Concomitant use of dextromethorphan and alcohol-induced dissociation in a patient with alcohol dependence

Background: Dextromethorphan (DXM) is an over-the-counter drug that is commonly abused by teenagers. Its main pharmacological property is a low-affinity N-methyl-d-aspartate (NMDA) receptor antagonist.

Case presentation: We report acute psychotic dissociation induced by DXM and alcohol in a patient with alcohol dependence, which made it difficult to distinguish alcohol withdrawal symptoms with limited information. The psychotic symptoms were ameliorated by haloperidol; however, in cases of DXM abuse, haloperidol treatment should be avoided.

Conclusion: In the consultation of patients with addiction, the possibility of various addictive drugs must be kept in mind. The concomitant use of DXM and alcohol causes easy dissociation and high-dose usage of DXM and alcohol withdrawal symptoms are difficult to distinguish.