateau is probably the hardest to hit; many people "overshoot" it. Please keep in mind that these effects listed are general effects, and that individual results may vary considerably. A first plateau trip usually takes between 20 and 40 minutes to start (on an empty stomach), peaks about 1.5 to 2 hours later, and lasts between 4 and 6 hours. Gel capsules take up to 1 hour additional to dissolve. Hangovers are very rare from this plateau, but if they do occur, they tend to consist mainly of lethargy. The primary effects of the first plateau are general euphoria, euphoria specifically linked to music and motion, slight disturbances in balance, moderate stimulation, and very slight intoxication. The intoxication and balance disturbances are similar to that induced by alcohol, but much weaker and without the mental confusion; there is little if any mental sluggishness or confusion with a first plateau trip. Some people have difficulty hitting the first plateau. It can take several trials; as a general guideline, if you notice double vision, you've gone way too far. A lot of the more pleasurable first plateau effects, in particular the music euphoria, are set and setting dependent. Being in good physical condition, avoiding excessive caffeine, and being in a good mood are all important factors in achieving a good first plateau dose. .............................................................................. Sensory Effects Most of the effects of the first plateau relate to the senses. The best known, and probably the most responsible for first plateau use of DXM, is the effect upon hearing (specifically upon music). Sounds may seem "richer" or "deeper", and music in particular is affected (the difference between listening to music on DXM versus sober has been compared to the difference between music in a concert hall versus on a cheap radio). In addition to the change in the nature of hearing itself, music can bring a sense of euphoria, often quite intense. In comparison to the positive effects on music reported by some users of cannabis, the DXM music effect is usually characterized as much "speedier". The type of music with which this effect most strongly occurs will tend to vary from person to person. Rave music is one of the most commonly affected, possibly due to the regular beat (at higher plateaus especially, much of DXM's sensory effects seem beat or rhythm related). Classical and Celtic/folk also seems to be popular. Really, though, the strongest indicator of personal response to a given piece of music seems to be 1) that the user enjoys it, and 2) that it has an "intense" or thematic quality. Visual effects are not particularly strong at this plateau. If present, they usually consist of motion trails (as if afterimages of each "frame" of vision were not clearing quickly enough). There may be some deterioration of stereoscopic vision (and thus depth perception). Colors may seem slightly more vivid. Taste, smell, and touch do not seem to be appreciably affected, although some users have reported that taste and smell are enhanced and mildly euphoria-linked. Others have reported the same effect for touch. Balance and body position sense can be significantly affected, ranging from a mild disturbance (some call it "sea legs") to a near total loss of position and balance sense (generally this only happens on upper plateaus). The changes seem to relate to an anesthesia of the body senses in particular. The effect (like the other sensory DXM effects) can be euphoric; some users like to roll around, do cartwheels, dance, march, whatever. Interestingly, I have not heard any reports of motion sickness (as might be expected if balance sense were blocked). .............................................................................. Cognitive Effects Even though DXM has a slight "stoning" or intoxicating effect on the first plateau, there are surprisingly few deficits of cognitive function. Language is the most strongly affected, although these effects are usually limited to occasional word and syllable repetition (especially in already-repeated syllables, e.g., "banana" to "banananana"), spoonerism (e.g., "share boulders" instead of "bare shoulders"), and difficulty coming up with specific words. Some users report that they feel more creative and capable of non-linear thought on DXM, and this seems to be maximized on the first and second plateaus. Whether this is, in fact, true, or just seems true because of the drug, I have no idea; to my knowledge there are no studies on this. Another cognitive characteristic that occasionally occurs at the first plateau (but more commonly at the second) is that things can seem much more interesting, or at least much less dull and boring, than they usually are. There may be an overall increase in approach-related behavior. Many DXM users report a moderate to strong stimulant effect at the first plateau, which disappears at higher dosages. This seems to be enhanced by caffeine. One user reported being able to stay up for 48 hours by maintaining a first plateau level. (Note that I don't recommend this). Another characteristic of first (and second) plateau trips is a lowering of inhibitions related to conversation. Many people find they can discuss painful or embarrassing topics without difficulty. This is usually described as a very positive effect, and those who have experienced it often state that they feel more comfortable with themselves after the trip. Some have reported a strengthening of friendships due to this effect. It's interesting