Dextromethorphan is an over-the-counter medication for coughs caused by the common cold and flu. These drugs are widely available and generally safe, so they’re often the go-to for people when they have a cold.
If you’re pregnant or breastfeeding, however, it’s important to understand the risks of taking cold medication – both for you and your unborn baby. While research has demonstrated that dextromethorphan is generally safe during pregnancy, it’s extremely limited.
Key Points
- Dextromethorphan is an over-the-counter medication for cough from the common cold and flu.
- Dextromethorphan is generally considered safe to take during pregnancy, but there’s limited research into its effects on miscarriage, birth defects, and low birth weight.
- There are other risks to dextromethorphan, including drug interactions and dextromethorphan abuse.
What Is Dextromethorphan?
Dextromethorphan is an ingredient in over-the-counter and prescription cold and flu medications like Delsym or Robitussin. It may be sold as a single medication in pill, liquid, and cough drop forms or a multi-symptom cold, cough, and flu medication. It’s a cough suppressant and affects the brain’s signals that trigger the cough reflex.
Is Dextromethorphan Safe While Pregnant?
The research into the effects of dextromethorphan during pregnancy is limited.
One study looked at the infants of 184 women who took dextromethorphan anytime during their pregnancy and found no increased chance of stillbirth or low birth weight.[1] Studies have not been done to see if dextromethorphan increases the chances of other pregnancy-related problems, such as preterm delivery.[2]
Miscarriage and birth defects can occur with any pregnancy, with the latter at a rate of 3-5%.[3] Studies have not been done to see if taking dextromethorphan affects your ability to get pregnant or has any impact on future behavior or learning for the child.
Keep in mind that there are limited studies demonstrating the safety of dextromethorphan during pregnancy. However, studies have found a possible link between dextromethorphan and a small number of birth defects. It’s possible that the mothers used other drugs or combination medications that may have affected the results.[4]
You should always talk to your doctor about what medications are safe to take while pregnant, including over-the-counter medications like dextromethorphan.
Can I Breastfeed While Taking Dextromethorphan?
It’s important to be careful about what you ingest while breastfeeding, as many substances can pass through to the baby. One study looked at 20 breastfeeding people who took one dose of 30 mg of dextromethorphan and found that the medication transfers to breastmilk in small amounts.[5]
In this study, one baby had a rash that went away without treatment, but it’s not established if the rash was related to the medication in the breast milk or another cause. Because only small amounts are passed through breast milk, side effects in nursing children aren’t expected.
Dextromethorphan Side Effects, Risks, and Interactions
Dextromethorphan is generally well tolerated. One of the most common side effects is stomach upset. However, more serious side effects may include seizures or convulsions, confusion, hallucinations, slow and shallow breathing, severe dizziness, anxiety, restless feeling, or nervousness.[6]
If you experience signs of an allergic reaction, such as swelling of your face, tongue, lips, or throat, or difficulty breathing seek emergency medical help.
Dextromethorphan can have interactions with other drugs, including MAO inhibitors like:[7]
- Isocarboxazid
- Phenelzine
- Rasagiline
- Selegiline
- Tranylcypromine
- Methylene blue injection
Serious, life-threatening side effects can occur if you take dextromethorphan with these drugs.
You should also avoid using any other over-the-counter cough, cold, or allergy medication without discussing it with your doctor or pharmacists. It’s easy to accidentally overdose on combination medications without realizing it.
Several other drugs may interact with dextromethorphan, including celecoxib, cinacalcet, darifenacin, imatinib, quinidine, ranolazine, ritonavir, sibutramine, antidepressants, terbinafine, and medicines to treat high blood pressure.[8]
Avoid drinking alcohol while taking dextromethorphan – especially while pregnant. This can increase the risk of side effects from dextromethorphan and pose a risk to your unborn baby. If you struggle to stop drinking alcohol consider seeking the help of an alcohol addiction program. You should also avoid diet pills, caffeine pills, or other stimulants like ADHD medications without your doctor’s advice. Taking a stimulant with a cough medicine can increase the risk of side effects.
Dextromethorphan Abuse
Dextromethorphan is abused in high doses to experience euphoria and visual and auditory hallucinations. People may take different amounts to achieve these effects, with some ingesting as much as 1,500 milligrams in a single dosage – far more than the recommended therapeutic doses.[9]
On the street, the illicit use of dextromethorphan is referred to as “robo tripping,” “skittling,” or “dexing.” Often, dextromethorphan abuse involves drinking large volumes of OTC liquid cough preparations, but some people may abuse the tablet or gel capsule preparations.
Long-term abuse of dextromethorphancan can result in severe psychological dependence so seeking substance abuse treatment is essential if stopping is difficult. Using high doses of dextromethorphan in combination with alcohol or other drugs is particularly dangerous, especially while pregnant, and increases the risks of overdose and death.
The studies conducted on dextromethorphan and pregnancy evaluate the risk at occasional therapeutic doses. It’s not known how dextromethorphan abuse may affect you during pregnancy, but higher doses would likely increase the risk of adverse effects.
What Cold Medications Aren’t Safe During Pregnancy?
Though the research is limited for dextromethorphan during pregnancy, there are a few cough and cold medications that have demonstrated risks during pregnancy. Always follow your doctor’s recommendations for what drugs are safe for you.
- Nasal steroid sprays such as triamcinolone (Nasacort) may result in birth defects in the respiratory tract when taken during pregnancy.[10]
- Oral decongestants like pseudoephedrine (Sudafed) have limited research into their safety during pregnancy. However, some studies show a higher risk of birth defects, so it’s best to avoid them during the first trimester.[11]
- Nasal decongestant sprays like oxymetazoline (Afrin) may be linked to birth defects.[12] However, little research exists, so your medical provider may recommend them for a limited duration since the medication is directed only into the nose.
- Liquid medications that contain alcohol can cause pregnancy loss, birth defects, and developmental problems in your baby.[14] Make sure liquid medication is alcohol-free.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen should be avoided at 20 weeks or later in pregnancy since they can decrease the amount of fluid in your belly that protects your baby and may impact the development of the baby’s lungs, kidneys, and other organs.[13]
- Combination products like DayQuil contain multiple medications, some of which may not be safe during pregnancy, such as phenylephrine and pseudoephedrine.
Stay Safe During Pregnancy
Dextromethorphan may be safe to take during pregnancy if you have a cold or the flu, but the research is limited. There are other risks and interactions with dextromethorphan as well, including possible abuse and serious side effects. Talk to your doctor about what medications are safe for you to take during pregnancy.