DXM

Romilar 1968 Ad

Dextromethorphan (also known as 'DXM', 'DM' or 'robo') is an over-the-counter antitussive (cough medicine) which, when taken at doses exceeding the recommended therapeutic range, becomes a powerful dissociative drug with psychedelic properties.

While DXM can be used safely it is not an inherently safe drug. Repeated use within a short period of time, combination with certain types of drugs, certain genetic factors and the prevalence of other active ingredients which become harmful at doses needed for disassociation make for a drug which must be used with caution.

The high is not for everyone; it is said to loosely follow the rule of thirds: one third hates it, one third doesn't care, and one third like it. It should not be underestimated as a hallucinogenic, at higher dosages it mimics high doses of ketamine but with more psychedelic properties.

DXM manifests its effects in a series of plateaus, with dose determining which plateau (and consequently which effects) one will experience. Lower dose plateaus can be well suited to relaxation, light social interaction and listening to music, while higher doses result in a more encompassing dissociative experience which does not lend itself to attentive social attention. At high doses it's common to have strong hallucinations, experiences of detachment, depersonalisation, and out-of-body experiences. These all-encompassing states can be startling and uncomfortable for some.

Its mechanisms of action are multiple, including action as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist. DXM and it's major metabolite, dextrorphan, also acts as an NMDA receptor antagonist at high doses, which produces effects similar to, yet distinct from, the dissociative states caused by other dissociative anaesthetics such as Ketamine and PCP.

DXM does not typically show up in normal drug tests, however it can produce false positive results for PCP and/or opioids in extended or specialized drug tests. Occasional use should not produce these false-positive results after a couple days have passed.

History

The racemic parent compound racemorphan was first described in a Swiss and US patent application from Hoffmann-La Roche in 1946 and 1947, respectively; a patent was granted in 1950. A resolution of the two isomers of racemorphan with tartaric acid was published in 1952, and DXM was successfully tested in 1954 as part of US Navy and CIA-funded research on nonaddictive substitutes for codeine.

The FDA approved DXM in 1958 after research supported its legitimacy and effectiveness as a cough suppressant. After its approval, it was introduced as an OTC medication under the name Romilar, which was introduced as a replacement for codeine containing cough remedies in an effort to cut down on abuse. In early 1960s Beat poets Allen Ginsberg and Peter Orlovsky, musicians such as Daevid Allen Soft Machine, and alternative authors such as Jack Kerouac known to have used DXM in the form of Romilar. In 1973, Romilar was taken off the shelves after a burst in sales because of frequent misuse, and was replaced by cough syrup in an attempt to cut down on abuse. In 1975, the popularity and extensive abuse of DXM was recognized, and Romilar was removed from the OTC market. However, DXM was specifically excluded from the Controlled Substances Act (CSA) of 1970, therefore, it was still legal to produce and use.

A few years after its removal from OTC, companies began introducing refined DXM products (e.g., Robitussin, Vicks-44, Dextrotussion) that were designed to limit recreational use by creating an unpleasant taste if consumed in large quantities. Within a short time those same manufactures began to produce forms of DXM with "some appealing flavoring," which led at least one researcher to suggest that the cycle of recreational abuse may be repeated. In 1996, DXM HBr powder could be purchased in bulk from online retailers, allowing users to avoid consuming DXM in syrup preparations.

Different Forms

DXM is widely available in over-the-counter cough treatments which appear in different forms including gelcaps, lozenges and syrups. DXM is also less commonly found in a more pure powder form, either extracted or bought directly from a chemical manufacturer.

While there are some products available which contain only DXM as active medical ingredients it is common to find products which contain DXM but also contain enough of another active ingredient to pose a serious risk to the user's health.

Pure/Extractions

The ideal source of DXM would be the purest. The safest way to use dxm is with pure powder (and at least 5-10ml propylene glycol to aid digestion) or an extraction. However, for most this form will prove impractical due to obtaining the pure powder.

