Cough Medicine Emergencies

Cough Medicine Ingredient Responsible for Over 12,000 Hospital ER Visits in 2004

Dextromethorphan (DXM), an ingredient commonly found in over-the-counter cough and cold remedies, was a contributing factor in an estimated 12,584 visits to hospital emergency departments during 2004, and 5,581 of those visits were attributed to nonmedical use, says a study from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Emergency Department Visits Involving Dextromethorphan, the latest report from SAMHSA’s Drug Abuse Warning Network (DAWN), shows that of those visits related to nonmedical use, almost half (48 percent) involved patients ages 12 to 20. Nonmedical use of DXM in this report includes those taking more than a prescribed or recommended dose, as well as other forms of drug misuse or abuse, and does not include accidental ingestion, suicide attempts, or medical use.

DXM is generally recognized as safe when marketed according to FDA’s regulations. But when taken in large amounts, it can produce hallucinations and a "high" similar to psychotropic drugs, such as phencyclidine (PCP). Serious side effects have included blurred visions, loss of physical coordination, abdominal pain, and rapid heartbeat.

"This report shows that there can be severe, even life-threatening, consequences associated with the misuse of some over-the-counter cough medicines," said Assistant Surgeon General Eric Broderick, D.D.S., M.P.H., SAMHSA Acting Deputy Administrator. "When it comes to our children, parents play a key role in ensuring the responsible use of this widely available medication."

To support parents, SAMHSA has developed educational information about dextromethorphan at http://www.family.samhsa.gov/get/otcdrugs.aspx .

The rate of emergency department visits resulting from nonmedical use of this product was 7.1 visits per 100,000 people ages 12 to 20, compared with 2.6 visits or fewer per 100,000 people in other age groups. Alcohol was also implicated in 36 percent of those same nonmedical use visits for patients ages 18 to 20, and 13 percent of visits for patients ages 12 to 17.

About 30 percent of all DXM-related visits to the emergency department in 2004 were attributed to adverse reactions to medical use — when the DXM products were used as prescribed or according to directions. Patients aged 12 to 20 constituted only 17 percent of these visits. The rates of these visits ranged from 0.8 to 2.2 visits per 100,000 people across all age groups.

Suicide attempts accounted for 14 percent of DXM-related emergency department visits and ranged from 1.4 to 1.7 per 100,000 people ages 12 to 34.

In May 2005, the Food and Drug Administration (FDA) issued a warning against the abuse of dextromethorphan after five reported deaths of teenagers that might have been associated with the consumption of pure, powdered DXM sold in capsules.

The report is available on the web at dawninfo.samhsa.gov .

DAWN collects data from emergency departments in a national sample of short-term, general, non-Federal hospitals and publishes estimates of emergency department visits involving illicit drugs, alcohol, and nonmedical use of pharmaceuticals.

Join Together publishes selected press releases on recently published research related to alcohol and drug policy, prevention, and treatment. The views expressed are those of the organization issuing the release.


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