that as the third plateau is approached, recall and discussion of such topics seems to become more and more "mandatory". .............................................................................. Motor Effects The other main characteristic of a first plateau DXM trip is its effect upon motion and motor skills. Users tend to walk and move in specific ways (varying somewhat from person to person) characterized by large, fluid movements. In fact, it may be difficult to perform small or abrupt motion. Motor tasks initiated may continue beyond their targets (this can range from fun to distracting). To an outside observer, this can seem quite strange, especially the changes in gait. It is possible, however, to move normally. These changes may be related to euphoria linking of body kinetic sense (see Sensory Effects, above) which would make large and sweeping motions more enjoyable. It is also possible that something more directly involved in the planning and carrying out of complex motor tasks may be at work. .............................................................................. Memory Effects The memory effects of a first plateau trip are slight but usually noticeable. Most of the effects probably come from a general deterioration of short-term memory. Working memory (the "train of thought") can become stuck in repetitive thoughts; other times it can be very easy to become distracted. Recall of events prior to the trip does not seem to be degraded. Encoding (i.e., making new memories) may be worsened, so that after the trip there is some difficulty in recalling events during the trip. Also probably because of the deterioration of short-term memory, it may be easy to lose track of time. .............................................................................. Emotional Effects Mood enhancement is the most regular emotional effect of the first plateau; many people find themselves fairly bouncy and happy, occasionally euphoric. Unlike many drugs, there is not usually much "let-down" when the trip ends. Fear is rare at the first plateau. There may be a sense of energy or drive. The effects upon libido evidently tend to vary from person to person. Some people report an increase in sex drive; others find that playing, physical contact, music, etc., seem much more interesting and enjoyable than sex. The effects on sexual performance itself are not very strong at the first plateau, though males may have some difficulty in achieving orgasm. When orgasm does occur, it is often accompanied by extreme muscle tension and profuse sweating. ------------------------------------------------------------------------------ [3.3] The Second Plateau With the second plateau (around 2.5-7.5mg/kg), several new effects become evident. The most profound is that DXM begins to take on a heavier "stoning" characteristic, and senses and cognitive function are affected accordingly. Hallucinations start for some people on the second plateau. Some of the first plateau effects, e.g., the music and motion linked euphoria, may diminish or stop entirely. Second plateau trips usually take between 30 and 60 minutes to start (on an empty stomach), peak about 2 to 3 hours later, and last about 6 hours. Again, gel capsules take up to 1 hour additional to dissolve. Hangovers are not common with lower second plateau trips, but some people experience them. .............................................................................. Sensory Effects The most general sensory effect of the second plateau is "flanging". Flanging, also called phlanging, phasing, stop-action, framing, strobing, etc., is the sensation that continuous sensory input has been chopped up into frames (as if you were watching a badly animated cartoon), often with some echo effect of each frame. There does not seem to be any loss of sensory content; instead, it is as if the ability to keep sensory input time-continuous were disturbed. The best analogy from other drugs may be the effects of nitrous oxide upon sound. The best analogy from non-drug experiences is listening to a voice through an echo/delay effects box (which is where the term "flanging" comes from). An interesting and probably associated sensory phenomenon is that it seems as if one is aware of several temporal stages of sensory processing all at once. In other words, a sentence may be heard not sound for sound or word for word, but all at once (this is difficult to describe). Similarly, visual images may be jumbled together with previous images. This may be due to an excessive persistence of sensory buffering. Vision in particular is changed on this plateau. Depth perception is often lost, and the ability to keep both eyes focused on the same thing is diminished (leading to slight double vision). This is most noticeable in people without a dominant eye. Sound, as already mentioned, tends to be flanged. With the sense of touch, there is not necessarily flanging so much as a noticeable delay between the stimulus and recognition of it. Pain especially tends to be somewhat dissociated. Taste and smell are usually simply dulled, though a few people report a vastly improved sense of smell. The sense of balance is severely disrupted, as is body position and kinetic sense. Keep in mind that dissociation of pain and the disruption of body sense together make physical exertion somewhat risky, as it is possible to over-exert and not notice. Hallucinations tend to begin at the second plateau (and in fact are the reason I distinguish this from the first plateau). Usually these are