dextromethorphan / Generic mfg. - LARVOL DELTA

In-silico, in-vitro, and proteomics analyses on repurposed drugs in targeting the small GTPase, Rho subfamily protein (Rho GTPase), and putative Rho GTPase-activating protein (RhoGAP) of Giardia lamblia. (PubMed, J Genet Eng Biotechnol) - "Giardia lamblia is a globally prevalent protozoan responsible for Giardiasis, an intestinal disease commonly treated with nitroimidazoles such as metronidazole, tinidazole, and albendazole...Target sequence analysis revealed Dextromethorphan and Azathioprine as candidate Rho GTPase inhibitors, and Imatinib, Dasatinib, and Ponatinib as RhoGAP inhibitors...These findings highlight RhoGAP as a promising therapeutic target in G. lamblia, with Dasatinib showing potential as a repurposed treatment for Giardiasis. Proteomic data are publicly available in the MASSIVE database under identifier MSV000097321."

Journal • Preclinical • Gastrointestinal Disorder • Infectious Disease

Awareness and practices of community pharmacists toward dextromethorphan misuse in Jeddah, Saudi Arabia: implications for regulation and public health. (PubMed, Front Med (Lausanne)) - "Their broad support for regulatory restrictions and preventive campaigns indicates readiness to contribute to public health strategies. Nonetheless, limited confidence in managing suspected cases highlights the need for targeted training and continued research across multiple regions to inform effective regulatory and educational responses."

Journal • Cough • Respiratory Diseases

The effect of dextromethorphan on reward-related behaviors: A systematic review of preclinical and clinical evidence. (PubMed, J Affect Disord) - "Extant literature suggests that DXM administration attenuates reward-related behaviors in rats. There is a paucity of human studies investigating the effect of DXM on reward outcomes. Future research should prioritize the investigation of the effect of DXM on validated reward paradigms in persons with anhedonia."

Journal • Preclinical • Review • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Psychiatry

Time Course of Serum Dextromethorphan Concentrations in a Case of Serotonin Syndrome After Massive Overdose. (PubMed, Am J Case Rep) - "CASE REPORT A 24-year-old man with bipolar disorder and attention-deficit/hyperactivity disorder, treated with trazodone and methylphenidate, ingested 300 mg of DXM (4.6 mg/kg)...He developed serotonin syndrome with spontaneous clonus and seizures, requiring diazepam, sedation, intubation, and ventilation...CONCLUSIONS Our case report provides a detailed timeline of blood DXM concentrations along with the clinical course in a patient with serotonin syndrome after an acute overdose. The serial measurements support the importance of symptom-focused monitoring to guide treatment decisions."

Journal • ADHD (Impulsive Aggression) • Anesthesia • Attention Deficit Hyperactivity Disorder • Bipolar Disorder • CNS Disorders • Epilepsy • Mood Disorders • Psychiatry

Comparing synaptic mechanisms of iTBS and 10-Hz rTMS corticomotor plasticity. (PubMed, Transcranial Magn Stimul) - "However, 10-Hz rTMS benefitted from NMDAR agonism with d-cycloserine (DCS) more than iTBS (β = 0.516, p < 0.001), which was partially attenuated by adding NMDAR antagonist dextromethorphan (DXM) to DCS. To test whether GABAR removal contributes to enhanced MEP excitability, as suggested by animal studies with 10-Hz, we reasoned that inhibition induced by GABAR agonism via lorazepam (LZP) would be less than at baseline, after GABAR removal by TMS...Nevertheless, it is the first to compare the synaptic-level mechanisms of iTBS and 10-Hz rTMS, suggesting both iTBS and 10-Hz act predominantly through NMDAR-dependent LTP-like mechanisms rather than GABAergic mechanisms. The differential effects between protocols (i.e., 10-Hz produced more facilitation with DCS and more inhibition with LZP) could be accounted for by iTBS producing occlusion with DCS and compensatory facilitation with LZP, but this is speculative and requires preclinical work to confirm."

