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Coricidin (Triple C) Abuse Guide: Symptoms and More

The drug Coricidin is a brand name decongestant for allergies as well as cold and flu symptoms. It is sold over the counter (OTC), and it comes in three types: Cough & Cold, Cold & Flu, and Cold & Flu Extra Strength. All three varieties contain the antihistamine chlorpheniramine, which can cause some dizziness and drowsiness like other kinds of OTC antihistamines. 

Both Cough & Cold and Cold & Flu Extra Strength varieties contain a cough suppressant called dextromethorphan (DXM), which is safe in OTC doses but has become the focus of substance abuse. It is especially popular as a substance of abuse among teenagers because significantly large doses of DXM are easy to purchase, and they can cause an intense body high and hallucinations. Although there are several brands of OTC cold, cough, and flu medicines that contain DXM and are potential subjects of abuse, Coricidin has become the most recent focus.

Why Is Dextromethorphan in Coricidin?

Dextromethorphan is a cough suppressant which, in the United States, has mostly replaced codeine in over-the-counter cold, cough, and flu medicines. In fact, DXM was originally developed in 1958 as a less addictive substitute for codeine in these kinds of medicines. The U.S. Food and Drug Administration (FDA) approved dextromethorphan to be released under its first brand name, Romillar; however, by 1975, there were numerous reports of widespread DXM abuse, so Romillar was removed from its position as an OTC drug.

Companies developed “modified” versions of DXM that were designed to taste bad in large quantities to combat the potential for addiction or abuse. Since DXM was excluded from the first version of the Controlled Substances Act (CSA) in 1970, and has not been added since, it can still be sold over the counter. Manufacturers who created modified cough, cold, and flu drugs with DXM quickly had their products approved and placed on the market.

Abuse rates are hard to obtain, but many adolescents all over the U.S. abuse this drug, along with numerous adults who struggle with abuse of other drugs. While the federal government has not regulated DXM, many states now require a photo ID when purchasing OTC cough medicines, so people who are under 18 years old cannot buy them. Some states have put a limit on the number of bottles of cough syrup that can be purchased at one time.

DXM can be found in more than 120 OTC cold medications, sometimes by itself but more often in combination with other medicines like acetaminophen or an antihistamine. The average dose for a healthy adult is between 15 mg and 30 mg, which would be taken three to four times daily. The cough-suppressing effects from a standard dose of DXM work for between five and six hours after it is ingested.

How Much Coricidin Is Intoxicating?

When a recreational, unsafe dose of DXM is taken, the goal is to get high. People who abuse this drug experience euphoria and hallucinations, usually both visual and auditory. The amount needed to get to that high, however, can differ a little based on a person’s body weight and what kind of high the individual wants. Recreational doses range from 250 mg to 1,500 mg, which can quickly cause poisoning and death. There are specific effects to expect from typical recreational doses. 

  • First plateau at 100-200 mg: mild stimulation similar to a high from marijuana
  • Second plateau at 200-400 mg: euphoria and hallucinations similar to a high from ecstasy
  • Third plateau at 300-600 mg: distorted visuals along with loss of physical coordination and balance
  • Fourth plateau at 500-1500 mg: out-of-body sensations

For a long time, abusing Triple C—as Coricidin is sometimes called when it is a drug of abuse—involved drinking a lot of liquid cough syrup. However, there are now gel capsule forms of many OTC cough suppressants, including Coricidin, which makes it is easier to consume a large dose of DXM very quickly. Although DXM products are inexpensive and easy to find, which make them a prime target for adolescents to abuse, the drug is not regulated under the Controlled Substances Act (CSA) like prescription medications and even some OTC drugs.

A study in 2010 found that 1 out of 10 U.S. teenagers abused DXM products to get high, making this substance more popular among those who are ages 12-17 than ecstasy, cocaine, crystal meth, and LSD. The drug acts on the same brain cells as PCP or ketamine, which are dissociative drugs, meaning someone who takes too much will feel disconnected or separated from their environment and body.

Although some of the effects of DXM, ketamine, and PCP may be disturbing or disorienting, they also release a small amount of dopamine through the brain’s reward pathway, which reinforces good feelings and wanting to take more of the drug, potentially leading to a cycle of abuse.