not "true" hallucinations, but instead are considerable enhancement of imagination, up to fully eidetic imagery (i.e., you experience lucidly what you imagine). This is especially powerful with memories; some users are able to re-experience past events, or "simulate" future events, as if actually there, interacting with the environment (I call this the "Holodeck Effect"). Many users report this to be quite useful for introspection. Actual hallucinations, if they do exist, tend to be abstract and cartoon-like. There seems to be an emphasis on linear structures - long, thin lines, or long queues of simple objects. There may also be Lilliputian hallucinations (everything seems either way too big or way too small, or both). Some people find considerable similarity with fever hallucinations. This can be unpleasant to some people. Your experiences throughout the day will influence the hallucinations you see and the imagery you can create. For example, if you have spent the day playing DOOM[tm], your hallucinations are likely to involve scenes and elements from the game. Eidetic imagery works a little different - you can conjure up images, but they are likely to have a "DOOM[tm]-esque" feel to them (bitmapped textures, ugly walls, etc.). This is an interesting effect, and my hunch is that DXM hallucinations and imagery may be very dependent upon what's already stored in short term memory. So it might be worth planning the events of the day with your trip objectives in mind. This may also be possible to some extent during the trip itself; e.g., if you want to imagine yourself in space, go to a planetarium. .............................................................................. Cognitive Effects Higher reasoning is still not appreciably affected at the second plateau; in fact one of the more interesting aspects of DXM at the first and second plateau may be its ability to disturb one function of the mind while leaving another almost untouched. An interesting cognitive effect that is pronounced at the upper second through the third plateau is a change in self-referential thinking. Self-referential thoughts or ideas (e.g., "this statement is false") may seem much more easily understandable, both in the abstract and on a "gut level". Thoughts can, in fact, get quite abstract, sometimes to the point of seeming meaningless to other observers. Quite a few people have reported some sort of self-referential or abstracting aspect to thoughts, such as a "self-creating and self-invoking meme" that consists of the concept of itself. Another example is abstracting the concept of abstraction (and abstracting that, and so on and so on). Language becomes difficult, partly due to cognitive changes (as in the first plateau) and partly due to difficulty in coordinating the mouth and tongue motions. Similarly, interpreting spoken language is difficult due to sensory flanging. However, thinking in language is still fairly easy. The curious detachment from painful or embarrassing topics of conversation that occurs at the first plateau continues and is much stronger at this plateau. Again, this is generally viewed as a positive event, although if you're not prepared to encounter and possibly discuss your deepest, darkest secrets, you might want to avoid higher doses until you're comfortable with DXM. .............................................................................. Motor Effects The first-plateau effects on motor skills continue to exist, and may be considerably stronger. Some users find themselves contorting their limbs into rigid positions, others may extend and stretch themselves. These effects are not always immediately apparent; when they are, the user usually reports that it just "feels right" to be in that position. It is still possible to override this. Another accentuation of first-plateau motion effects that sometimes occurs is that the large, sweeping motions, once initiated, may continue for considerable time (looking somewhat like a cross between modern dance and Huntington's disease). Again, it just "feels right" to do. .............................................................................. Memory Effects Short-term memory and working memory may be severely disturbed, although experience with DXM seems to help people compensate. Possibly because of the changes in memory, it may be very difficult to get bored, even with repetitive tasks. At this plateau, a lot of time may get lost, and the more mundane aspects of the trip are easily forgotten after it is over. .............................................................................. Emotional Effects The other primary characteristic of the second plateau (hallucination being the first) is probably the motivational aspects. Repetitive, mundane, boring tasks suddenly become doable, and (if one can avoid distraction) may be easily accomplished, even if they take hours. There may be a considerable stimulant effect remaining at the second plateau. The euphoria from the first plateau continues but diminishes as dosage across the second plateau increases. ------------------------------------------------------------------------------ [3.4] The Third Plateau At the transition between the second and third plateau, (roughly 7.5 to 15mg/kg), several unrelated effects may occur. These probably belong more to the transitional stage than to a given plateau, and will be dealt with here. The first is a sensation that has been described as the opening of nasal ----------------------------------------------------------------------