Dextromethorphan - C18H25NO (DXM) is an over-the-counter (OTC) cough suppressant commonly found in cold medications like Robitussin and Coricidin . Robo is abused in doses by adolescents to generate ecstasy, visual and auditory hallucination. illegal use of Skittles is called "Robo-tripping" or "skittling”.

Half life 1.4–3.9 hours , Excretion Renal,

Side-effects:

blurred vision
body rash/itching
diarrhea
dilated pupils
dizziness
drowsiness
excitation
fever
hypertension
nausea
shallow respiration
sweating
urinary retention
vomiting

herbal remedies: Cough-ease Syrup

Uses: Cough, Bronchial Spasms

Comments: 1 tsp. crushed Mullein leaves
1 tsp. powdered Echinacea
1 tsp. Elecampane
1 tsp. Red Clover
1 tsp. Marshmallow root
1 tsp. Peppermint
1/2 tsp. Licorice
1 quart purified water
2. Tbsp. Honey
2 Tbsp. vegetable glycerin

Mix the herbs into the quart of water in an enamael saucepan, bring to a boil and reduce to a simmer for 20 minutes, covered. Strain the tea and pour back into the well-rinsed saucepan. Bring the tea back to a simmer with the lid off and cook it down slowly until half of the original liquid remains. This creates a more potent formula than the original tea. Add the honey and glycerin. Mix well.
This syrup can be flavored with a concentrated extract of cherry or another flavored syrup. Store in a glass bottle.

ans01360.html

The Food and Drug Administration (FDA) is concerned about the abuse of dextromethorphan (DXM), a synthetically produced ingredient found in many over-the-counter (OTC) cough and cold remedies.

The agency is working with other health and law enforcement authorities to address this serious issue and warn the public of potential harm, after five recently reported deaths of teenagers that may be associated with the consumption of powdered DXM sold in capsules.

DXM abuse, though not a new phenomenon, has developed into a disturbing new trend which involves the sale of pure DXM in powdered form.

DXM has gradually replaced codeine as the most widely used cough suppressant in the United States.

It is available OTC in capsule, liquid, liquid gelatin capsule, lozenge, and tablet forms.

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Child deaths lead to FDA hearing on cough, cold meds - CNN.com
http://www.cnn.com/2007/HEALTH/10/17/cough.syrup.deaths/index.html

BLOOMINGTON, Illinois (CNN) -- On a recent chilly Illinois morning, Dimitria Alvarez sat at her kitchen table and looked through her son Devon's baby clothes.

Devon Mehlberg-Alvarez died at 4 months from an overdose of an ingredient in cough syrup.

Alvarez followed the doctor's directions and gave Devon the suggested amount.

Deborah Mehlberg found out her grandson was dead after returning from a weekend trip.

Devon's family says they were told later that Devon's body could not metabolize one of the key ingredients found in many infant cold and cough medicines.

Jennifer Pifer is a senior producer with CNN Medical News.

11563p.pdf
http://www.usdoj.gov/ndic/pubs11/11563/11563p.pdf

Adolescents are the primary abusers of the drug, most likely because it is inexpensive and relatively easy to obtain.

Additionally, because DXM is a common ingredient in many cough and cold medicines, many adolescents do not perceive any risk in abusing the drug.

When ingested at recommended dosage levels, DXM generally is a safe and highly effective cough suppressant; however, when ingested in larger amounts, DXM produces negative physiological effects.

Reports of DXM abuse have resulted in monitoring by the Drug Enforcement Administration (DEA), and DXM could be added to the Controlled Substances Act if warranted.

Abusers ingest various amounts of DXM depending on their body weight and the effect or plateau that they are attempting to achieve (see text box on page 2).

Some abusers ingest 250 to 1,500 milligrams in a single dosage, far more than the recommended therapeutic dose of 10 to 20 milligrams every 4 hours or 30 milligrams every 6 to 8 hours.

Over-the-counter products that contain DXM often contain other ingredients such as acetaminophen, chlorpheniramine, and guaifenesin.

Large dosages of acetaminophen can cause liver damage; large dosages of chlorpheniramine can cause increased heart rate, lack of coordination, seizures, and coma; and large dosages of guaifenesin can cause vomiting.

National surveys conducted to estimate rates of drug abuse do not include questions regarding DXM.

However, the American Association of Poison Control Centers reports that the total number of calls to centers nationwide involving DXM abuse or misuse have increased since 2000 (see Table 1).

One of the most frequently abused products containing DXM is Coricidin® HBP Cough & Cold, which contains 30 milligrams of DXM per tablet.

1075.pdf
http://stroke.ahajournals.org/cgi/reprint/22/8/1075.pdf

Stroke is published by the American Heart Association.

Experimental evidence indicates that the excitatory neurotransmitter glutamate may play an important role in mediating ischemic neuronal damage.1 Both in vitro and in vivo ischemia models have demonstrated that antagonists of the iV-methyl-D-aspartate (NMDA) subclass of glutamate receptors have neuroprotective properties.1-2 Recently, the dextrorotatory morphinan dextromethorphan has been shown to be an NMDA antagonist capable of attenuating hypoxic neuronal injury in cell culture3 and reducing infarct size in animal stroke models.4 The primary metabolite of dextromethorphan, dextrorphan, is also an NMDA antagonist with neuroprotective properties in experimental ischemia models.4 A number of safety issues regarding the use of NMDA antagonists in clinical trials have been raised.5 In particular, the NMDA receptor appears to play an important role in synaptic plasticity; therefore, NMDA antagonists could interfere with learning and memory function.

sive doses and thus appears to be an attractive compound for initial clinical investigation.

Although it is difficult to extrapolate human dose requirements from animal data, it is likely that dextromethorphan doses higher than typically used for antitussive effects will be required for neuroprotection.

It is possible that neuropsychologic changes might be detected in a larger study, although we note that no patient had a change on any test that would be considered clinically significant.

As this study was being completed, it was reported that NMDA antagonists can induce vacuoles in neurons in the retrosplenial and cingulate cortices in experimental animals.

This variability probably results from several factors, including the variable rate of metabolism of dextromethorphan to dextrorphan between individuals7 and concomitant medications.