Podcast 539:  Coricidin Abuse

<p><strong>Contributor:  Rachel Beham, PharmD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Coricidin HBP Cough & Cold (dextromethorphan and chlorpheniramine) is one of the more commonly abused over-the-counter medications</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Dextromethorphan, binds to multiple receptors, particularly at high doses</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Opioid receptors, causing respiratory depression, CNS depression</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">NMDA receptors, causing agitation and hallucinations</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Serotonin-reuptake inhibition, which may lead to serotonin syndrome, especially when combined with other agents</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Dextromethorphan also contains bromide, which when chronically abused can lead to bromism (behavioral changes, hallucinations, weight loss, and neurologic changes)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Chlorpheniramine is an antihistamine and can cause anticholinergic effects in overdose, such agitation, hyperthermia, and hallucinations</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Acute treatment of Coricidin abuse is mostly supportive, which may include benzodiazepines, naloxone, dialysis, sodium bicarbonate, and physostigmine depending on the predominate toxidrome and symptoms present</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400; font-size: 10pt;">Ritter D, Ouellette L, Sheets JD, Riley B, Judge B, Cook A, Houseman J, Jones JS. "Robo-tripping": Dextromethorphan toxicity and abuse. Am J Emerg Med. 2019 Nov 17. pii: S0735-6757(19)30655-2. doi: 10.1016/j.ajem.2019.10.001.</span></p> <p