Dextromethorphan (DXM) & Sleeping pills
DXM is a cough suppressant that acts on the central nervous system (CNS) and has dissociative and some sedative properties. It is sometimes found in over-the-counter cough and cold medications. When combined with sleeping pills, there is a potential for increased sedation and respiratory depression, which can be dangerous.
The mechanism of interaction between DXM and sleeping pills is primarily due to their combined sedative effects on the CNS. Dextromethorphan acts on the N-methyl-D-aspartate (NMDA) receptor and inhibits glutamate, an excitatory neurotransmitter. This leads to a decrease in neuronal activity, which can result in sedation. Also, it acts like a nonselective serotonin reuptake inhibitor.
Sleeping pills, such as benzodiazepines and non-benzodiazepine sedative-hypnotics, enhance the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that reduces brain activity and promotes sleep. And even if the mechanism of action of sleeping pills differs from benzodiazepines and does not involve direct interaction with DXM, the general vector for CNS depression allows us to predict undesirable reactions.
The side effects of combining DXM and sleeping pills can include excessive sedation, dizziness, confusion, slowed breathing, and even coma. It is important to note that the risks associated with this combination are higher in individuals with respiratory problems, and those who are older or have other medical conditions.
Consider the interactions of DXM with various groups of sleeping pills:
Benzodiazepines: Temazepam, Estazolam, Triazolam, Diazepam (Valium). In a bad trip, small amounts of benzodiazepines can be used to help alleviate symptoms. However, it's important to note that combining these substances can increase the risk of ataxia and sedation, which could lead to an unexpected loss of consciousness at higher doses. If this happens, there is a risk of vomit aspiration if the person is not placed in the recovery position. So, it's essential to use caution when using benzodiazepines to manage a DXM bad trip.
In the case of most other groups of sleeping pills, adverse reactions similar to benzodiazepines are expected. At the same time, the use of other groups of sleeping pills to manage the bad trip may be less effective. Other groups include:
Non-Benzodiazepine Hypnotics (Zolpidem, Eszopiclone, Zaleplon).
Melatonin Receptor Agonists (Ramelteon, Tasimelteon ).
Orexin Receptor Antagonists (Suvorexant).
Barbiturates (Phenobarbital, Pentobarbita).
Antihistamines: Diphenhydramine, Doxylamine. Drugs from this group can load the cytochrome P450 system. Namely, the enzyme CYP2D6, which is responsible for the processing of DXM. As a result, the concentration and elimination of the substance will be difficult, which will increase the risks of serious adverse reactions. Such as respiratory depression, confusion, decreased blood pressure, tachycardia, drowsiness or dizziness, severe nausea or vomiting, muscle hypertonicity, irritability or motor restlessness, and ataxia.
Some antidepressants can also be effective at promoting sleep (Trazodone, Doxepin). In this case, the risks are much greater. Using DXM together with antidepressants can increase the chance of serotonin syndrome. Some of the symptoms include confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, shaking, muscle spasms, nausea, vomiting, and diarrhea. Severe cases can result in coma and even death.
Considering the above, we recommend treating this combination with great caution or in some cases avoiding this combination under any conditions.
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