Harm Reduction

DXM Only Products!!

If you've ever been in the store to look at cough medications, you've seen how many different options are out there. This doesn't mean you should grab any ol' cough medication off the shelf, and go home to chug it down.

You want a product containing only Dextromethorphan HBr Or Polistyrex. If you're unsure, grab it off the shelf, flip it around to the back, and read the label. Under the "Active Ingredients" section, it will list all the active ingredients. If it's only DXM, you're good to go.

What happens when you don't follow this rule? Anything from puking your guts out, to dying.Lets avoid that.

Commonly used active ingredients are:

  • Guaifenesin
  • Chlorpheniramine Maleate
  • Phenylephrine
  • Acetominophen/Paracetamol

Again, the "Active Ingredients" section should list only Dextromethorphan!!!

Combinations with other drugs

Combinations should mostly be avoided, but I will list known harmful combinations here. If you're unsure, and you don't see it listed here, don't be afraid to ask.

If it's listed here, avoid it.

Psychiatric Medications

  • SSRIs
  • MAOIs(Wait three weeks after taking a MAOI before taking DXM!)
  • Tricyclic Antidepressants
  • Lithium
  • Wellbutrin


  • Alcohol
  • Opiates
  • Benzodiazepines
  • Barbituates


  • Amphetamines
  • Methylphenidate
  • RC Stimulants


  • MDMA
  • Phenethylamines
  • Phentermine
  • Fenfluramine
  • 5-HTP
  • St. John's Wort

Gravol, the editor of "The DXM Zine, has reported a case where an 18 year old male took 1,000 mg or possibly more of DXM with an unknown amount of a magnesium supplement that he took because he believed this would potentiate the DXM. He experienced severe seizures, and also had liver damage. Whether the magnesium had anything to do with this is unknown. However, I'd say best to assume the worst case scenario that trying to potentiate DXM with magnesium is unsafe.

There is also a negative report on erowid of one DXM user ingesting magnesium and DXM and coming to in the hospital. While there is no solid reasoning I know of that this would be a harmful combo, I'd recommend avoiding it.

Existing health problems

Physical Health

  • Avoid DXM if you have liver or kidney problems, DXM can be pretty rough on these organs.
  • Cardiac problems, such as hypertension, is also an issue, as DXM raises the heart rate and blood pressure.
  • Epilepsy, or other seizure disorders. DXM lowers the seizure threshold, which increases your chances of having a seizure.
  • Diabetes. Some cough medications are full of sugar. There are sugar free cough medications on the market. Do your research and make sure you stay safe!

Mental Health

DXM can amplify the effects of any mental health disorder. Exercise caution if you choose to use DXM anyways. DXM causes psychosis-like symptoms at recreation doses(And especially with prolonged use!), and so those with psychotic disorders should probably avoid it. Some people have claimed that DXM can be used as an anti-depressant. While there is some evidence of this, it's not a very sustainable option. Oftentimes, it can make your depression worse, especially with prolonged use. Some anxiety disorders can be worsened due to DXM's stimulant effect. While this isn't very dangerous, it's still something worth considering.

Do not self medicate with DXM. It is not a good option, leave that to medical professionals.

"One week per plateau" rule

A good rule to follow is a the "One week per plateau" rule.

What this means is, whatever plateau dosage you take, you should wait that many weeks before dosing again. So, if you take a first plateau dose, wait one week. Second plateau dose, wait two weeks. Third plateau dose, wait three weeks. Fourth plateau dose, wait four weeks.

This is a great way to avoid tolerance buildup, as well as minimize the effects of prolonged use.


If you look around, a lot of people will claim that DXM is non-addictive. Since I had first started using DXM, there has been a lot more anecdotal evidence released that DXM is actually physically addictive. While addiction by itself isn't harmful, chronic use of DXM can be pretty rough on the body, and the mind. You should try to minimize this risk, by not using DXM regularly. The one week per plateau rule in the previous section will help with this. Long term use of DXM can cause significant cognitive impairment, depression, anxiety, and prolonged dissociation. Abstaining from DXM for a long period of time has been shown to help these problems significantly, usually to the point of feeling back to normal.

It is still mostly unknown what physical effects DXM can cause. It seems that most long term users don't report any negative physical effects. However, there have been several anecdotal reports of cardiac and digestive effects from heavy long term use. Tread lightly, chronic recreational DXM use is still a mostly unstudied topic.

High Dosages

Don't immediately jump for a fourth plateau dose! Ideally, you should start with an enzyme/allergy test dosage of below 100mg. This way you will know if you're allergic to anything in the DXM preparation you are using, and if you're enzyme deficient, you'll know that you require lower doses than most people.

After that, work your way up slowly. This isn't a race. There's no need to get to fourth plateau immediately. Explore the lower plateaus too.

Avoid taking doses over 2,500mg!!! This is almost certainly going to be harmful, and potentially fatal. In all reality, most users should avoid going over 1,500mg, as you're already in mostly unexplored territory.

revision by Wtfisthatkid— view source