Facts about Cold and Cough Medications:  cough_syrup

  • Several of the cough and cold medications that can be purchased over the counter (OTC), as well as prescription cough/cold medications, have active ingredients that can cause mind altering effects, when taken in amounts that are above the recommend dosages.
  • Because the medications have the ability to produce psychoactive/mind altering effects, these medications are often abused.  When taken in large doses the medications can produce mild euphoric effects, a feeling of detachment from the environment, distorted sensory perceptions, and even hallucinations.
  • Over the counter cough and cold medications, with the active ingredient Dextromethorphan (DXM), are the most commonly abused.
  • These drugs are frequently abused by young people because they are so easy to obtain, and on occasion are used as a way to cope with psychiatric disorders (Ackerman, 2010).  When the drug is taken in large amounts to obtain a high it is sometimes referred to as “robo-tripping”.  Taken from the brand name Robitussin.



  • Another medication that is often abused is Promethazine-codeine cough syrup.  This medication is available by prescription only, but as with any other prescription drugs of abuse, people find a way to obtain it.  It is a popular choice for abuse because it contains the opioid codeine. It also contains promethazine HCl, an antihistamine that can cause sedation.
  • Opioid medications work very well as a cough suppressant.  However, they can also produce relaxation and euphoria when consumed at a higher-than-prescribed dose. So the relaxing, euphoric, and sedating effects of  promethazine-codeine cough syrup, make it a popular choice to be diverted for abuse.



  • Abuse of promethazine-codeine cough syrup increased in popularity during the late 1990s.  This trend was attributed to frequent references to the drug in some popular music during that time. Some song titles included: “Sippin’ on Some Syrup”, “Sippin’ and Spinnin”, and “Talkin’ Sizzurp”, just to name a few (Mann, 2011).  The drug trend became the new “thing to do” among youth that were looking to “get high”.  It is often referred to by teens as skittling, dexing, and robotripping.  New names are frequently created, as slang terms, for illicit drug use.cough-med-teens.jpg
  • The cough syrup is often mixed with soda, alcohol, or candy, and given street names such as sizzurp, purple drank, barre, or lean (Mann, 2011).
  • Pseudoephedrine is another cold medicine that needs to be controlled now due to abuse.  The ingredient is found in many nasal decongestants and over the counter cold medicines.  Unfortunately, products with this ingredient are often used in the production of methamphetamine.  For this reason, products containing pseudoephedrine are sold “behind the counter” nationwide. Some states now even require you to obtain a prescription, and there are strict limits on how much of the medication a person is allowed to purchase each month (NIDA, 2017).



How abuse of cough/cold medication’s affect the body:

  • When used as directed, these medications safely treat the symptoms and discomfort caused by colds, cough, flu, and respiratory congestion. But when taken in higher quantities, or used frequently when such symptoms aren’t present, they can affect the brain in ways that are very similar to the effects of illegal drugs.
  • When taken in high doses, Dextromethorphan (DXM) acts on the same cell receptors as dissociative hallucinogenic drugs, such as PCP or ketamine. Users have describe feeling sensations of physical distortion and hallucinations.  Some people are also susceptible to experiencing panic attacks when consuming high doses.  DXM is not a safe drug, and it has not been well studied at recreational levels; if taken for purposes other than intended, you are taking a risk, possibly a big one.
  • Codeine works on the same nerve cells in the brain as all other opioids, including illegal opioids like heroin. Opioid drugs can produce a feeling of euphoria, especially when ingesting higher doses than are prescribed. This can also contribute to addiction.  People who are addicted to these drugs often take several times the recommended safe amount, due to a tolerance that is acquired after a short period of using the drug, as well as an attempt to achieve feelings of euphoria.
  • Both codeine and promethazine HCl cause depression of the central nervous system, producing sedating or calming effects.  It is very dangerous to consume high doses of drugs that depress the central nervous system.  Our respiratory center is also located in the central nervous system.  Depressing the respiratory center can result in respiratory arrest (cessation of breathing).
  • Many of the cough and cold medications also contain an expectorant, called guaifenesin, which can cause nausea if taken in large amounts.

Dangers of Abusing Cough Medication

  • Every year hospital emergency departments treat approximately 12,000 cases of overdose related to cold or cough medications (NIDA, 2017).  In addition, there are many medications, such as antidepressants, diet pills, certain antihistamines, among many others, that can interact negatively with dextromethorphan.  For example, taking DXM with Desyrel (trazodone) or Serzone (nefazodone) has resulted in severe cases of permanent liver damage.  Taking too much DXM with an antidepressant, that affects serotonin levels in your brain, can result in a life threatening condition called serotonin syndrome.  Some herbal remedies such as Yohimbine have resulted in permanent brain damage, when taken with DXM.  In summary, hopefully I have conveyed the message that DXM is not a drug that can be safely used recreationally, and can result in serious consequences to your health.
  • Many people don’t realize that dextromethorphan has effects on serotonin in the brain.  These effects are similar to the those of the common antidepressants, such as Paxil, Prozac, and Celexa, to name a few.  Therefore, if dextromethorphan is taken over long periods of time people can also experience withdrawal symptoms similar to antidepressant withdrawal syndrome.  Symptoms can include disturbances in mood, thinking, sleep, as well as increased feelings of anxiety and depression.
  • Opioid withdrawal can include muscle and bone pain, trouble sleeping, diarrhea, vomiting, very uncomfortable uncontrollable leg movements that can prevent a person from being able to sit still, chills and cold flashes combined with heavy sweating, and severe cravings.  Repeatedly seeking to experience the initial euphoric feeling, combined with cravings, and extremely uncomfortable withdrawal symptoms, can lead to addiction.
  • Substance use disorder (also referred to as addiction) is a chronic relapsing brain condition characterized by inability to stop using a drug despite damaging consequences to a person’s life and health.  Many people need help to stop using a drug that they are physically and/or psychologically dependent on.  The best way to help a loved one, or yourself, experiencing addiction issues is to obtain professional guidance and treatment.  Many treatment centers today include outpatient programs.  If you need help I have compiled a list of Helplines & Crisis Hotlines There are helplines for parents, individuals, teenagers, and even text options to reach help.  So please don’t be afraid or hesitant to reach out if you are struggling.


  • The most serious side effects from abusing these medications can include brain damage or even death.  The sedating effects of these drugs can cause depression in the respiratory center, located in the central nervous system.  This can deprive the brain and other parts of the body of oxygen and result in serious consequences to the individual.  It is not safe to use cough and cold medications recreationally (for fun), it’s not worth the risk.


Ackerman, S. (2010). “Dextromethorphan Abuse and Dependence in Adolescents”. Journal of Dual Diagnosis.

Mann, L. (2011). Top ten songs about ingesting cough syrup for leisure.  Retrieved from http://www.dallasobserver.com/music/listomania-top-ten-songs-about-ingesting-cough-syrup-for-leisure-7050435

National Institute on Drug Abuse [NIDA]. (2017). Over-the-Counter Medicines. Retrieved from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines on 2017, December 22

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