What Are the Effects of Mixing Dextromethorphan and Alcohol?

Dextromethorphan (DXM) is an opioid-like cough suppressant found in many over-the-counter cough and cold medicines. Beyond its cough-suppressing ability, at higher doses DXM has some sedative and dissociative qualities similar to those of ketamine and PCP. Combining DXM with other depressants such as alcohol can greatly increase the risk of overdose and other side effects.

When taken in quantities larger than the recommended therapeutic dose, DXM can produce hallucinations, dissociation, and euphoria.1,2 A typical medical dose is approximately 10 to 30 mg every 4 to 6 hours or every 6 to 8 hours. For recreational users, a single dose can range anywhere from 240 to 1500 mg. At lower recreational doses, the drug produces a mild stimulant effect with distorted visual perceptions. At higher recreational doses, it can create complete dissociation from one’s body.3

Mixing any medication with alcohol is unsafe and risky. Combining DXM with alcohol intensifies the side effects of both and can produce a dangerous interaction. In small doses it can cause nausea, vomiting, dizziness, and a wide range of other side effects. In large doses, it can cause alcohol poisoning, respiratory failure, and death.2,4

Concerns of Mixing Alcohol with Other Drugs

The Side Effects of Taking Dextromethorphan With Alcohol

Although it’s possible to overdose on DXM itself, it takes a particularly high dose to do so. However, when DXM is combined with the other active ingredients found in cough and cold medicines such as acetaminophen, pseudoephedrine, and guaifenesin, serious side effects can occur. For example, large doses of guaifenesin can cause nausea and vomiting. Pseudoephedrine is a stimulant with potentially negative cardiovascular and respiratory effects at high doses. Liver damage, heart attack, stroke, and death can also occur after taking high doses of acetaminophen.

Combining DXM with other depressants such as alcohol can greatly increase the risk of overdose and other side effects. Drinking alcohol after taking acetaminophen (which is found in many cough syrups containing DXM) can produce long-term, irreversible liver damage.2,4

Heavy, long-term use of DXM can also cause Olney’s lesions to form in the brain. These lesions are a type of brain damage that affects emotions, cognition, and memory. Stopping use of the drug can sometimes heal the lesions and reverse brain damage. But in some cases it is permanent and can lead to epilepsy or permanent psychosis. Brain damage can also occur after respiratory depression if the brain is without oxygen for too long. The risk of brain damage is intensified when DXM is combined with alcohol.1,2,4

Other adverse effects that may occur when mixing DXM with alcohol include:1,2,3,4

  • Drowsiness.
  • Dizziness.
  • Nausea/vomiting.
  • Skin irritation.
  • Rapid heartbeat.
  • Numbness.
  • High blood pressure.
  • Muscle spasms.
  • Sweating.
  • Difficulty concentrating.
  • Hallucinations.
  • Dissociation.
  • Altered perception of time.
  • Confusion.
  • Paranoia.
  • Lethargy.
  • Hyperactivity.
  • Impaired thinking/judgment.
  • Loss of sensory perception.
  • Liver damage.
  • Alcohol poisoning.
  • Increased risk of overdose.
  • Respiratory depression.
  • Death.

Treatment for Addiction to Dextromethorphan and Alcohol

DXM produces only moderate tolerance and isn’t typically considered physically addictive. However, it can be psychologically addictive for those who become entranced by its dissociative effects. Some users also report experiencing withdrawal symptoms including anxiety, restlessness, dysphoria, insomnia, upset stomach, vomiting, diarrhea, and severe weight loss.2,3

People who are addicted to DXM and alcohol use should seek treatment for both simultaneously. Because individuals facing multiple addictions face additional challenges when seeking recovery, it’s important to find a treatment center that specializes in dual diagnosis.

While it may be challenging to find a center that specializes specifically in the treatment of both DXM and alcohol addiction, many centers offer treatment for co-occurring addictions. Because DXM addiction can contribute to the development of psychotic disorders and potentially exacerbate other existing mental illnesses, these conditions may need to be treated as part of the overall recovery process.2,5,6

Treatment for addiction to DXM and alcohol is available on both an inpatient and outpatient basis. Inpatient treatment takes place in a residential therapeutic community for approximately 30 to 90 days. Individuals remain in the facility 24 hours a day, 7 days a week until treatment is completed.

Those undergoing inpatient addiction treatment typically have little contact with the outside world so that they can focus all of their energy on recovery. Inpatient treatment lowers the risk of relapse and is often the best choice for people with severe, recurring, and multiple addictions.5

Outpatient treatment is also an option for people seeking treatment for alcohol and DXM addiction. Outpatient treatment takes place for several hours each week and the individual doesn’t reside at the facility full-time. This care is best for people who wish to remain active in their personal and professional lives during addiction treatment.5

Whether on an inpatient or outpatient basis, treatment for co-occurring DXM and alcohol addiction may include a combination of the following approaches:5,6

  • Detox
  • Behavioral intervention
  • Individual counseling/therapy
  • Family counseling/therapy
  • Group counseling/therapy
  • 12-step programs
  • Peer support groups
  • Life skills training
  • Education
  • Holistic therapies
  • Relapse prevention
  • Ongoing support and aftercare

Hotline to Call

Please call our 24-hour hotline or fill out our contact form if you need information about treatment for addiction to DXM or alcohol for yourself or for a loved one who is experiencing the effects of mixing DXM and alcohol.


  1. National Institute on Drug Abuse. (2014). DrugFacts: Cough and cold medicine abuse.
  2. Dartmouth University Student Wellness Center. (2009). DXM (Robitussin).
  3. Center for Substance Abuse Research.(2013). Dextromethorphan (DXM).
  4. National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful interactions: Mixing alcohol with medicines.
  5. National Institute on Drug Abuse. (2016). DrugFacts: Treatment approaches for drug addiction.
  6. Mutschler, J.,Koopmann, A., Grosshans, M., Hermann, D., Mann, K., & Kiefer, F. (2010). Dextromethorphan withdrawal and dependence syndromeDeutsches Arzteblatt International107(30), 537–40.