Extractions from OTC sources requires time and a chemical procedure which most people are not equipped to do safely. If you are properly equipped, there is some detailed information on this page: https://erowid.org/chemicals/dxm/faq/dxm_chemistry.shtml

Gel Caps

DXM Gelcaps such as Robitussin Gelcaps or other products containing only DXM encased in a gelcap are often the preferred source for DXM users. For most users, gelcaps which contain only DXM produce a more clear headed high in lower doses (slower digestion, see . Most users experience fewer side effects from gelcaps than from syrup, however some users report an upset stomach, indicating that some users may have a sensitivity to the edible plastics used to make the gelcaps.

Some brands such as Cordicin Cough and Cold (also known as CCC) have a variety of products, most of which contain other active ingredients such as antihistamines or CPM (Chlorpheniramine Maleate) and may have one or two products which contain only DXM.

WARNING: Cordicin Cough & Cold is one of the most commonly used sources of DXM, and also one of the most dangerous. Nearly every single CCC product contains other active ingredients such as CPM, which can cause severe and life-threatening symptoms including seizures, shortness of breath or troubled breathing, weakness, loss of consciousness, severe dryness of the mouth, nose or throat, bleeding from the skin, mouth, eyes, rectum and vagina, and possibly death. CCC also is additionally harmful to your kidneys, liver and heart. Avoid it.

Lozenges

There are also sore-throat and cough medications containing DXM which exist in the form of a hard-candy like lozenge. These sometimes contain only DXM, however most brands of DXM lozenges also contain analgesics such as acetaminophen or benzocaine.

Always choose a product which only has Dextromethorphan in the active ingredients!

Syrup

Cough syrup is the most common source for DXM users. While there are many brand name and no-name syrups which only contain DXM as an active ingredient there are many active and "inactive" ingredients commonly found in cough syrups which can cause negative effects ranging in severity. See Adulteration for more information.

Some have reported the high produced from syrup is mostly sedating. You may feel sluggish when using it to get high on DXM, possibly as a result of other ingredients found in syrup however because of the even dispersion of DXM throughout the syrup it is said to produce a more 'solid' trip.

Delsym

Delsym is brand with many formulations which contain Dextromethorphan Polistrex.

This is an extended release form of DXM which produces a longer lasting trip with weaker, more physical effects. It is somewhat more difficult to reach the third plateau using polistrex preparations, which may be preferable to beginners or users who would prefer these effects. Since it is an extended release dxm product, this means your enzyme is more able to keep up with the conversion of DXM to DXO, meaning more of a body high and less of the psychedelic DXM high. It is for this reason why it is difficult to reach 3rd plateau with polistrex. Generally, a 3rd plateau experience has a Higher percentage of DXM than DXO.

See Dosage information below

Dosage

The dosage below refers to an "average" 180lbs / 80kg person taking DXM HBR. Before dosing it's important to note a few things:

• HBR and Polistirex doses vary significantly due to polistirex slow absorbsion rate.
  • Dextromethorphan Polistrex, being extended release, means that your enzyme is more able to convert dxm into dxo. DXO being a more physical, less trippy drug, leads to this preparation of dxm feeling much less intense, and in many cases, very subtle. It is therefor recommended by some to predose with grapefruit juice to fully enjoy polistrex because it slows down the conversion of dxm to dxo, effectively making polistrex "more trippy" because of a higher amount of dxm that didn't get converted. It should be noted that inhibiting digestive enzymes with grapefruit juice is risky and can interact with several medications and drugs and not be taken lightly. For more information look up "CYP3A4 Inhibition drug interactions".

• DXM doses are affected by weight. For more accurate dosage information, see the following resources:

• For a graphical chart of the dosage ranges this chart is helpful.

• For an easy calculator that does the math for you, this page can be helpful.

Before dosing, be sure to read the Plateaus section to know which level you want to dose for.

Plateau range dosage for a 80kg (180lb) person.

First	122-200mg
Second	200-600mg
Third	600-1200mg
Fourth	1200-1600mg
Risk of death	2.2g+

Duration

Oral HBR

High of 6-8 hours

Afterglow effect of 8-16 hours after dose, depending on dose

Oral Polistirex

High of 8-12 hours

Afterglow effect of 16-36 hours after dose, depending on dose

Redosing

Redosing is not advised because of potential risk of risk of sigma. For more information, see Plateau Sigma

It's better to know how much you've taken at the start of the trip, rather than guesstimate how much you're on as you keep dosing. The effects will start to come in waves and may not be pleasant. If you feel the need, it's recommended to take a high initial dose and a lower dose 1-2 hours in. As the duration of the trip is extended with dose boosting or redosing, the dysphoric aspects of the experience increase, until eventually most people report feeling like the walking dead. Not to mention by extending the duration of the trip you are increasing the chance for adverse effects and brain damage.

