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Dextromethorphan Addiction Mediated Through the NMDA System

Common Pathways With Alcohol?

Roy, A. Kenison III MD; Hsieh, Chenen MD; Crapanzano, Kathleen MD

doi: 10.1097/ADM.0000000000000152
Case Report

Dextromethorphan, an antitussive (cough suppressant) drug of the morphinan class with sedative and dissociative properties found in cough syrup and other over-the-counter products, is also a substance of abuse, seen primarily in young adults all over the world. A case of dextromethorphan use disorder is presented in a 45-year-old women. Her repeated attempts at abstinence were unsuccessful secondary to continued intense cravings. Treatment with topiramate resulted in complete resolution of her cravings. Topiramate was chosen empirically because of a common action with dextromethorphan in the NMDA system. Genetic testing was obtained and the patient was found to be a carrier of the GRIK1 rs2832407(C:C) allele. The (C:C) allele has been associated with an increased risk of alcohol use disorder and a treatment response of patients with heavy drinking to topiramate. This case provides an opportunity to discuss personalized medicine (treatment options aided by the use of genetic testing) and the possible shared genetic susceptibility for dependence in 2 substances of abuse.

Addiction Recovery Resources; River Oaks Psychiatric Hospital; Tulane University School of Medicine Department of Psychiatry, New Orleans; Louisiana State University Health Sciences Center Department of Psychiatry, Baton Rouge (A.K.R.); Louisiana State University Health Sciences Center Department of Psychiatry (C.H.); Louisiana State University Health Sciences Center Department of Psychiatry (K.C.), Baton Rouge, LA.

Send correspondence and reprint requests to Chenen Hsieh, MD, 5246 Brittany Dr, Baton Rouge, LA 70808. Tel: +1 646 4172172; E-mail:

Received 4 March, 2015

Accepted 2 July, 2015

The patient provided written consent for the publication of this case report.

The authors declare no conflict of interest.

© 2015 American Society of Addiction Medicine