Side Effects

Side effects from taking Coricidin, even when a typical dose is taken, may include: 

  • Drowsiness
  • Nausea and vomiting
  • Dizziness
  • Diarrhea
  • Nervousness
  • Restlessness
  • Constipation

These effects can occur in someone who takes Coricidin for a few days, as the drug builds up in the body. This happens even if a person is taking the recommended doses. However, these side effects are more likely to happen, be more frequent, and appear more serious in people who abuse Coricidin for nonmedical purposes, specifically, to get high.

Signs of Abuse

Someone who is experiencing DXM intoxication, including from taking a lot of Coricidin, will look and act drunk. This may include behaviors like:

  • Trouble walking
  • Confusion
  • Drowsiness

However, some of the signs of extreme intoxication may include borderline psychosis, including the following issues: 

  • Being out of touch with reality
  • Sitting or standing in unnatural postures
  • Acting extremely frightened or paranoid

One of the problems with abusing DXM is that, when mixed with other decongestants, too much of the drug can lead to passing out and breath suppression, which can cause oxygen deprivation. While this is a risk from any large dose of DXM, additional decongestants make this risk much higher, so the person is much more likely to experience brain damage or death. Coricidin may have become a popular substance of abuse because the medication proudly proclaims that it does not contain any decongestant; however, abusing DXM and the other substances contained in Coricidin is still very dangerous.

Serious side effects from taking too much Coricidin that may require medical attention are:

  • Respiratory depression or shallow breathing
  • Hallucinations
  • Vomiting
  • Changes in blood pressure, either high or low
  • Fast heartbeat
  • Blackouts
  • Skin rashes
  • Double vision
  • Convulsions

Long-term Coricidin abuse can damage the heart muscle and nervous system, including the brain. Ingredients in Coricidin besides DXM may cause liver damage, so someone who abuses this drug is at risk of liver failure. There are other forms of long-term harm, including: 

  • Mental illness, including psychosis
  • Chronic high blood pressure
  • Muscle contortions
  • Nystagmus, or rapid back-and-forth eye movements

The most harmful issue associated with Coricidin, when it contains DXM, is increasingly more severe psychiatric symptoms, leading to a psychotic break that may not go away.

Overdose

It is possible to overdose on Coricidin by accident, through substance abuse, or intentionally. Specific signs to look for are:

  • Breathing trouble, including shallow, irregular, slow, or stopped breathing
  • Bluish tint to the skin, especially around the lips, the tip of the nose, and under the fingernails
  • Blurry vision
  • Constipation
  • Nausea and vomiting
  • Seizures
  • Drowsiness
  • Hallucinations
  • Dizziness
  • High or low blood pressure
  • Pounding or very fast heartbeat
  • Elevated body temperature, up to hyperthermia, which can cause kidney damage
  • Muscle twitches
  • Spasms of the stomach and intestines
  • Coma

It is extremely important to call 911 if you see someone display signs of a drug overdose, including a DXM overdose. There is no such thing as sleeping off or walking off an overdose of a drug. It is life-threatening, and the person needs emergency medical attention.

Data from 2000 to 2010 shows that DXM abuse hit its peak in 2006, with 34,755 reported single exposures to the dangerous drug reported to the National Poison Data System.

Withdrawal Symptoms

Although abuse of DXM and other OTC medications is an increasing problem, it is not known if DXM is truly addictive or if the people who abuse DXM are also at risk of abusing several kinds of drugs because they seek a consistent high. 

Typically, compulsive behaviors and intense cravings are associated with addiction to a substance along with physical tolerance and dependence. There is disagreement within the medical community about whether someone displaying compulsive behaviors around consuming DXM is addicted to this drug or if those behaviors are a problem around multiple kinds of drugs, which indicates the difference between addiction and substance abuse.