Predosing

Grapefruit juice effects dxm due to interactions with cytochrome P450-2D6. Essentially, it inhibits the enzyme that converts dxm to dxo, making a higher DXM:DXO ratio, meaning a higher, more psychedelic high, and less of a body high. With 1st and 2nd plateau, it can make it much more "trippy" and less of a physical high.

In order to properly predose, drink around 16oz (500mL) of grapefruit juice 1-2 hours prior to the point where you dose the dxm itself.

Effects

As previously stated, the effects of this drug vary wildly from plateau to plateau, this list is in general from ALL plateaus.

Positive

• Euphoria, mood lift

• Increased giggling and laughing

• Dissociation of mind from body (positive when sought)

• Creative dream-like experiences

• Increased tactile sensation

• Some users report empathy and forgiveness towards other people

Neutral

• Pupil dilation

• Visual stop motion effect (flanging or strobing)

• Visual and aural (auditory) hallucinations

• Decreased sexual functioning (difficulty achieving orgasm)

• Confusion, disorientation

• Skin sensitivity, alters tactile (touch) and skin sensations

• Robotic, zombie-like walking, "robo-walk"

• Dis-coordination, reduced agility

• Loss of appetite

• Involuntary flexing of muscles

• Feelings of merging with adjacent objects like a couch or bed (with higher doses)

• Some users report feeling disconnected, isolated from others, (positive when sought)

Negative

• Vomiting

• Dizziness

• Body itching

• Rash, red blotchy skin (similar to a niacin rush)

• Diarrhea

• Fever

• Tachycardia (racing, pounding heart)

After-Effects

The after-effects of DXM are referred to as the afterglow.

The afterglow is almost non-existent on the First Plateau.

For a Second Plateau dose, the afterglow can be quite pleasurable, although some feel depressed/hungover afterwards for up to 14-16 hours after the initial dose. Expect to feel lazy and fairly tired the next day, easily remediable with caffeine and/or nootropics.

For a Third Plateau dose, the afterglow may additionally add a headache, feel more like an alcohol hangover, and almost like a 1st plateau trip for most of the day after. The effects of this may last for up to 16-20 hours, with some people feeling the "brain-dead", tired and lazy effects up to 72 hours! The tired and "brain-dead" effects can be remedied with caffeine and/or nootropics.

For a Fourth Plateau dose, don't plan anything for the day after, because you will be very "out of it" for a good 24-32 hours after dosing, with some people feeling the sedation/"brain-dead"/lazy effects up to 72 hours!. Definitely plan a Fourth Plateau dose at least a good 2 days away from social events, work, school, ect. (IE, do it Friday night/Saturday Morning if you have to work Monday). Eating becomes a difficult task during a Fourth Plateau afterglow. The best things to eat during this period are soft foods like yogurt, mashed potatoes, soups, and nutritional milkshakes like SlimFast or ENU Total Nutrition Meal Replacement Shakes. This afterglow may be fairly painful like an alcohol hangover, but can be slightly remedied with Ibuprofen/Acetaminophen, a multivitamin and the aforementioned supplements/food, caffeine and/or nootropics. . You will also appear to be extremely high from an outward appearance. Expect to feel very tired, lethargic and "brain-dead" for up to 72 hours.

Robo-Walk

The robo-walk feels like all of the muscles in your body are activated at once and while strange to the observer is not painful to the user. You can still walk but detailed coordination such as running, jumping, or maneuvering around furniture becomes much harder if not impossible. However, when you you start getting the effects of robo-walk, you really wouldn't want to be moving around anyway. The best thing to do is get a good pair of headphones, turn off the lights, close your eyes and let your mind wander.

