Cough and Cold Medicine (DXM and Codeine Syrup)
Also known as: robotripping, robo, tussin, triple c, dex, skittles, candy, velvet, and drank
Millions of Americans take cough and cold medicines each year to help with symptoms of colds, and when taken as instructed, these medicines can be safe and effective. However, several cough and cold medicines contain ingredients that are psychoactive (mind-altering) when taken in higher-than-recommended dosages, and some people may abuse them. These products also contain other ingredients that can add to the risks.
Two commonly abused cough and cold medicines are:
- Cough syrups and capsules containing dextromethorphan (DXM). These over-the-counter (OTC)—meaning they can be bought without a prescription—cough medicines are safe for stopping coughs during a cold if you take them as directed. Taking more than the recommended amount can produce euphoria (a relaxed pleasurable feeling) and dissociative effects (like you are detached from your body).
- Promethazine-codeine cough syrup. These prescription medications contain an opioid drug called codeine, which stops coughs, but when taken in higher doses produces euphoria.
Cough and cold medicines are usually sold in liquid syrup, capsule, or pill form. They may also come in a powder. Young people are more likely to abuse cough and cold medicines containing DXM because these medicines can be purchased without a prescription. Some people mix promethazine-codeine cough syrup with soda or alcohol and flavor the mixture by adding hard candies.
When cough and cold medicines are taken as directed, they safely treat symptoms caused by colds and flu. But when taken in higher quantities or when such symptoms aren’t present, they may affect the brain in ways very similar to illegal drugs.
DXM acts on the same brain cell receptors as drugs like ketamine or PCP. A single high dose of DXM can cause hallucinations (imagined experiences that seem real). Ketamine and PCP are called "dissociative" drugs, which means they make you feel separated from your body or your environment, and they twist the way you think or feel about something or someone.
Codeine attaches to the same cell receptors as opioids like heroin. High doses of promethazine-codeine cough syrup can produce euphoria similar to that produced by other opioid drugs. Also, both codeine and promethazine depress activities in the central nervous system (brain and spinal cord), which produces calming effects.
Both codeine and DXM cause an increase in the amount of dopamine in the brain’s reward pathway. Extra amounts of dopamine increase the feeling of pleasure and at the same time cause important messages to get lost, causing a range of effects from lack of motivation to serious health problems. Repeatedly seeking to experience that feeling can lead to addiction.
Learn more about how the brain works and what happens when a person abuses drugs.
DXM abuse can cause:
- Loss of coordination
- Feeling sick to the stomach
- Increased blood pressure
- Faster heart beat
- In rare instances, lack of oxygen to the brain, creating lasting brain damage, when DXM is taken with decongestants
Promethazine-codeine cough syrup can cause:
- Slowed heart rate
- Slowed breathing (high doses can lead to overdose and death)
Also, cough and cold medicines are even more dangerous when taken with alcohol or other drugs.
Yes, high doses and repeated abuse of cough and cold medicines can lead to addiction. That’s when a person seeks out and takes the drug over and over even though they know that it is causing problems with their health and their life.
Yes. Abuse of promethazine-codeine cough syrup slows down the central nervous system, which can slow or stop the heart and lungs. Mixing it with alcohol greatly increases this risk. Promethazine-codeine cough syrup has been linked to the overdose deaths of a few prominent musicians.
NIDA’s Monitoring the Future study collects data on teen abuse of cough medicines:
Swipe left or right to scroll.
|Drug||Time Period||8th Graders||10th Graders||12th Graders|
|Cough Medicine (non-prescription)||Past Year||[2.00]||3.70||4.10|
* Data in brackets indicate statistically significant change from the previous year.
For the most recent statistics on teen drug abuse, see results from NIDA’s Monitoring the Future study.
If you or a friend are in crisis and need to speak with someone now, please call:
- National Suicide Prevention Lifeline at 1-800-273-TALK (they don't just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by).
If you need information on treatment and where you can find it, you can call:
- Substance Abuse Treatment Facility Locator at 1-800-662-HELP or visit www.findtreatment.samhsa.gov.
For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.
- Commonly Abused Prescription Drugs Chart
- DrugFacts: Prescription and Over-the-Counter Medications
- PEERx Initiative for Teen Prescription Drug Abuse Prevention
- Research Report Series: Prescription Drug Abuse
Statistics and Trends
Monitoring the Future (University of Michigan):
Substance Abuse and Mental Health Services Administration: