Home' Australian Pharmacist : Australian Pharmacist July 2016 Contents Australian Pharmacist July 2016 I ©Pharmaceutical Society of Australia Ltd.
Pseudoephedrine addiction can cause a
host of unwanted side effects. These include
confusion, dizziness, light‐headedness, dry
mouth, rashes, headache, insomnia, tremors,
muscle weakness, vomiting, restlessness,
anxiety, chest tightness, heart palpitations,
hypertension, arrhythmia, tachycardia,
seizures, hallucinations and malignant
Malignant hypertension is hypertension
coupled with organ impairment. Damage is
a life‐threatening condition where organs
actually shut down. This is particularly true
for people taking MAO inhibitors (MAOI).
When pseudoephedrine is mixed with a
MAOI, it frequently results in malignant
Its use to lose weight and improve
performance in athletics has been noted.
Because pseudoephedrine causes blood
vessels to constrict, it can severely affect a
developing fetus during pregnancy.
Pseudoephedrine addiction may be a sign
of future addictions. Pseudoephedrine
is the main chemical used to make
methamphetamine. If someone starts out
abusing pseudoephedrine, it is possible they
will move on to harder drugs in the future.
Dextromethorphan is used widely in
OTC cough and cold remedies. It is the
dextro‐isomer of the codeine analog of
levorphanol. Its maximum recommended
daily dosage is approximately 120 mg/day.
However, anecdotal reports of abuse have
Its popularity amongst adolescents is
through intoxication by taking from five
to ten times the recommended dosage.
In large doses of greater than 2 mg/kg,
it can produce intoxicating, hallucinogenic
effects. Online procedures for cold water
extraction from syrups are readily available.
High doses of dextromethorphan have
psychological and physiological effects
similar to phencyclidine (PCP) and
dependence and withdrawal have resulted.
Abuse of antihistamines by minors
is a problem. Medications such as
chlorpheniramine, cyclizine and
diphenhydramine appear to be targeted
at sedation resulting from H1 receptor
antagonism. However, antihistamines may
affect dopaminergic transmission resulting
in cocaine‐like effects.
Dextromethorphan is an N‐methyl‐D ‐
aspartate (NMDA) receptor antagonist,
which is actively being studied for use
in treating neuropathic pain. In doses
greater than 240 mg, it can produce
dissociative effects. Users describe
distinct dose‐dependent ‘plateaus’
that range from a mild stimulant effect
coupled with a distorted visual perception
(at low doses around 120 mg) to a feeling
of complete dissociation from one’s body
(at doses of 10 fluid ounces [283,495 mg]
Typically effects can last for about
six hours. Recent literature suggests
that heavy dextromethorphan use
may produce phencyclidine (PCP)‐like
effects from the metabolic conversion
of dextromethorphan to its immediate
metabolite, dextrorphan, which acts like an
NMDA receptor antagonist. These effects
include bizarre and hyperactive behaviour,
nystagmus, ataxia, hallucinations, CNS
depression, intermittent euphoria and
severe cognitive deterioration. To date, the
record for the highest daily consumption
of dextromethorphan in a single individual
is reported as 36–48 fluid ounces of
2,160–2,880 mg of dextromethorphan
hydrobromide. This is reported for a period
of time; up to five years.
In part two the abuse of anticholinergics,
antipsychotics, antidepressants and
anticonvulsants will be discussed.
A useful references relating to the above
discussion is at the end of this article.
If in doubt that these practices actually
occur, you need simply to Google search
any drug name and search for the
words ‘Recreational Use Drug Forum’.
Sites like these supply detailed advice.
They disclose drug abuse and often
encourage illicit drug use.
The prime purpose of this article is to
highlight potential problems. The possible
abuse of these medicines does not provide
evidence of a widespread problem.
When taken appropriately medicines are
the foundation of beneficial treatment.
As pharmacists we need to be aware that
a minority of customers may abuse certain
We need to expand our list of suspicion to
include all medications affecting the CNS. Also,
these items should be prescribed with caution
to those with a history of drug abuse.
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of addiction. Drug Alcohol Depend 2006; 83 (Suppl 1): S4–S7.
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