Adolescents and dextromethorphan. Between 1999 and 2004, calls to the California Poison Control System concerning the abuse of dextromethorphan rose 15 times among children and adolescents nine to 17 years of age (from 0.11 to 1.68 cases per 1,000 calls), according to a study published in the Archives of Pediatrics and Adolescent Medicine. The greatest number of calls concerned teens ages 15 and 16. Similar trends were seen in data from the American Association of Poison Control Centers and the Drug Abuse Warning Network.

At high doses, dextromethorphan, a cough suppressant found in many over-the-counter cough and cold preparations, is metabolized to dextrorphan, which is chemically similar to phencyclidine (PCP) and can produce euphoria and hallucinations. Other adverse effects included tachycardia, lethargy, hypertension or hypotension, confusion, pupil dilation, dizziness, ataxia, slurred speech, nystagmus, fever, loss of consciousness, tachypnea, and seizure. Serious pulmonary complications were seen in seven cases. Some teens refer to the high achieved with dextromethorphan as "robotripping" because Robitussin cough syrup is a popular source. Coricidin HBP Cough and Cold tablets (known by abusers as "triple C") was the most abused product.

Infant deaths with cold medications. According to Morbidity and Mortality Weekly Report, between 2004 and 2005 more than 1,500 infants younger than two years of age were treated in EDs for adverse effects of cough and cold preparations. These preparations were blamed for the deaths of three infants, all under six months of age, who were found at autopsy to have high blood levels of the common decongestant pseudoephedrine. Because of the risk of serious adverse effects in infants and a lack of evidence showing that cold medications have therapeutic value in children younger than two, the Centers for Disease Control and Prevention strongly cautions against using these preparations in this age group.

Fran Mennick, BSN, RN