Clinical • Journal • CNS Disorders • Depression • Psychiatry

Multifactorial Myeloneuropathy and HHV6 Encephalomyelitis Following Allogeneic Transplant in a Patient with Secondary AML (SNO 2025) - P1 | "Superimposed viral infections such as HHV6 further complicate the clinical picture.Case Presentation:A 31-year-old woman with secondary AML arising from CML (MECOM rearrangement, complex karyotype) underwent allogeneic stem cell transplant from a 10/10 HLA matched unrelated donor on clinical trial (NCT03802695) following thiotepa, busulfan, and fludarabine conditioning with ex vivo engineered graft (Naive T cell depleted; OrcaQ graft) with no post HCT immunosuppression...She was treated empirically with B12/B9/B6, dextromethorphan, SAM, leucovorin, IVIG, steroids, and plasma exchange without neurological improvement.Subsequent CSF demonstrated high HHV6 viral load and elevated protein and HHV6 viremia. She started on foscarnet...This case highlights a multifactorial neurologic syndrome involving myeloneuropathy and encephalitis, likely due to overlapping neurotoxicity from intrathecal chemotherapy, craniospinal radiation, and HHV6. Serial CSF and imaging studies..."

Clinical • Acute Myelogenous Leukemia • CNS Disorders • Hematological Malignancies • Immunology • Infectious Disease • Leukemia • Pain • Transplantation • Urinary Incontinence • Urology • MBP • MECOM

A Study to Investigate the Effect of Capivasertib on the Pharmacokinetics of Oral Dextromethorphan (CYP2D6 Substrate) in Healthy Participants (clinicaltrials.gov) - P1 | N=35 | Not yet recruiting | Sponsor: AstraZeneca

New P1 trial

Comparative Analysis of Classic and Novel Antitussives on Cough Suppression in Guinea Pigs. (PubMed, Pharmaceutics) - " This study evaluated and compared the antitussive efficacy of classic (codeine, cloperastine, dextromethorphan, levodropropizine) and novel (gefapixant) agents using a citric acid-induced cough model in guinea pigs. These findings highlight the potential clinical relevance of both centrally and peripherally acting non-opioid alternatives. Continued investigation of these agents may help address the unmet need for safer and more effective cough treatments."

Journal • Cough • Respiratory Diseases

The Toxicity of Impurities of Illicit Heroin in Rats. (PubMed, J Appl Toxicol) - "Different heroin samples were analyzed using gas chromatography and classified into four distinct groups, labeled A, B, C, and D, based on the presence of pharmaceutical additives such as acetaminophen, caffeine, and dextromethorphan...The results showed that each type of heroin had a specific pattern of tissue toxicity, and the extent of brain and liver damage varied among the groups. The findings of this research emphasize the importance of accurately identifying the composition of heroin available in the market and its impact on consumers' health, which can serve as a basis for preventive measures and harm reduction policies related to substance abuse."

Journal • Preclinical • CNS Disorders • Psychiatry • Substance Abuse

Serotonin syndrome induced by Bromfed DM in a patient on sertraline. (PubMed, SAGE Open Med Case Rep) - "It is commonly linked to combinations of serotonergic prescription drugs; however, over-the-counter or prescription cold medications containing dextromethorphan (DM) or first-generation antihistamines may also pose a risk. This case underscores the importance of recognizing the serotonergic potential of common cold medications and the risk of SS even at therapeutic doses, particularly in patients on selective serotonin reuptake inhibitors (SSRIs). Prompt identification and cessation of the causative agents are critical to avoid complications."

Journal • Cough • Respiratory Diseases

An Evaluation of the Drug Interaction Potential of Encorafenib in Combination With Binimetinib Using the Inje Cocktail in Patients With Cancer. (PubMed, Clin Pharmacol Ther) - "A clinical drug-drug interaction (DDI) study was designed to evaluate the effect of single and multiple oral doses of encorafenib on the single oral dose pharmacokinetics (PK) of the cytochrome P450 (CYP) enzyme probe substrates, losartan (CYP2C9), midazolam (CYP3A4), caffeine (CYP1A2), omeprazole (CYP2C19), and dextromethorphan (CYP2D6) administered as a cocktail (Inje). Based on these results regarding co-administration with encorafenib, sensitive substrates of CYP3A should be avoided or dose adjusted based on the recommendations of their approved product labeling. This information has been included in the updated prescribing information for encorafenib."

