The drug hardly causes typical opioid side
effects. High and very high doses in particular can
cause neuropsychiatric symptoms (euphoria, restlessness,
misperception, hallucination, "schizophrenic" reactions)
that are similar to the effects of the hallucinogenic agent
phencyclidine. It has not been established whether these
problems are related to the metabolic phenotype of the
individuals. Besides that, there are gastrointestinal
symptoms and skin reactions. The most immediate risk arising
from dextromethorphan seems to be its sporadic abuse.
A few cases of addiction have been recorded.
In combination with monoamine oxydase inhibitors
dextromethorphan can cause a severe reaction ("serotogenic
syndrome" with fever, hypertension, arrhythmias): avoid this
combination if possible!
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