Pharmacokinetics and pharmacodynamics of dextromethorphan: clinical and forensic aspects
Drug metabolism reviews (Softcover ed.) April 2, 2020 Ana Rita Almeida Calixto Silva, R. Dinis-Oliveira
Dextromethorphan (DXM), a common cough suppressant in over-the-counter medications, can produce psychoactive effects at high doses, leading to abuse. This review describes DXM's metabolism, including sequential O-demethylation and N-demethylation by enzymes to produce dextrorphan (the major active metabolite) and other compounds, as well as glucuronide conjugation. Genetic variations in metabolizing enzymes and drug interactions cause large differences between individuals in DXM's effects and toxicity. Understanding this metabolism helps explain variable responses and avoid adverse effects.