Agitation dextromethorphan

Uses Obesity Action Blocks uptake of norepinephrine, serotonin, dopamine Dose 10 mg/d PO, may to 5 mg after 4 wk Caution [C, -] w/ SSRIs, Li, dextromethorphan, opioids Contra MAOI w/in 14 d, uncontrolled HTN, arrhythmias Disp Caps SE HA, insomnia, xerostomia, constipation, rhinitis, tach, HTN Interactions T Risk of serotonin synd W/ dextromethorphan, ergots, fentanyl, Li, meperidine, MAOIs, naratriptan, pentazocine, rizatriptan, sumatriptan, SSRIs, tryptophan, zolmitriptan, St. John s wort effects W/ cimetidine, erythromycin, ketoconazole T CNS depression W/ EtOH EMS Use fentanyl w/ caution, may T risk of serotonin synd concurrent EtOH use can T CNS depression OD May cause tach, HTN, diaphoresis, HA, fever, agitation, muscle tremors, and Szs symptomatic and supportive... 

In another three cases (girls aged 10, 13, and 15 years) severe acute psychosis was associated with the use of an over-the-counter formulation containing ephedrine or pseudoephedrine and dextromethorphan combined with other compounds (225). The psychopathology included agitation, depressed mood, flat affect, pressure of speech, visual and auditory hallucinations, and paranoia. All three improved dramatically, with residual symptoms of irritability, 2-4 days after withdrawal of the mixture and treatment with risperidone 0.5-2.0 mg/day. 

Roberge RJ, Hirani KH, Rowland PL 3rd, Berkeley R, Krenzelok EP. Dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia case report. J Emerg Med 1999 17(2) 285-8. 

Dextromethorphan Nausea, elevated temperature, low blood pressure, agitation, seizures, coma... 

Psychiatric A 60-year-old woman developed a psychosis after taking dextromethorphan at more than the recommended over-the-counter dosage, propoxyphene, and hydrocodone [71 ]. She developed religious and paranoid delusions, olfactory and visual hallucinations, and agitation. Propoxyphene may have slowed the metabolism of dextromethorphan, resulting in intoxication. 

Jamison SC, Vasudeva S. A 60-year-old woman with agitation and psychosis following ingestion of dextromethorphan and opioid analgesics. J Psychopharmacol 2009 23(8) 989-91. 

Psychiatric A 60-year-old lady developed agitation, paranoia, and psychosis after taking dextromethorphan, propoxyphene, and hydrocodone [48 ]. She had no history of previous mental illness. She had taken propoxyphene and hydrocodone + paracetamol for pain and dextromethorphan for cough in higher than recommended doses associated with a respiratory tract infection. 

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