Psychosis dextromethorphan

Miller SC. Dextromethorphan psychosis, dependence and physical withdrawal. Addict biol December 2005 10(4) 325-7. 

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. 

Soutullo CA, Cottingham EM, Keck PE Jr. Psychosis associated with pseudoephedrine and dextromethorphan. J Am Acad Child Adolesc Psychiatry 1999 38(12) 1471-2. Price LH, Lebel J. Dextromethorphan-induced psychosis. Am J Psychiatry 2000 157(2) 304. 

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... 

Price LH, Lebel J. Dextromethorphan-induced psychosis. Am J Psychiatry 2000 157(2) 304. 

A 2-year-old child developed hyperirritability, psychosis, and ataxia after being overmedicated with a cough formulation containing pseudoephedrine and dextromethorphan. The child made an uneventful recovery after an observation period of 4 hours in the emergency department. 

Memantine is chemically related to amantadine, and the manufacturer advises that concurrent use should be avoided or undertaken with caution because of the increased risk of adverse CNS-related drug reactions such as psychosis. Although there are no data, an increased risk is also predicted for ketamine and dextromethorphan, which are also NMDA antagonists. Avoidance of, or caution with, concurrent use is advised. 

The US manufacturer of tranylcypromine notes that the concurrent use of MAOIs and dextromethorphan has resulted in brief episodes of psychosis or bizarre behaviour. Similarly, the US manufacturer of phenelzine mentions one case of drowsiness and bizarre behaviour when dextromethorphan lozenges were used by a patient taking phenelzine. They also note that concurrent use of dextromethorphan may cause a reaction similar to... 

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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