It's similar to being overly aware that you are walking incorrectly and overcompensating because of it. Not much you can do about it except to minimize your walking by having everything ready before you start (food, water, triptoys, grapefruit juice, dxm in whatever preparation, ect).

Plateaus

There are various 'stages' to DXM trips called plateaus. Traditionally, there are only four plateaus that someone should try to aim for. All of them share general feelings of dissociation, but the strength and effects of these feelings are more pronounced in the later two plateaus.

The first two plateaus are commonly associated with a mix of being high on THC and drunk on alcohol. If you take a First Plateau dose, it's totally possible to socialize. At second, it becomes harder, but not impossible. Lower plateau doses are relatively easy to hide compared to higher plateau doses and talking with others becomes a lot easier while under the influence of DXM. It would also be fun to chill in your room alone and do whatever you normally do for fun, but it's suggested to try something that will take up most of your attention but allow your mind to wander at the same time. Something like playing a casual video game, or drawing whatever comes to mind.

If you take a Third or Fourth plateau dose, it is recommend to trip alone or with a close friend, as it is not a social drug at this dose. The best way to enjoy it is to lay back and listen to music with your eyes closed.

Choosing your destination plateau will depend a lot on what other drugs you've done and how comfortable you are with your own mind. People who have never tried any hallucinogen other than marijuana and/or alcohol should start with a First Plateau dose, while people with mushrooms or LSD experience could start at a Second Plateau dose. It is not advised to start at the Third or Fourth plateau unless you have extensive experience with other dissociatives.

First Plateau

The First Plateau is the lightest in effect. It feels a bit 'off', and is often likened to something of a cross between the effects of MDA and Alcohol. First plateau is usually slightly stimulating. The First plateau has also been described as "basically like a hit or two of good weed and 2-3 beers with 10 minutes of a 'trip' about 2 hours in."

Effects commonly experienced at the first plateau level

• A shift in thinking perspective; things look and feel 'different'

• Increased tactile sensation

• Increased appreciation of music

• Feeling heavy, sensation of increased body weight

• Enhanced emotional response & sensitivity

• Some dizziness or vertigo

First Plateau dose: 1.5-2.5mg/kg.

Second Plateau

This plateau is a bit more intense. You may feel like you are stoned and movement may become difficult. The second plateau can be fun yet disorienting. Music sounds much deeper, clearer, almost like you are there at the concert. Walking/Moving your body becomes slightly difficult at this point. Some may experience some closed eye visuals at this point. You can socialize with close friends and you could say you're slightly drunk. A slight warning, DXM is almost like a truth serum and you may share embarrassing or "secret" things you wouldn't normally share. You may start to get a bit of disassociation, and the high starts to get somewhat intense in the second plateau.

Second Plateau dose: 2.5-7.5mg/kg.

Transitional

Most people stop their DXM journey here, as the higher two plateaus are not really fun but introspective and enlightening. We don't recommend crossing this threshold until you're ready to move on from a lighter, happier experience to a sometimes darker and definitely more introspective full blown trip. Enjoy the 2nd plateau as long as you can because it's more of a fun experience and one tends to enjoy second plateau less after visiting the third plateau. "Once you see what's behind the curtain, you can't enjoy the show" so they say.

Additionally, approximate at 7.5mg/kg there is an elusive "Eiffel Tower" dose where you may experience the effects of both the Second and Third plateaus in waves.

Third Plateau

Third Plateau is a full on dissociative experience. At this point it is no longer a social drug and should be done alone or with a tripsitter. The third plateau is considerably more sedating and movement becomes a bit harder. Closed eye visuals are more prominent at this level. You will lose track of time quit easily as it becomes meaningless quite quickly. Large amounts of dissociation happens at this level, and the internal thoughts can be quite interesting. To explain further, you may start to feel like you don't belong in your own body, or that your mind and body are two separate beings. Additionally, thoughts may be similar to "My body is only what everyone else sees but not really me, because I am just my mind, not my body."

There is a little bit of post-trip amnesia starting at 3rd Plateau. As stated previously, 3rd Plateau is quite intense. It's not the full comatose stage that the 4th Plateau is, but it can be pretty overwhelming nonetheless.

Third Plateau dose: 7.5-15 mg/kg.

