Dextromethorphan Abuse in Thai Adolescents: A Report of Two Cases and Review of Literature
Boonying Manaboriboon MD*, Chulathida Chomchai MD*
Affiliation : * Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Introduction: 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).
Case Report : We report here two cases of dextromethorphan overdose that presented to the Pediatric Toxicol-
ogy 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.
Conclusion : 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.
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