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Dextromethorphan poisoning: Treatment

Chris Rosenbaum, MD, MSc, FACEP
Edward W Boyer, MD, PhD
Section Editor
Michele M Burns, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH


The treatment of dextromethorphan poisoning will be reviewed here. The epidemiology, pertinent pharmacology, and clinical features of dextromethorphan poisoning are discussed separately. (See "Dextromethorphan abuse and poisoning: Clinical features and diagnosis".)

Related issues such as methylenedioxymethamphetamine (MDMA) abuse, serotonin syndrome, anticholinergic poisoning, ketamine intoxication, phencyclidine (PCP) intoxication, ethanol intoxication, and a general approach to management of the poisoned patient are presented elsewhere. (See "MDMA (ecstasy) intoxication" and "Serotonin syndrome (serotonin toxicity)" and "Anticholinergic poisoning" and "Ketamine poisoning" and "Phencyclidine (PCP) intoxication in children and adolescents" and "Ethanol intoxication in children: Clinical features, evaluation, and management" and "General approach to drug poisoning in adults" and "Approach to the child with occult toxic exposure".)


The clinical features and diagnosis of dextromethorphan poisoning are discussed separately. (See "Dextromethorphan abuse and poisoning: Clinical features and diagnosis".)


Recommendations for care of children and adults with dextromethorphan poisoning are derived from case series and reports and are driven by physical findings. The treatment of dextromethorphan poisoning is primarily supportive. (See "Dextromethorphan abuse and poisoning: Clinical features and diagnosis", section on 'Clinical features'.)

In addition, to careful assessment and support of airway, breathing, and circulation as needed, the clinician should anticipate and aggressively manage dissociative signs and symptoms (eg, psychosis, hallucinations, agitation), hyperthermia, rhabdomyolysis, and dehydration [1-4]. Specific antidotal therapy may be necessary for patients who manifest coma and respiratory depression, serotonin syndrome, or concomitant anticholinergic poisoning. (See 'Naloxone' below and 'Other toxins' below.)

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Literature review current through: Nov 2017. | This topic last updated: May 12, 2017.
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