Fourth Plateau

This is the deep meditative state. This is most akin to a "k-hole" that people experience after taking large amounts of ketamine. Few people enjoy going this far, as all one can really do (or really wants to do) is sit, listen to music, close your eyes, and experience a full blown dissociative trip. You can create universes in your mind just by thinking of them. DXM users have been known to have extremely vivid, controllable hallucinations and out of body experiences at this level. Full blown disassociation from everything and full on ego death is very common at this level. Other very common hallucinations at this level are people visiting aliens, meeting god (sometimes the two being the same entity) and becoming god. One explanation of the fourth plateau "It's kind of like the top of your skull pops off and all the knowledge of the universe is poured into your head, but by the end of the trip it's all seeped out again and you are left with the realization that you really don't much of anything at all." Another explanation is : "A total detachment from the body. The ego is pulled inside. Everything is very distant. Walking, talking, moving is not possible. Thinking is however. Left free to observe the self from a dark quiet immobility. A strange taste in the mouth. Like the numb of the dentist in every tissue. Loss of emotion, loss of anything earthly. "

It is quite difficult to recall these very powerful hallucinations as post-trip amnesia is very common.

Fourth Plateau dose: 15mg/kg-20mg/kg. Higher is possible, but not advised, because risk of death around 25mg/kg, but varies slightly from person to person

Plateau Sigma

There is another level that DXM can take you to, but it is not higher in dosage than 4th plateau, it is more of an extension of 2nd and 3rd plateaus. In order to get to this state, you must binge. For this reason WE HIGHLY RECOMMEND AGAINST IT! For example, a user has said "I took a 3rd plateau dose, then when it was starting to wear off, I took a 2nd plateau dose, when that was finally coming down, I took a 3rd plateau dose again, and when that came down, I did ANOTHER 2nd plateau dose. When that final dose hit, I was stuck in Plateau Sigma."

Many people refer to this level as "plateau sigma" because when you get to this state, your sigma receptors are hit on, and HARD. This completely changes the trip. This mind state is generally referred to as dysphoric, dark, confusing and "a hellish introspective nightmare". As one user put it "it's a dark and confusing dream-like state where everything you think you know is insanely hard to grasp while all of your wildest, most bizarre fantasies are merely common, boring every day events that feel as normal as waking up and drinking coffee."

As with 4th plateau, it's hard to describe as amnesia is quite common and information about this state is quite rare as it is. That being said, this state has VERY RARELY been reported as being pleasurable AT ALL. Most people describe it as dark and confusing, like a living nightmare.

For more information, the William White FAQ has a section on Plateau Sigma at This Page

Harm Reduction

There is only three MAJOR rules about dxm use, and they are as follows :

• NEVER use any preparation of DXM that has ANY other active ingredients, as they can make you sick and/or dead. See Adulteration
• Keep in mind this general rule of thumb for DXM : 1 plateau/week.
  • In other words, If you take a Third Plateau Dose, wait 3 weeks before using again. If you use a Second Plateau dose, wait 2 weeks before using again.
• Watch out what you are mixing DXM with, as mixing with certain drugs can cause serotonin syndrome, or Ataxia, see Interactions

See Dissociative Harm Reduction for general information.

Adulteration

Many products which contain DXM also contain other medication or otherwise non-medically-active ingredients that can cause serious harm in the doses found in DXM containing products. If a user intends to use an OTC cough medication in order to get high on DXM they almost always will have to consume a dangerous quantity of other dangerous ingredients if they are present in the medication. For this reason it is strongly recommended to find a source which contains DXM as the ONLY active ingredient

The following is a summary of other ingredients commonly found in DXM products.

