DXM (dextromethorphan) For Opiate Withdrawal

Opiate withdrawal can be extremely challenging both mentally and physically. Opiates are considered the most difficult drugs to discontinue, along with cigarettes. But with the right combination of support and information, relief during opiate withdrawal is possible.

In this guide, I'm going arm you with practical advice to reduce the severity of your opiate withdrawal symptoms immediately.

DXM For Opiate Withdrawal?

Research has shown that DXM or dextromethorphan is in fact useful for reducing some of the symptoms of opiate withdrawal.

That being said, DXM is also a dangerous substance if you aren't careful about the dosage. For example, an excessive dose of DXM could trigger a dissociative state with hallucinations. The effects of DXM at high doses are analogous to the hallucinogenic states produced by ketamine and PCP.

Before trying anything yourself, it's always recommended to consult a physician during withdrawal. Drug combinations like naloxone plus trazodone (or clonidine) effectively ease opiate withdrawal.

What's DXM?

Dextromethorphan is a cough suppressant and common over-the-counter ingredient in cough medicines. DXM has sedative and dissociative properties and has also found other uses in medicine for pain relief and the treatment of addiction.

Despite it's application in the treatment of addiction, DXM is also used recreationally. The recreational use of DXM is referred to as "robotripping" and is popular amongst some teenagers since DXM is available over-the-counter.

Basic DXM Pharmacology

To better understand why DXM helps relieve opiate withdrawal symptoms, we're going to need to discuss DXM pharmacology. DXM "works" via the following mechanisms:

  • Inhibits serotonin re-uptake (increasing serotonin like SSRI antidepressants)
  • Activates the sigma-1 receptor
  • Blocks the NMDA receptor (a glutamate receptor)

DXM's pharmacology is similar to the anesthetic ketamine, which is now being used clinically as a rapid-acting antidepressant.

DXM's ability to block NMDA (glutamate) receptors is what contributes to DXM's anti-addictive properties.*

*This is not technically correct, because DXM's affinity for the NMDA receptor is too low to be clinically meaningful. Instead, DXM is a prodrug for the main metabolite, dextrorphan, which more strongly antagonizes (blocks) NMDA receptors.

DXM For Opiate Withdrawal: Evidence Review

What's the evidence that DXM actually helps reduce the severity of opiate withdrawal?

A clinical study published in 2013 reported that DXM effectively relieves withdrawal symptoms. The study was double-blind and randomized. Participants were allocated to two groups: one group received clonidine alone (0.4-1.2mg/day), and the other received clonidine plus dextromethorphan (300 mg/day).

Withdrawal symptom severity was evaluated at the following intervals: 24h, 48h and 72h. On the second day, the withdrawal symptoms of the clonidine + DXM group decreased significantly (P < 0.001). To read more about the clinical study, click here.

Neuronal Target Binding Affinities
Noncompetitive NMDA receptor antagonist Ki = 7,253
Sigma-1 and Sigma-2 receptor agonist Ki = 150 nM and 11,060 nM, respectively
Nicotinic acetylcholine antagonist Ki in micromolar range
mu, dela, and kappa-opioid antagonist Ki = 1,280 nM, 11,500 nM, 7,000 nM, respectively
Serotonin and norepinephrine transporter inhibitor Ki = 23 nM and 240 nM
NADPH oxidase inhibitor _