Cough and Cold Medicine (DXM and Codeine Syrup)

Street names: Candy, Drank, Robo

Revised March 2019

What are cough and cold medicines?

Cough syrup-close up©Shutterstock/Africa Studio

Also known as: Candy, Dex, Drank, Lean, Robo, Robotripping, Skittles, Triple C, Tussin, and Velvet

Millions of Americans take cough and cold medicines each year to help with symptoms of colds. When taken as instructed, these medicines can be safe and effective. They become harmful when taken in a way or dose other than directed on the package. 

Several cough and cold medicines contain ingredients that are psychoactive (mind-altering) when taken in higher-than-recommended dosages, and some people misuse them. These products also contain other ingredients that can add to the risks. Many of these medicines are bought “over the counter” (OTC), meaning you do not need a prescription to have them. 

Two commonly misused cough and cold medicines are:

  • Dextromethorphan (DXM) cough syrup, tablets, and gel capsules. These OTC cough medicines are safe for stopping coughs during a cold if you take them as directed. Taking more than the recommended amount can produce a "high" and sometimes 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 a "buzz" or "high."

Read more about prescription drugs and what happens to the brain and body when someone misuses them.

How Cough and Cold Medicines Are Misused

Cough and cold medicines are usually sold in liquid syrup, capsule, or pill form. They may also come in a powder. Drinking promethazine-codeine cough syrup mixed with soda (a combination called syrup, sizzurp, purple drank, barre, or lean) was referenced frequently in some popular music beginning in the late 1990s and has become increasingly popular among youth in several areas of the country.

Young people are often more likely to misuse cough and cold medicines containing DXM than some other drugs because these medicines can be purchased without a prescription. 

What happens to your brain when you misuse cough or cold medicines?

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 you don't have any symptoms, they may affect the brain in ways very similar to illegal drugs, and can even lead to addiction. 

All drugs, including cough and cold medicines, change the way the brain works by changing the way nerve cells communicate. Nerve cells, called neurons, send messages to each other by releasing chemicals called neurotransmitters. These neurotransmitters attach to molecules on neurons called receptors. Drugs affect this signaling process. (Learn more about how neurotransmitters work.)

DXM acts on the same brain cell receptors as hallucinogenic 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 a high similar to that produced by other opioid drugs. Over time, it takes more and more of the drug to get that good feeling. This is how addiction starts. 

Both codeine and promethazine slow down activities in the central nervous system (brain and spinal cord), which produces calming effects.

Learn more about how the brain works and what happens when a person uses drugs.

What happens to your body when you misuse cough or cold medicines?

Short-Term Effects

DXM misuse can cause:

  • loss of coordination
  • numbness
  • feeling sick to the stomach
  • increased blood pressure
  • faster heart beat
  • vision changes
  • slurred speech
  • feeling very excited
  • in rare instances when DXM is taken with decongestants, lack of oxygen to the brain, creating lasting brain damage

Promethazine-codeine cough syrup misuse can cause:

  • slowed heart rate
  • slowed breathing (high doses can lead to overdose and death)

Cough and cold medicines are even more dangerous when taken with alcohol or other drugs.

Long-term effects of cough and cold medicines are not known.

Are cough and cold medicines addictive?

Yes, high doses and repeated misuse of cough and cold medicines can lead to addiction. That’s when a person seeks out and takes the drug over and over again, even though it is causing health or other problems.

Can you overdose or die if you use cough and cold medicines?

Yes. Misuse 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. 

Overdose can be treated with CPR and certain medications depending on the person's symptoms, but the most important step to take is to call 911. The drug naltrexone can be given to stop an opioid overdose if codeine was taken. 

How many teens misuse cough and cold medicines?

Teens misuse cough and cold medicines by taking them for the effect they cause on their own, or mixing them together with other OTC medicines to create new products. Below is a chart showing the percentage of teens who misuse cough and cold medicines. 

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Cough Medicine (non-prescription) for 8th Graders, 10th Graders, and 12th Graders; 2018 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Cough Medicine (non-prescription) Past Year 2.80 3.30 3.40

For the most recent statistics on teen drug use, see results from NIDA’s Monitoring the Future study.

What should I do if someone I know needs help?

If you, or a friend, are in crisis and need to speak with someone now: 

  • Call the 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 want to help a friend, you can:

If a friend is using drugs, you might have to step away from the friendship for a while. It is important to protect your own mental health and not put yourself in situations where drugs are being used.

For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.

Chat Day Transcripts

Infographics

See text description below

Monitoring the Future 2018 Survey Results

Published: December 17, 2018
This infographic of the NIH’s 2018 Monitoring the Future survey highlights drug use trends among the Nation’s youth for vaping, marijuana, alcohol, cigarettes, and prescription/OTC drugs.
See text description below

Monitoring the Future 2017 Survey Results

Published: December 12, 2017
This infographic of the NIH’s 2017 Monitoring the Future survey highlights drug use trends among the Nation’s youth for marijuana, alcohol, cigarettes, e-cigarettes (e-vaporizers), and prescription opioids.
See text description below

Monitoring the Future 2016 Survey Results

Published: December 13, 2016
This infographic of the NIH’s 2016 Monitoring the Future survey highlights drug use trends among the Nation’s youth for marijuana, alcohol, cigarettes, e-cigarettes, and prescription opioids.
See text description below

Monitoring the Future 2015 Survey Results

Published: December 16, 2015
NIH’s 2015 Monitoring the Future survey shows long term decline in illicit drug use, prescription opioid abuse, cigarette and alcohol use among the nation’s youth.
See text description below.

Prescription Drug Abuse: Young People at Risk

Published: June 07, 2012
The RX Risk: Roughly 1 in 9 youth abused prescription drugs in the past year.
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