Dextromethorphan

Dissociative

Dextromethorphan

DXM

Experience

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Problems

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Titration strategies

Oral dose ladder (Erowid, HBr salt)▲0▼×

Erowid's dosage documentation for oral dextromethorphan hydrobromide reports the following tiers:

• Light: 100-200 mg
• Common: 200-400 mg
• Strong: 300-600 mg
• Heavy: 600-1,500 mg

Threshold not characterized. Duration 4 to 8 hours for standard HBr formulations; 6 to 12 hours for extended-release polistirex formulations. Erowid notes that doses are affected significantly by body weight and recommends conservative starting amounts. A critical harm note: many OTC formulations containing DXM also include acetaminophen, chlorpheniramine maleate (CPM), guaifenesin, or other active ingredients that become dangerous at the doses required for psychoactive DXM effects; use of single-ingredient preparations is

essential for harm reduction.

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Effects

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Interactions

Pharmacogenomic + mechanism interactions6 edges

Pharmacokinetic mechanismSubstrate / metabolism relationships from primary literature

Enzyme:CYP2D6 substrate major Primary 80 / 100Rate

FDA Drug Interactions Table: sensitive index substrate of CYP2D6.

Inferred from pharmacokinetic dataMaterialised by the inference engine; provenance shown per row

Quinidine pk raises via CYP2D6 Inferred 76 / 100Rate

Quinidine inhibits CYP2D6 (inhibitor_strong, intensity 95); Dextromethorphan is a substrate_major of CYP2D6 (intensity 80). Derived: Dextromethorphan exposure raised.

⏱ reversible competitive, effect resolves over ~5 inhibitor half-lives

Inferred via Enzyme:CYP2D6 (exposure raised)

Fluoxetine pk raises via CYP2D6 Inferred 72 / 100Rate

Fluoxetine inhibits CYP2D6 (inhibitor_strong, intensity 90); Dextromethorphan is a substrate_major of CYP2D6 (intensity 80). Derived: Dextromethorphan exposure raised.

⏱ mechanism-based, interaction persists ~4-6 weeks after stopping the inhibitor

Inferred via Enzyme:CYP2D6 (exposure raised)

Paroxetine pk raises via CYP2D6 Inferred 72 / 100Rate

Paroxetine inhibits CYP2D6 (inhibitor_strong, intensity 90); Dextromethorphan is a substrate_major of CYP2D6 (intensity 80). Derived: Dextromethorphan exposure raised.

⏱ mechanism-based, interaction persists ~4-6 weeks after stopping the inhibitor

Inferred via Enzyme:CYP2D6 (exposure raised)

Bupropion pk raises via CYP2D6 Inferred 68 / 100Rate

Bupropion inhibits CYP2D6 (inhibitor_strong, intensity 85); Dextromethorphan is a substrate_major of CYP2D6 (intensity 80). Derived: Dextromethorphan exposure raised.

⏱ reversible competitive, effect resolves over ~5 inhibitor half-lives

Inferred via Enzyme:CYP2D6 (exposure raised)

Mirabegron pk raises via CYP2D6 Inferred 44 / 100Rate

Mirabegron inhibits CYP2D6 (inhibitor_moderate, intensity 55); Dextromethorphan is a substrate_major of CYP2D6 (intensity 80). Derived: Dextromethorphan exposure raised.

Inferred via Enzyme:CYP2D6 (exposure raised)

Patient experience

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Relevant Literature

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Summary

Classes

Dissociative

Common uses

Pharmacy

Pharmacology

Purported mechanism

NMDA antagonist; sigma-1 agonist; serotonin reuptake inhibitor