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DXM (Dextromethorphan) & Kratom: How Do They Interact?

DXM and kratom are both relatively safe compounds when used at the right dose. However, some people are mixing kratom with DXM to potentiate the effects of both substances. 

Mixing DXM and kratom in high doses is dangerous and likely to lead to side effects.

Here, we’ll explore what can happen if you mix kratom and DXM together. 

Last updated 4 weeks ago by Tom Krah

DXM (Dextromethorphan) & Kratom: How Do They Interact?

Does Kratom Interact With DXM?

Yes, kratom and DXM compete for the same metabolic pathway and will therefore interact when used together.

Chemically speaking, DXM is an opioid, but it does not act on the body’s opiate receptors. 

Kratom, on the other hand, isn’t an opioid, and yet it interacts meaningfully with the opioid receptors in the central nervous system. 

In terms of their effects, kratom and DXM are neutral to each other. Kratom’s psychoactive effects are not in any way disturbed by DXM, nor are DXM’s anti-cough properties affected by kratom.

Nevertheless, there is a cause for concern in terms of how they are metabolized by the body.

DXM is mainly metabolized by two cytochrome P450 enzymes: CYP2D6 [1] and CYP3A4 [2]. Incidentally, kratom has a strong inhibitory effect on both these enzymes [3].

This means that kratom consumption can lead to an increased presence of DXM and its metabolites within the body. 

Related: What Drugs Interact With Kratom?

DXM Specs: 

Drug Name Dextromethorphan
Trade NamesDelsym, Dexalone, Nyciff, Pedicare, Robitussin
Other Names Dextromethorphan 
Classification Antitussive & Dissociative
CYP MetabolismCYP2D6 & CYP3A4
Interaction With Kratom Kratom inhibits DXM’s metabolization (both substances become stronger)
Risk of InteractionModerate-High

Is it Safe to Take Kratom With DXM?

As we’ve seen, kratom has inhibitory effects on the metabolization of DXM. But is this really an issue?

The reality is this: if you’re taking DXM responsibly and using the proper dosage, then it’s unlikely to lead to any noticeable side effects in combination with kratom.

DXM is not meant to be used for long periods of time. Additionally, incredibly large amounts of DXM need to be consumed to cause immediate adverse effects.

There are only two caveats:

If you have a condition that forces you to take DXM regularly (remember: it is present in many medications), then you might want to be careful about mixing it with kratom. 

Lastly, studies have identified that a significant portion of the population has CYP2D6 deficiencies, which means they have trouble metabolizing compounds with the CYP2D6 enzyme [4]. If you are a part of this cohort, mixing kratom and DXM is slightly riskier.

What is DXM?

Dextromethorphan — or DXM — is a compound found in over 120 over-the-counter medications most often meant to treat a cold or a cough. As a medication, DXM falls under the antitussives category.

DXM is available in a wide variety of forms, such as tablets, syrups, and sprays. Its effects last up to 5 to 6 hours. When taken responsibly, it rarely presents side effects.  

DXM is known to have sedative, dissociative, and stimulant properties, which means DXM does have the potential for misuse. If taken at excessive doses, it acts as a dissociative hallucinogen. This is known as ‘robotripping.’

What is DXM Used For?

DXM is taken to relieve coughing, usually brought on by the flu or other ailments. 

Coughing is a quite complex mechanism that involves nerves in the body sending a message to your brain to make you cough. DXM works by disrupting these communications between the brain and nerves, which suppresses coughs [5]. 

However, it will treat cough symptoms but will not treat the cause or aid in the recovery process.

DXM is regularly found alone or in combination with antihistamines, pain relievers, decongestants, etc. If you’re unsure about which type of DXM medication is best for you, it’s best to consult a pharmacist.

For instance, the antihistamines found in conjunction with many DXM medications can induce feelings of drowsiness, making it unsuitable for daytime use.

What’s the Dose of DXM?

The proper dosage of DXM — as with most medications — is highly dependent on several factors. However, since DXM is taken to relieve cough and cold symptoms in the vast majority of cases, this does simplify things. 

The main factors you should be aware of are:

  • The type of DXM (immediate-release or extended-release)
  • Other ingredients in the formula (many DXM products contain acetaminophen or aspirin)
  • Age (some adult DXM products are unsuitable for children)
  • Method of consumption (tablets, pills, or liquids)

Now, having taken these factors into account, these are the generally recommended dosages for adults and children with each of their consumption methods. 