Journal • Oncology • Solid Tumor • BRAF • CYP1A2 • CYP2C19 • CYP2C9 • CYP3A4

Multifactorial Myeloneuropathy and HHV6 Encephalomyelitis Following Allogeneic Transplant in a Patient with Secondary AML (WFNOS 2025) - P1 | "Superimposed viral infections such as HHV6 further complicate the clinical picture.Case Presentation:A 31-year-old woman with secondary AML arising from CML (MECOM rearrangement, complex karyotype) underwent allogeneic stem cell transplant from a 10/10 HLA matched unrelated donor on clinical trial (NCT03802695) following thiotepa, busulfan, and fludarabine conditioning with ex vivo engineered graft (Naive T cell depleted ; OrcaQ graft) with no post HCT immunosuppression...She was treated empirically with B12/B9/B6, dextromethorphan, SAM, leucovorin, IVIG, steroids, and plasma exchange without neurological improvement.Subsequent CSF demonstrated high HHV6 viral load and elevated protein and HHV6 viremia. She started on foscarnet...This case highlights a multifactorial neurologic syndrome involving myeloneuropathy and encephalitis, likely due to overlapping neurotoxicity from intrathecal chemotherapy, craniospinal radiation, and HHV6. Serial CSF and imaging studies..."

Clinical • Acute Myelogenous Leukemia • CNS Disorders • Hematological Malignancies • Immunology • Infectious Disease • Leukemia • Pain • Transplantation • Urinary Incontinence • Urology • MBP • MECOM

Methotrexate Induced Central Nervous System Manifestations in Children Receiving Treatment for Acute Lymphoid Malignancies (ASH 2023) - "Treatment of MTX-induced CNS manifestations consisted of therapeutic drainage of cerebrospinal fluid (CSF) with their scheduled IT chemotherapy administration (65%), acetazolamide (57%), theophylline + leucovorin + dextromethorphan (64%), and addition of hydrocortisone with IT medications (36%). These patients responded well to acetazolamide and therapeutic drainage of CSF. Finally subcortical while matter changes on T2/FLAIR MRI was a common CNS manifestation."

Clinical • Acute Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Oncology

New advances in small molecule drugs targeting NMDA receptors. (PubMed, Acta Pharmacol Sin) - "Among various therapeutic indications, depression has emerged as an especially active area of investigation, with mechanistically diverse compounds ranging from broad-spectrum channel blockers (ketamine, dextromethorphan, esmethadone) to glycine site modulators (rapastinel, 4-chlorokynurenine, D-cycloserine) and allosteric modulators (apimostinel, zelquistinel), progressing through clinical pipelines. Beyond depression, NMDA receptor-targeted drug discovery is also advancing in other challenging CNS disorders, including neurodegenerative diseases (salzanemdor, NYX-458), pain (NYX-2925), epilepsy (radiprodil), and stroke (nelonemdaz, NP10679). Collectively, these developments reflect the maturation of NMDA receptor pharmacology and reaffirm the broad therapeutic potential of NMDA receptor modulation, while highlighting promising directions for future drug discovery."

Journal • Review • Cardiovascular • CNS Disorders • Depression • Epilepsy • Mental Retardation • Pain • Psychiatry

Severe Drug-Induced Liver Injury From Chronic Stimulant Use Exacerbated by Over-The-Counter Cough Syrup (ACG 2025) - "Dextromethorphan acts as a competitive inhibitor, potentially impairing amphetamine clearance and increasing toxicity. Clinicians should maintain a high index of suspicion for DILI in patients on stimulant therapy presenting with acute liver injury, particularly in the presence of interacting agents."

ADHD (Impulsive Aggression) • Asthma • Attention Deficit Hyperactivity Disorder • Autoimmune Hepatitis • CNS Disorders • Cough • Fibrosis • Hepatology • Immunology • Inflammation • Liver Cirrhosis • Liver Failure • Psychiatry • Respiratory Diseases

A SHOT OF TROUBLE: OMALIZUMAB-INDUCED ANAPHYLAXIS: A CASE REPORT (CHEST 2025) - "Following this she was given IV dextromethorphan, IV steroids, and IM epinephrine in the office itself then was taken to the Emergency room, where she ultimately required intubation. Given the potential risks, adherence to safety recommendations—such as a 2-hour observation period after initial doses and ensuring patients have epinephrine pens—is crucial. It is also important to discuss the potential for anaphylaxis when considering omalizumab as a treatment option with the patient."