Adulterant Table

Name	Description	Common Brands	Danger
Acetaminophen/Paracetamol/APAP	a painkiller found in headache/flu medicine	Tylenol, Vicks (NyQuil), TheraFlu, Triaminic	APAP is Hepatoxic in high doses. This means it will damage your liver if taken in high doses. Your body can only process a certain amount of APAP at once before it the normal pathways become saturated. Once the regular pathways used for metabolizing APAP have been saturated, the remaining APAP gets broken down in the liver by an enzyme called cytochrome P450 When forced to break down APAP this enzyme produces toxic metabolites!
Guaifenesin	Guaifenesin is an expectorant.	Robitussin DM, Mucinex, Robefen	Guaifenesin overdoses cause severe nausea and vomiting in most users. Guaifenesin can also cause kidney stones with chronic use.
Antihistamines	Found in Allergy/Sleep/Nighttime medications	Coricidin Cough and Cold, Zicam, Dimetapp, Chloraseptic	When taken in high doses antihistamines can cause dizzyness, nausea, a strong dysphoria, paranoia, delirium and hallucinations. Many antihistamines can also have a dangerous synergy with DXM which can lead to liver, kidney and heart complications.
PPA, pseudoephedrine, and phenyleprine	Decongestant agents	Sudafed, Vescadril, Curedex, Watkins, Hardex	Vasoconstriction (constriction of blood vessels) and decreased nasal secretions , and with larger doses insomnia, hypertension, heart rhythm abnormalities, hemorrhaging, stroke, or death. 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.

Inactive Ingredients Adulterant Table

Name	Description	Common Brands	Danger
Food Coloring/Dyes	Dyes added for color	Almost ALL brands except Zarbee's Naturals and Chestal Naturals	Usually these dyes are not harmful in low doses however in doses which may be required for DXM's effects they can become problematic. Tartrazine (FD&C Yellow #5) is one of the most notable coloring ingredients to cause reactions. Not necessarily dangerous unless you are allergic to certain dyes. Check out the ingredients list if you are.
Glucose, sucrose, fructose, invert sugar	Cough syrups usually contain one or more chemicals used to make them taste sweet.	Pretty much all brands except Prospan, Diabetic Tussin and Scot-Tussin	These sweeteners pose an obvious risk to people with blood sugar conditions such as diabetes or hypoglycemia. If you have diabetes or hypoglycemia, make sure you get a diabetic brand, gel-caps, or even an extraction instead of syrup. In rare cases, excessive, chronic use of cough syrup HAS led to people getting diabetes.
Propylene glycol or Polyethylene glycol	Thickening agents	Pretty much all brands of syrup	These are not toxic nor inherently dangerous but may cause an upset stomach when consumed in large doses.

Interactions

DXM has several potentially dangerous interactions with pharmaceutical and recreational drugs including analgesics (painkillers), antihistamines, antidepressants and stimulants.

DXM has the potential to cause Serotonin Syndrome if mixed with other serotonergic drugs such as antidepressants that act as SSRIs, MAOIs, empathogens which affect serotonin release such as MDMA, MDA, Mephedrone, Tramadol, 2-c-t-x drugs, MXE, aMT, 5-HTP, ect. Serotonin Syndrome causes discomfort, excitability, irritability, diarrhea, moodswings, seizures, coma and can be deadly if not treated.

• See Drug combinations and Dissociative Interactions for more information.

Chemistry and Pharmacology

IUPAC:(4bS,8aR,9S)-3-Methoxy-11-methyl-6,7,8,8a,9,10-hexahydro-5H-9,4b-(epiminoethano)phenanthrene.

Dextromethorphan is the dextrorotartory enantiomer of levomethophan, which is the methyl ether of levophanol, both opioid analgesics.

Pharmacodynamics

Binding receptors

NMDA - 7253

SERT - 2015

NET - 110606

Sigma-1 - 23

Sigma-2 - 240

Pharmacokinectics

Following oral dosing, DXM is rapidly absorbed from the GI tract. Where it enters the bloodstream, and crosses the blood-brain barrier.

At therapeutic doses, DXM acts centrally (brain) as opposed to locally (Respiratory tract). It's rapidly absorbed from the GI tract into the active metabolite Dextrophan (DXO) in the liver by the cytochrome P450 enzyme CYP2D6.

Around 10 percent of the Caucasian population has little or no CYP2D6 enzyme activity, leading to long-lived high drug levels. ALL Caucasians should take a small test dose (1st plateau or medical levels) to feel for this ahead of time.

Images

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  Robitussin brand DXM Gel Caps

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Links

• The Dexterous World of DXM from TripSit
• DXM FAQ
• DXM timeline on Erowid
• Wikipedia
• Dextroverse