Over-The-Counter Cough Medication (Dextromethorphan) Abuse: A Case Report of Dexing or Robo-tripping

Dextromethorphan (DXM) and DXM-containing cough preparations are available over-the-counter (OTC) and are commonly abused for their euphoriant and hallucinogenic properties. These effects occur when DXM is taken in high doses (10-20 times the amount recommended for cough suppression). Awareness of DXM abuse in the primary care setting is warranted due to its prevalent use and potential to result in drug-induced liver injury (DILI). Reaching a diagnosis of DILI involves an extensive workup to exclude other known causes. If a physician is to identify the use of a single drug as the cause of a patient’s liver injury, a high level of suspicion must be held. We herein present a case of an 82-year-old male who was dependent on over-the-counter, DXM-containing products and who used them regularly for three years. This case report highlights DILI as one potential consequence of chronic OTC DXM use, as is evident from our diagnostic workup.