Case report • Clinical • Asthma • Cardiovascular • Dermatology • Immunology • Inflammation • Respiratory Diseases • Urticaria

Anaphylaxis to dextromethorphan with positive skin testing: a case report. (PubMed, Allergy Asthma Clin Immunol) - "This case highlights an uncommon allergy to a combination cold medicine, with skin testing identifying DM as the cause."

Journal • Allergy • Cough • Immunology • Respiratory Diseases

METHOTREXATE-INDUCED STROKE-LIKE SYNDROME IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA (SIOP 2025) - "Background and Aims: Methotrexate-induced Stroke-like syndrome is characterized by symptoms resembling cerebral ischemia or hemorrhage, not explainable by other causes, occurring within 21 days of administration of intrathecal or high-dose intravenous Methotrexate, with symptoms including paresis, dysarthria and even seizures, lasting up to 96 hours, and complete neurologic recovery, presenting a diagnostic challenge with differential diagnoses that include Asparaginase-induced thrombosis, Central Nervous System (CNS) bleeding, and CNS leukemic infiltration...Full recovery within 48 hours, with Dextromethorphan started 24 hours after onset of symptoms, due to persistence of paresis... Methotrexate-Induced Stroke-like syndrome has a distinct clinical and MRI profile, and should be considered within the differential diagnoses in ALL patients who present with acute neurologic deficit. A high index of suspicion is necessary to establish a proper diagnosis."

Clinical • Acute Lymphocytic Leukemia • Central Nervous System Leukemia • CNS Disorders • Epilepsy • Hematological Disorders • Hematological Malignancies • Leukemia • Thrombosis

A Systematic Review of the Effects of N-Methyl-D-Aspartate Receptor Antagonists on Pancreatic Islets. (PubMed, Neuroendocrinology) - "These mechanisms may subserve the antidepressant effects of select NMDA antagonists (e.g. ketamine/esketamine, dextromethorphan). Further research should aim to investigate the effects of subanesthetic doses of ketamine/esketamine on pancreatic function and on delta cells."

Journal • Review • CNS Disorders • Depression • Diabetes • Metabolic Disorders • Psychiatry • KEAP1

Treatment Patterns, Cough Formulations, and Antibiotics Usage for Pediatric Acute Cough in India: A Real-World Study. (PubMed, J Pharm Bioallied Sci) - "Among the antitussive combinations, chlorpheniramine + dextromethorphan + phenylephrine was widely prescribed for productive as well as nonproductive cough, respectively (9.2%, 20.22%). Azithromycin (nonproductive cough: 19.92% and productive cough: 19.55%) and cefpodoxime were frequently prescribed antibiotics...Overprescription of antibiotics and diverse management approaches, using mono- and combination therapies, across different types of pediatric acute cough highlight potential gaps in clinical practice and perhaps understanding. The results underscore the need for improved prescription monitoring, education across the specialties on cough categorization and effective management of pediatric acute cough and adherence to clinical guidelines."

Journal • Real-world evidence • Cough • Infectious Disease • Pediatrics • Respiratory Diseases

INFLUENZA A-ASSOCIATED ACUTE NECROTIZING ENCEPHALITIS PRESENTING AS A STROKE MIMIC (CHEST 2025) - "He was prescribed oseltamivir and Bromfed (bromphenirimine, pseudoephedrine, dextromethorphan), which he took for 2 days...Seizures were controlled by levetiracetam... Influenza A-associated acute necrotizing encephalitis is a rare but severe complication of influenza infection that should be considered in patients with neurological symptoms. Early recognition, appropriate antiviral therapy, and supportive care are essential for improving patient outcomes."