  • Insomnia
  • Dysphoria
  • Toxic psychosis that does not go away with detox
  • Anxiety
  • Restlessness
  • Diarrhea
  • Vomiting
  • Extreme weight loss
  • Stomach problems


However, there are reported withdrawal symptoms from DXM abuse, so there is the possibility that someone who consistently abuses DXM will develop a physical dependence on the presence of the drug. Withdrawal symptoms include:

Treatment for Addiction and Abuse

There are no specific prescription medication interventions for DXM addiction, unlike for opioid or alcohol abuse. However, a medically supervised detox is still important because it can assist with withdrawal symptoms like discomfort or nausea, and it can also ensure you remain safe and reduce your risk of relapse.

After you detox safely, entering a rehabilitation program that provides evidence-based behavioral therapy is crucial. This is the key to overcoming addiction to over-the-counter substances like Coricidin. Cognitive behavioral therapy, mutual support groups, and contingency management with rewards can help you learn which problems can trigger a craving or substance abuse; then, you can learn different coping mechanisms to manage the urge to abuse the drug and deal with the stress itself.

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Rehabilitation starts with group therapy, and you also may attend individual therapy with a licensed addiction specialist or therapist. This may lead to discovering that you struggle with a mental health condition like depression or anxiety, which is associated with a higher risk of substance abuse, so you may receive a prescription for an antidepressant to stabilize your mood.

Since teenagers are most at risk for abusing DXM products like Coricidin, there are specific treatment programs that focus on helping adolescents overcome substance abuse. Many of these rehabilitation programs allow the teen to live at home with their family and attend school during regular school hours; other programs provide school alongside inpatient treatment. Depending on what your teenager needs, you can choose the best approach to treatment with help from a medical professional.

Sources

Coricidin Cough & Cold. Coricidin: Cough, cold and flu relief that is decongestant free. Retrieved September 2018 from https://www.coricidin.ca/en/products/cough-cold/

Coricidin Cold & Flu. Coricidin: Cough, cold and flu relief that is decongestant free. Retrieved September 2018 from https://www.coricidin.ca/en/products/cold-flu/

Coricidin Cold & Flu Extra Strength. Coricidin: Cough, cold and flu relief that is decongestant free. Retrieved September 2018 from https://www.coricidin.ca/en/products/cold-flu-extra-strength/

(September 2015). Cough and Cold Medicine Abuse. KidsHealth – For Parents. Retrieved September 2018 from https://kidshealth.org/en/parents/cough-cold-medicine-abuse.html

Dextromethorphan. Everyday Health. Retrieved September 2018 from https://www.everydayhealth.com/drugs/dextromethorphan

(October 29, 2013). Dextromethorphan. Center for Substance Abuse Research (CESAR). Retrieved September 2018 from http://www.cesar.umd.edu/cesar/drugs/dxm.asp

(2015). XII Drugs of Concern: DXM. 2015 Edition: A D.E.A. Resource Guide. Retrieved September 2018 from https://portal.ct.gov/-/media/DCF/Substance_Abuse/pdf/DXMpdf.pdf?la=en

(August 7, 2007). Teen Drug Slang: A Dictionary for Parents. CBS News. Retrieved September 2018 from https://www.cbsnews.com/news/teen-drug-slang-a-dictionary-for-parents/

(March 2014). Dextromethorphan. Drug Enforcement Administration, Office of Diversion Control, Drug & Chemical Evaluation Section. Retrieved September 2018 from https://www.deadiversion.usdoj.gov/drug_chem_info/dextro_m.pdf

Cough and Cold Medicine (DXM and Codeine Syrup). The National Institute on Drug Abuse Blog Team, NIDA for Teens. Retrieved September 2018 from https://teens.drugabuse.gov/drug-facts/cough-and-cold-medicine-dxm-and-codeine-syrup

Substances of Abuse: Coricidin (CCC, Triple C’s) & Dextromethorphan (DXM). Florida Poison Information Center – Tampa. Retrieved September 2018 from http://www.poisoncentertampa.org/poison-topics/substances-of-abuse/#coricidin

(September 15, 2017). Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis. Psychopharmacology Bulletin. Retrieved September 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601090/

(September 23, 2017). Dextromethorphan overdose. Medline Plus. Retrieved September 2018 from https://medlineplus.gov/ency/article/002628.htm

(December 2017). Over-the-Counter Medicines: What Are Over-the-Counter medicines? National Institute on Drug Abuse (NIDA). Retrieved September 2018 from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines

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