Is Dextromethorphan Safe for Pregnancy? Understanding the Risks

Dextromethorphan is a substance used in medications to treat flu and cold symptoms, such as some Vicks or Mucinex products. It’s also available over the counter as a cough medicine. While generally safe and widely available, dextromethorphan has side effects and risks like any other medication.

For pregnant or breastfeeding women, dextromethorphan may have additional risks to the mother and the unborn baby. Research has indicated that dextromethorphan is safe to take during pregnancy. More research is needed to understand the risks fully.

Key Points

• Dextromethorphan is used in cold and flu medications to treat cough symptoms.
• Dextromethorphan is considered safe to take while pregnant, but more research is needed to understand the potential risks of miscarriage, birth defects, and low birth weight.
• In addition to pregnancy concerns, dextromethorphan may have other risks and considerations.

What Is Dextromethorphan?

Dextromethorphan is an ingredient in over-the-counter (OTC) and prescription combination cold and flu medications like Robitussin and Delsym. It may also be available as a sole medication in pill, liquid, or cough drop (lozenge) forms. Dextromethorphan works as a cough suppressant and affects the signals in the brain that trigger the cough reflex.

Is Dextromethorphan Safe While Pregnant?

There’s limited research into the effects of dextromethorphan during pregnancy. One study evaluated the infants of 184 participants who took dextromethorphan at any time during their pregnancy and found no increased risk of stillbirth or low birth weight.[1] More studies are needed to determine if dextromethorphan increases the chances of pre-term delivery or other pregnancy-related problems.[2]

Miscarriage and birth defects can happen with pregnancy, but the latter occurs at a rate of 3% to 5%. Dextromethorphan is not expected to increase that risk.[3] More research is needed to determine if dextromethorphan affects women’s ability to get pregnant or if the drug can lead to learning or behavioral problems for the baby in the future.

Studies demonstrating the safety of dextromethorphan during pregnancy are limited as well. One study found a possible link between dextromethorphan and a small number of birth defects, but there may have been other medications involved.[4]

Talk to your doctor about medication safety during pregnancy, including any prescription and OTC medications you take.

Can I Breastfeed While Taking Dextromethorphan?

Breastfeeding can pass many substances the mother ingests to the baby. One study evaluated 20 people who were breastfeeding and took 30 mg of dextromethorphan. It was found to transfer to breastmilk in small amounts.[5] One baby got a rash that went away without treatment, but whether it was related to the medication or another cause is unknown. With only small amounts passing through the breastmilk, side effects in nursing children aren’t likely.

Dextromethorphan Side Effects, Risks, and Interactions

Dextromethorphan is a generally safe and well-tolerated drug, but it can have side effects. One of the most common side effects is stomach upset, but convulsions, seizures, confusion, slow and shallow breathing, hallucinations, anxiety, restlessness, dizziness, and nervousness are possible.[6]

Allergic reactions, including difficulty breathing or swelling of the face, tongue, lips, or throat, require emergency medical attention.

Dextromethorphan can have interactions with other OTC and prescription drugs, including MAO inhibitors like:[7]

• Selegiline
• Phenelzine
• Isocarboxazid
• Tranylcypromine
• Rasagiline
• Methylene blue injection

Taking dextromethorphan with these drugs can cause serious, potentially life-threatening problems.

You shouldn’t take dextromethorphan with any other over-the-counter cough, cold, or allergy medication that may contain dextromethorphan or similar drugs. You can experience an overdose of the ingredients in combination medications.

Several other drugs may interact with dextromethorphan, including darifenacin, celecoxib, cinacalcet, imatinib, ritonavir, quinidine, ranolazine, sibutramine, terbinafine, antidepressants, and medicines to treat high blood pressure.[8]

Don’t drink alcohol while taking dextromethorphan, pregnant or otherwise. This combination can seriously increase the risk of side effects from dextromethorphan and may have risks for the unborn baby. You shouldn’t take caffeine pills, diet pills, or other stimulant medications without the guidance of a doctor, as serious side effects may occur.

Dextromethorphan Abuse

Dextromethorphan can be a drug of abuse. Some people may take high doses of dextromethorphan to experience euphoria and hallucinations. It can take different dosages to cause these effects, possibly leading to excessively high doses like 1,500 milligrams in a single dosage.[9]

The illicit use of dextromethorphan is referred to as “robo tripping,” “dexing,” or “skittling.” Usually, dextromethorphan is abused by drinking large amounts of over-the-counter liquid cough medications, but it’s possible to abuse the drug in tablet or gel capsule forms.

Long-term abuse of dextromethorphan is associated with severe psychological dependence. Taking high doses of dextromethorphan in combination with other substances like alcohol or opioids can be extremely dangerous, especially while pregnant.

The studies that evaluate dextromethorphan safety while pregnant are only evaluating therapeutic doses, not the high doses associated with dextromethorphan abuse. It’s not known how high doses may affect the mother or child during pregnancy or whether they can increase the risk of birth defects or other adverse effects.

What Cold Medications Aren’t Safe During Pregnancy?

The research into dextromethorphan while pregnant is limited, but there are a few cough and cold medications that have a known risk for pregnant women. Discuss your options with your doctor.

• Nasal steroid sprays like triamcinolone (Nasacort) may cause birth defects in the respiratory tract when taken during pregnancy.[10]
• Pseudoephedrine (Sudafed) and other decongestants have limited research into their safety during pregnancy, but studies show a higher risk of birth defects.[11]
• Oxymetazoline (Afrin) and other nasal decongestant sprays may be linked to birth defects, but more research is needed.[12] Your doctor may recommend them for a short course since the medication is directed only into the nose.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen should be avoided at 20 weeks or later in pregnancy.[13] They can decrease the amount of amniotic fluid (the fluid that protects the baby) and may lead to problems with the development of the lungs, kidneys, or other organs.
• Medications that contain alcohol can have risks for pregnant women, including birth defects, pregnancy loss, and developmental problems.[14]

Pay attention to the substances in combination medications like NyQuil and DayQuil, as some may not be safe during pregnancy – like phenylephrine and pseudoephedrine.

Avoid Risky Drugs During Pregnancy

Dextromethorphan is generally considered safe during pregnancy, but more research is needed to understand the short- and long-term effects and risks. Dextromethorphan has other risks and possible drug interactions as well, so it’s important to discuss the medications you’re taking with your doctor to ensure they’re safe during pregnancy.