Morphinan · Dissociative
5 dangerous interactions — combining DXM with certain substances may be life-threatening.
Updated
Mar 16, 2026
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Dextromethorphan (DXM) is a dissociative found in over-the-counter cough medicines. At recreational doses it produces dissociative and psychedelic effects. It carries significant serotonergic activity, making it dangerous in combination with SSRIs, MAOIs, tramadol, and MDMA. It is metabolized by CYP2D6, and poor metabolizers are at higher risk of adverse effects.
Last updated
Mar 16, 2026
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If someone is in crisis, call 911 or Poison Control: 1-800-222-1222
No dosage data available.
Full dosage guideNo duration data available.
| Substance | Status | Note |
|---|---|---|
| Alcohol | Dangerous | Both are CNS depressants. DXM at recreational doses combined with alcohol can cause dangerous respiratory depression, loss of motor control, and vomiting while unconscious (aspiration risk). |
| MAOIs | Dangerous | DXM is serotonergic and MAOIs prevent serotonin breakdown. This combination has caused deaths from serotonin syndrome. One of the most dangerous OTC drug interactions. |
| MDMA | Dangerous | Both substances are strongly serotonergic. The combination carries high risk of serotonin syndrome, hyperthermia, and potentially death. |
| Tramadol | Dangerous | Both substances have significant serotonergic activity and both lower the seizure threshold. The combination carries high risk of serotonin syndrome and seizures. |
| SSRIs | Unsafe | DXM has significant serotonergic activity. Combined with SSRIs, there is meaningful risk of serotonin syndrome. Several cases have been reported, some serious. This combination should be avoided. |
| Ketamine | Caution | Both are dissociatives and CNS depressants. The combination intensifies dissociation and increases risk of loss of consciousness and respiratory depression. |
No toxicity data available.
The combinations listed below may be life-threatening. Independent research should always be conducted to ensure safety when combining substances.
Both are CNS depressants. DXM at recreational doses combined with alcohol can cause dangerous respiratory depression, loss of motor control, and vomiting while unconscious (aspiration risk).
DXM is serotonergic and MAOIs prevent serotonin breakdown. This combination has caused deaths from serotonin syndrome. One of the most dangerous OTC drug interactions.
Both substances are strongly serotonergic. The combination carries high risk of serotonin syndrome, hyperthermia, and potentially death.
DXM has significant serotonergic activity. Combined with SSRIs, there is meaningful risk of serotonin syndrome. Several cases have been reported, some serious. This combination should be avoided.
Both substances have significant serotonergic activity and both lower the seizure threshold. The combination carries high risk of serotonin syndrome and seizures.
| Full | Unknown |
| Half | Unknown |
| Zero | Unknown |
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