Cardiovascular • CNS Disorders • Cytomegalovirus Infection • Epilepsy • Herpes Simplex • Herpes Zoster • Human Immunodeficiency Virus • Infectious Disease • Inflammation • Influenza • Multiple Sclerosis • Novel Coronavirus Disease • Respiratory Diseases • Varicella Zoster • Vascular Neurology

DISPARITIES IN MANAGEMENT OF REFRACTORY CHRONIC COUGH: A RETROSPECTIVE DATABASE REVIEW (CHEST 2025) - "For all patients, benzonatate was the most prescribed antitussive (23%), followed by guaifenesin (13%), codeine (11%) and gabapentin (7%). Black patients were more likely to be prescribed benzonatate (OR: 1.205, CI 1.14-1.274), guaifenesin (OR: 1.316, CI 1.213-1.428), and dextromethorphan (OR: 1.453, CI 1.314-1.608) compared to White patients but they were less likely to receive codeine (OR: 0.882, CI 0.793-0.981) and amitriptyline (OR: 0.661, CI 0.5-0.873)... This study highlights significant racial disparities in the prescribing patterns for RCC therapies. Black patients were more likely to receive non-opioid antitussives but less likely to be prescribed opioid-based treatments such as codeine and tricyclic antidepressants such as amitriptyline. These differences may reflect systemic biases or variations in clinical decision- making and warrant further investigation into their underlying causes."

Retrospective data • Review • Allergic Rhinitis • Asthma • Chronic Cough • Chronic Obstructive Pulmonary Disease • Cough • Gastroesophageal Reflux Disease • Immunology • Inflammation • Renal Cell Carcinoma • Respiratory Diseases

A Pilot Study on the Deposition of Drugs in Dental Tissues as Alternative Matrices for Forensic Toxicology. (PubMed, Acta Stomatol Croat) - "This study investigated enamel permeability to commonly ingested drugs, considering molecular characteristics (methadone - MET and dextromethorphan hydrobromide - DXM), pH, sugar content, and tooth conditions (intact enamel, cement-enamel junction-CEJ exposure, enamel wear). These findings suggest that other substances orally assumed might be endowed with similar effects on dental tissues, especially when combined with sugar or acid solutions, supporting teeth as viable matrices in post-mortem toxicology. However, pulp concentrations may reflect oral contamination rather than systemic levels."

Journal

Methotrexate-induced acute neurotoxicity in patients with osteosarcoma: a case report. (PubMed, J Med Case Rep) - "To the knowledge of these authors, this is the largest compilation of cases of methotrexate-induced neurotoxicity involving patients with osteosarcoma. There is no standard treatment for methotrexate-induced neurotoxicity. In our review we discuss dextromethorphan, aminophylline, and ketamine use in the treatment of methotrexate-induced neurotoxicity. Methotrexate is a crucial, first-line treatment for osteosarcoma and if safe, would be beneficial to continue even after acute neurotoxicity. Unfortunately, methotrexate is often discontinued after the first episode of neurotoxicity, owing to fear of recurrence on rechallenge. In our review, 5 of 16 patients were known to be rechallenged with methotrexate. None had recurrence of neurotoxicity with subsequent methotrexate treatment. While our study is limited by the number of cases, our findings suggest that methotrexate rechallenge in patients with osteosarcoma could be considered. Our review adds to the limited existing..."

Journal • Review • Acute Lymphocytic Leukemia • CNS Disorders • Epilepsy • Gastrointestinal Disorder • Hematological Malignancies • Leukemia • Oncology • Osteosarcoma • Sarcoma • Solid Tumor

Rethinking MS models: When Multiple Sclerosis Meets Schwannoma (ECTRIMS 2025) - "The patient initially declined treatment, but finally, accepted to receive corticoids, dextromethorphan, and alpha lipoic acid improving some of her symptoms. The present case, of a simultaneous presentation of MS and a vestibular schwannoma supports a novel immunopathological model in which peripheral tumors might enhance central immune activation. This case challenges the conventional dichotomy between CNS and PNS pathologies, advocating for a more integrated clinical and diagnostic approach in complex neuroinflammatory syndromes."

Alzheimer's Disease • Ataxia • Brain Cancer • CNS Disorders • Cognitive Disorders • Depression • Immunology • Movement Disorders • Multiple Sclerosis • Psychiatry • Solid Tumor • CD4 • IFNG • IL6