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Dextromethorphan (DXM) is a synthetic opioid used as an antitussive (cough suppressant) and dissociative drug. DXM is available in countless pharmaceuticals in many countries.

After recreational use of DXM became popular, Romilar, the original cough medicine containing only DXM in pills, was removed from the market and replaced with DXM-containing cough syrup in order to discourage recreational use. However, recreational use of DXM continued, exploded by the year 2000, and is present today almost everywhere where DXM is available. DXM-containing preparations are usually inexpensive and sold over-the-counter, which makes DXM attractive for minors. Most DXM users are teenagers and young adults.

The effects of DXM usually include dissociation of mind and body, euphoria, and closed-eye visuals, but also itching, nausea and other adverse reactions.

DXM is the dextrorotary enantiomer of racemethorphan (3-methoxy-17-methylmorphinan), an opioid. DXM is a N-methyl-D-aspartate (NMDA) receptor antagonist and a sigma1 receptor agonist; it also increases serotonin neurotransmission in the brain.

Common terms used for dextromethorphan are DXM, Dex, and DM. Slang names for certain pharmaceuticals containing DXM are also common, for example Robo for DXM-containing varieties of Robitussin.


Dextromethorphan was first patented under U.S. Patent 2,676,177 . The FDA approved dextromethorphan for over-the-counter sale as a cough suppressant in 1958. This filled the need for a cough suppressant lacking the sedative side-effects, stronger potential for abuse, and physically addictive properties of codeine phosphate, the most widely-used cough medication at the time. Codeine phosphate syrup is still available in small doses without a prescription in some states, but requires a signature and ID to purchase, similar to pseudoephedrine. As with most cough suppressants, studies show that dextromethorphan's effectiveness is highly debatable, especially in children.

During the 1960s and 1970s, dextromethorphan became available in an over-the-counter tablet form by the brand name Romilar. In 1973, Romilar was taken off the shelves after a burst in sales due to frequent abuse, and was replaced by cough syrup in an attempt to cut down on abuse.

More recently (the early 1990s) gel capsule forms began reappearing in the form of Drixoral Cough Liquid Caps and later Robitussin CoughGels as well as several generic forms of that preparation.

The effects of DXM

DXM has dissociative effects, somewhat similar to ketamine and PCP. The main effects are those of dissociation (separation of mind and body), which include:

Double vision and no perception of depth (eyes are not able to focus) Altered kinesthetic sense (distorted perception of gravity and movements) Overall reduction of external stimuli (loosens the connection between mind and body, can lead to out-of-body experiences) Total loss of reality awareness (dissociative anaesthesia – at high doses)

Other effects include

  • Euphoria
  • Emotion amplification
  • Hallucinations (closed-eye visuals, vision trails and increased awareness of color, flanging of sound)
  • Music appreciation

The effects of DXM usually start to become noticeable 30-60 minutes after consumption (on an empty stomach), peak at about 30-60 minutes after this, and generally last 4-8 hours in total, depending on dosage. While hangovers are often reported, some users report a so-called afterglow which may be present the day (sometimes several days) after a DXM experience. This is usually characterized by a general mood lift.

Some features of the experience, mainly timing and potency, seem to vary between different forms of DXM. For example, Zicam Cough Mist is commonly reported to act faster and more potently than Robitussin Maximum Strength Cough syrup.

The presence, intensity and duration of the above effects depend greatly on dosage. The dose and effect ranges are generally divided into so-called plateaus. There are four dosage-related DXM plateaus, and one named 'Plateau Sigma', which is achieved by prolonging DXM intake.