What are over-the-counter (OTC) medicines?
Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription. OTC medicines treat a variety of illnesses and their symptoms including pain, coughs and colds, diarrhea, constipation, acne, and others. Some OTC medicines have active ingredients with the potential for misuse at higher-than-recommended dosages.
Yes, a person can overdose on cold medicines containing DXM or
loperamide. An overdose occurs when a person uses enough of the
drug to produce a life-threatening reaction or death (Read more on
our Intentional vs. Unintentional Overdose Deaths webpage).
As with other opioids, when people overdose on DXM or loperamide,
their breathing often slows or stops. This can decrease the amount of
oxygen that reaches the brain, a condition called hypoxia. Hypoxia can
have short- and long-term mental effects and effects on the nervous
system, including coma and permanent brain damage and death.
A person who has overdosed needs immediate medical attention. Call
911. If the person has stopped breathing or if breathing is weak, begin
CPR. DXM overdoses can also be treated with naloxone. Read more
about naloxone at our Naloxone webpage.
Certain medications can be used to treat heart rhythm problems
caused by loperamide overdose. If the heart stops, health care
providers will perform CPR and other cardiac support therapies.
Yes, misuse of DXM or loperamide can lead to addiction. An addiction
develops when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home.
The symptoms of withdrawal from DXM and loperamide have not been well studied.
There are no medications approved specifically to treat DXM or
loperamide addiction. Behavioral therapies, such as cognitive-
behavioral therapy and contingency management, may be helpful.
Cognitive-behavioral therapy helps modify the patient's drug-use
expectations and behaviors, and effectively manage triggers and stress.
Contingency management provides vouchers or small cash rewards for
positive behaviors such as staying drug-free. Read more about drug addiction treatment on the Treatment webpage.
Points to Remember
- Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription. Those that have the potential for misuse include:
- Dextromethorphan (DXM), a cough suppressant found in many OTC cold medicines
- Loperamide, an anti-diarrheal
- When misusing DXM, people swallow large quantities of the medicine, sometimes mixing it with soda for flavor, called robo-tripping or skittling, Loperamide may also be swallowed.
- Short-term effects of DXM misuse can range from mild stimulation to alcohol-or marijuana-like intoxication. Loperamide misuse can cause euphoria, similar to other opioids, or lessen cravings and withdrawal symptoms, but other effects have not been well studied and reports are mixed.
- A person can overdose on cold medicines containing DXM or loperamide.
- Overdose can be treated with CPR and certain medications depending on the person symptoms, but the most important step to take is to call 911.
- Misuse of DXM or loperamide can lead to addiction.
- There are no medications to treat DXM or loperamide addiction. Behavioral therapies, such as cognitive-behavioral therapy and contingency management, may be helpful.