Dextromethorphan nausea

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

When dextromethorphan is administered with the monoamine oxidase inhibitors (see Chap. 31), patients may experience hypotension, fever, nausea, jerking motions to the leg, and coma... 

Opiates activate the chemoreceptor trigger zone in the medulla (by disinhibition) to cause nausea and vomiting, and cough suppression also occurs because of the inhibitory effects of opiates on the brainstem nuclei in the cough reflex pathway. Dextromethorphan is the non-opiate isomer of the opiate levorphanol and is an effective cough suppressant. 

Dextromethorphan, contained in many nonprescription cough medicines, will produce a heavy psychedelic trip, but the nausea characteristic of the opiates may constitute a problem. Kosterlitz and Villareal (Eds.) AGONIST AND ANTAGONIST ACTIONS OF NARCOTIC ANALGESIC DRUGS (1972) and Braude et al. (Eds.) NARCOTIC ANTAGONISES (1973) are useful. 

Dextromethorphan should be used with great caution in individuals who have a history of chronic or persistent cough, persistent headache, nausea, vomiting, or fever. 

In a trial of dextromethorphan in Parkinson s disease only one-third of the initial sample entered the double-blind, placebo-controlled phase (12). One-third of the sample had a reduction in the benefits of levodopa when dextromethorphan 30 mg/day was given. A further one-third withdrew because of failure to gain clinical benefit from the highest tolerated dose of dextromethorphan. Adverse effects included drowsiness, increased dystonia, increased impotence, light-headedness, sweating, and nausea. 

Morphi Dex contains morphine sulfate and dextromethorphan in a 1 1 ratio. Double-blind, single-dose analgesic efficacy studies in over 800 patients with post-surgical pain have shown superior analgesic activity for the combination (60 60 mg) than separate doses of the individual components (28,29). In double-bhnd, multiple-dose studies in 321 patients with chronic pain the combination provided satisfactory pain control with a significantly lower mean daily dose of morphine sulfate. Other studies have shown similar responses (28) and an adverse events profile similar to that of a similar dose of morphine sulfate (30). The most common adverse events seen in a multiple-dose, non-placebo-controlled study in 1400 subjects were nausea, dizziness, vomiting, somnolence, confusion, and pruritus. There was a significant trend toward lower incidence of constipation with the combination than with morphine sulfate alone (31,32). 

Adverse events are very uncommon with therapeutic doses (40-160 mg) however, dextromethorphan can cause some side effects such as dizziness, drowsiness, lightheadedness, nervousness, restlessness, nausea and vomiting, and stomach pain. 

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