Concomitant use of dextromethorphan and alcohol-induced dissociation in a patient with alcohol dependence.

Dextromethorphan (DXM), an over-the-counter drug commonly abused by teenagers, acts as a low-affinity NMDA receptor antagonist. A patient with alcohol dependence experienced acute psychotic dissociation after using DXM and alcohol together, making it difficult to distinguish from alcohol withdrawal symptoms. The psychotic symptoms improved with haloperidol, but haloperidol should be avoided in cases of DXM abuse. Clinicians should consider the possibility of various addictive drugs when consulting patients with addiction. Concomitant use of DXM and alcohol causes easy dissociation, and high-dose DXM usage and alcohol withdrawal symptoms are hard to distinguish.

Study at a glance

Abstract

Dextromethorphan (DXM) is an over-the-counter drug that is commonly abused by teenagers. Its main pharmacological property is a low-affinity N-methyl-d-aspartate (NMDA) receptor antagonist. We report acute psychotic dissociation induced by DXM and alcohol in a patient with alcohol dependence, which made it difficult to distinguish alcohol withdrawal symptoms with limited information. The psychotic symptoms were ameliorated by haloperidol; however, in cases of DXM abuse, haloperidol treatment should be avoided. In the consultation of patients with addiction, the possibility of various addictive drugs must be kept in mind. The concomitant use of DXM and alcohol causes easy dissociation and high-dose usage of DXM and alcohol withdrawal symptoms are difficult to distinguish.