DXM Addiction and Misuse

Dextromethorphan, commonly referred to as DXM, is a cough suppressant found in many over-the-counter cold medications.1 DXM is typically found in extra strength cough syrups, tablets, and gel capsules and is an ingredient in some antihistamines and decongestants, too.1

This page will discuss how DXM is misused, the common side effects and warning signs of DXM use, and what treatment options are available for DXM addiction.

What is DXM?

Cough syrup with DXM being poured into a spoon
Dextromethorphan is found in over 120 over-the-counter medications, often in combination with pain relievers like acetaminophen or cold medicines that contain decongestants, antihistamines, and expectorants.2

When taken as directed, over-the-counter cough and cold medicines can be helpful to many people. However, it is important to know that, depending on the dose, DXM can induce effects similar to using marijuana, ecstasy, or even ketamine or PCP.2

Yet, DXM is a legal cough suppressant. It is not a controlled substance or a regulated chemical under the Controlled Substances Act.2
When taken in large doses, DXM can produce feelings of euphoria, as well as auditory and visual hallucinations.2 The misuse of DXM is sometimes called “robo-tripping” or “dexing,”and the drug is often referred to as “skittles.”

How is DXM Misused?

DXM can be taken orally as gel capsules, tablets, or cough syrup. It is also sold as a powder that could be mixed with water and injected.2 DXM is also sold as tablets, by itself or mixed with ecstasy or methamphetamine.

DXM can be especially appealing to adolescents, as it is easy to obtain, consume, and conceal.2 Plus, the fact that it is an over-the-counter medication makes it more accessible than most other mind-altering substances.

Side Effects of DXM Misuse

Misuse of DXM can have serious side effects that may range from mild to severe, depending on the quantities consumed.
Short-term effects of DXM use on the mind and body may include:2

  • Mild stimulation or intoxication.
  • Euphoria.
  • Inappropriate laughter.
  • Paranoia.
  • Agitation.
  • Hallucinations.
  • Nausea.
  • Other sensory changes regarding hearing or touch.
  • Loss of motor coordination.
  • Slurred speech.

Long-term effects of DXM use may include:2

  • Psychological dependence.
  • Cognitive impairments.

DXM misuse can result in dangerous drug interactions, particularly with antidepressants.2 Misuse of DXM in combination products can result in health complications from other active ingredients, including:

  • Liver toxicity from acetaminophen.
  • Increased blood pressure from pseudoephedrine.
  • Central nervous system, cardiovascular, and anticholinergic toxicity from antihistamines.

Using DXM in high doses combined with alcohol and other psychoactive drugs is dangerous and can be fatal.3

Who Misuses DXM?

DXM is misused by people of all ages, but teenagers and young adults are particularly vulnerable, in large part due to its availability as an over-the-counter medication.2

There are even websites available that fuel DXM misuse by offering “how-to” information on misusing the drug.2
As recently as 2020, the Substance Abuse and Mental Health Services Administration reported that approximately 2.4 million people ages 12 and older misused non-prescription cough and cold medicines in the past year.4

Signs of DXM Misuse

There are warning signs to look for if you suspect a loved one is misusing DXM, but those signs can vary based on several factors, including the amounts used and the severity of the use. However, paranoia, anxiety, or aggression could all be signs that someone might be misusing DXM.1

Other potential effects from DXM misuse may include:1

  • Hyperexcitability.
  • Poor motor control.
  • Stomach pain.
  • Lethargy.
  • Sweating.
  • Increased blood pressure.

DXM Misuse vs. Addiction

While there are some overlapping symptoms, there are many differences between substance misuse and a clinical substance use disorder. Misuse of over-the-counter medication typically includes:1

  • Taking more of the medication or taking it more frequently than directed on the packaging.
  • Taking the medication simply for the effect it causes (like feeling high).
  • Mixing different OTC medicines to create a new product.

Misuse of substances puts a person at risk of developing addiction, a treatable chronic medical disease characterized by the compulsive uncontrollable use of a substance despite harmful, negative consequences.The diagnostic term for an addiction is a substance use disorder. Substance use disorders are defined by several criteria outlined in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition. Some of these criteria include, but are not limited to, the following:6

  • Consuming substances in larger amounts or over a longer period than intended
  • Cravings or strong desire to use the substance
  • Failure to fulfill obligations at work, school, or home because of substance use
  • Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by substance use
  • Continued substance use despite persistent or recurrent physical or psychological problems that have been caused or exacerbated by substance use

DXM Addiction Treatment

Getting help for a DXM-related substance use disorder is as important as getting help for any other substance use disorder. The fact that DXM is an over-the-counter medication doesn’t mean it is any less insidious if it is causing significant problems in a person’s functioning. It also does not mean that overdose or death are not real risks if use is continued, either.

Addiction is a treatable but complex condition that impacts brain function and behavior. While no single approach to treatment is right for everyone, it is essential to match treatment interventions and services to a person’s specific needs for long-term success. Treatment is not just about a person’s substance use. It should take into account the whole person, and treatment should encompass one’s physical, psychological, and emotional health; interpersonal relationships; and any vocational and legal issues they may be experiencing. Addiction treatment is highly individualized to meet the unique needs of each and every patient.

Get Help for Addiction at Recovery First

Recovery First is a leading inpatient drug rehab near Miami, Florida, offering various levels of care to suit your needs and help for special populations like Veterans and first responders.
Our compassionate rehab admissions navigators are available 24/7 to guide you through the process of finding the right treatment program and answer all your questions. For example, people often wonder how to pay for rehab and if insurance plans cover addiction treatment.

You can also verify your insurance right now by filling out this simple and secure

There is help and support available. Don’t wait. Call us right now at to get started on the road to recovery.


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