Discussion: Alcohol & Dextromethorphan (DXM)

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Alcohol & Dextromethorphan (DXM)​

Alcohol, also known as ethanol, is a psychoactive substance that affects the central nervous system (CNS) and has a wide range of effects on the human body.

Alcohol primarily acts on the CNS, producing a range of effects from mild euphoria to sedation, impaired judgment, and decreased motor coordination.

Interaction with Neurotransmitters:

• Gamma-Aminobutyric Acid (GABA): Alcohol enhances the effects of GABA, an inhibitory neurotransmitter. This leads to decreased neural activity, resulting in sedative effects.
• Glutamate: Alcohol inhibits the effects of glutamate, an excitatory neurotransmitter. This further reduces brain activity and contributes to the depressant effects of alcohol.
• Effects on Ion Channels: Alcohol can interfere with the function of several ion channels, including potassium (K+) and calcium (Ca2+) channels. This can alter the electrical activity of neurons.

Effects on the Body: The liver is the primary organ responsible for metabolizing alcohol. Moderate alcohol consumption may have protective effects on the heart, but excessive consumption can lead to hypertension, cardiomyopathy, and arrhythmias. Alcohol can irritate the stomach lining, leading to gastritis and ulcers. It can also affect the pancreas, leading to pancreatitis. Chronic alcohol use can lead to neurological disorders, including peripheral neuropathy and Wernicke-Korsakoff syndrome. Alcohol can disrupt the hormonal balance, affecting processes like reproduction, stress response, and metabolism.


Dextromethorphan (DXM) is an over-the-counter cough suppressant commonly found in many cough and cold medications. I

DXM primarily acts as an antagonist at the N-methyl-D-aspartate (NMDA) receptor. By blocking this receptor, DXM can suppress the cough reflex in the brain. The NMDA receptor is also involved in excitatory neurotransmission, and its blockade can lead to some of the psychoactive effects seen with higher doses of DXM.

Also, DXM has been shown to interact with the sigma-1 receptor, which may contribute to its analgesic and potential antidepressant effects.

At higher doses, DXM can inhibit the reuptake of serotonin, which can lead to increased serotonin levels in the brain. This mechanism may contribute to some of the mood-altering effects of DXM when taken in excessive amounts.

At higher doses, DXM can produce psychoactive effects, including euphoria, hallucinations, and dissociation.
Some studies suggest that DXM may have analgesic (pain-relieving) properties, although this is not its primary indication. Preliminary research has indicated that DXM, especially in combination with other medications, might have antidepressant effects. However, more research is needed in this area.


Interaction between alcohol and DXM is a topic of concern due to the potential risks and side effects associated with their combined use.

Both alcohol and DXM are CNS depressants - they slow down CNS. When taken together, they can have additive or synergistic effects, leading to enhanced CNS depression. This can result in drowsiness, dizziness, and impaired motor coordination.

The liver metabolizes both alcohol and DXM. Consuming them together can alter the way the liver processes these substances, potentially leading to increased levels of one or both in the bloodstream.

One of the most serious risks of combining alcohol and DXM is respiratory depression. This is a condition where breathing becomes shallow or may stop altogether, which can be life-threatening.

The combined sedative effects of alcohol and DXM can lead to significantly impaired judgment, coordination, and reaction times. This increases the risk of accidents and injuries.

Effects of both compounds can increase the risk of overdose, especially if large amounts of either or both substances are consumed.

Alcohol and DXM can irritate the stomach lining, leading to nausea, vomiting, and potentially gastritis or ulcers.

Absolutely refrain from using beyond the 1st plateau of DXM (1.5 - 2.5 mg/kg).

All things considered, we recommend avoiding this combination under any conditions.