Generic & Brand Name Versions

As mentioned before, DXM is an active component in over 100 medications.

DXM is available in some of the following brand names:

  • Creomulsion
  • Dayquil
  • Creo-Terpin
  • Delsym
  • Dexalone
  • Nyciff
  • Pedicare
  • Robitussin
  • Vicks Cough Relief

What Are the Side Effects of DXM

DXM comes with a lot of side effects. The most common is drowsiness and nausea. Some users take DXM recreationally for its dissociative effects (it makes users feel like they’re positioned outside the body entirely).

The higher the dose of DXM one uses, the more severe the side effects.

DXM may cause the following side effects:

  • Dizziness
  • Lightheadedness
  • Drowsiness
  • Nervousness
  • Restlessness
  • Nausea
  • Vomiting
  • Stomach pain

If these symptoms are severe or don’t go away, call your doctor. 

DXM can also cause severe rashes. Alert your doctor if this happens.

Additionally, the recreational use of DXM (which involves ingesting 5-10x the normal amount) is known to cause a whole swathe of adverse effects like respiratory depression. 

When consumed in this fashion, DXM has been found to have addictive potential, as well as causing withdrawal symptoms [6]. 

What is Kratom?

Kratom is a natural herbal extract derived from the leaves of the Mytragana speciosa tree. It’s a psychoactive compound with a wide range of effects. 

Indigenous people in Southeast Asia have been using it for centuries. Much like the coca leaf in South America.

Kratom’s effects come from the many plant-based alkaloids which it contains. These bind to opiate receptors in the central nervous system to produce either stimulant or depressive effects.

Kratom is available for consumption in many different methods. Kratom tinctures, tea, crushed powder pills, or even raw leaves are available for purchase through many distributors. 

What is Kratom Used For?

Kratom has many applications, but the most common include energy and focus support, pain relief, and anxiety and mood support.

In terms of its stimulant properties, kratom is great as a morning booster and is quite popular with creative types who want to enhance their mental energy.

The analgesic benefits of kratom are most popular with those dealing with chronic pain conditions, and it has even shown promise in alleviating the symptoms of opioid withdrawal

What’s the Dose of Kratom?

Everyone is different, so it’s never a good idea to completely trust a generalized dosage for kratom or any herb. Listen to your body and increase or decrease the dosage according to how you feel after taking it. 

With that said, there are average dosage recommendations to help identify the ideal starting dose. 

Here are the generalized kratom dosages:

  1. Low dose (1 – 5 g): this range excels in promoting the stimulant, mind-based effects of kratom.
  2. Medium dose (5 – 10 g): analgesic and anxiolytic properties start to become more evident the more you ingest kratom. 
  3. High dose (10 – 15 g): heavy sedative, analgesic, and anxiolytic qualities are to be found at this high dose. Do not consume this amount of kratom if you’re unsure as to how your body will handle it. 

What Are the Side Effects of Kratom?

Kratom, like any pharmacologically-active substance, can cause side effects in users. The more kratom you use, the more likely you are to experience side effects. 

The most common side effects of kratom are nausea and fatigue. 

Kratom can cause the following side effects:

  • Nausea and vomiting
  • Lethargy
  • Dizziness
  • Constipation
  • Brain fog
  • Anxiety

Additionally, it bears repeating that kratom can become addictive. However, the risk is fairly minimized if one abstains from consuming large doses for extended periods.

What Are the Different Types of Kratom?

Kratom comes in an assortment of different strains.

Now, it’s not like they’re radically different experiences; all kratom strains share the same basic suite of properties. However, each strain can accentuate different aspects of the kratom plant.

The strains are named after the color of the kratom leaf’s vein. But once they are processed and ground down into powder, they all look the same. 

A) White Vein Kratom

White-veined kratom strains are best thought of as falling under the mind-based spectrum of kratom benefits. They stimulate mental focus, euphoria, and generalized states of increased mental activity.

If you’re looking to try kratom for its stimulant-like properties, then White Vein kratom is likely your best option.

B) Red Vein Kratom

In comparison to white-veined strains, red vein kratom can be found on the opposite end of the spectrum.

It is best used to promote the analgesic and anti-anxiety benefits of the kratom plant, making it popular with chronic pain patients who do not want to treat themselves with pharmacological pain killers.

Red vein kratom users also report it encourages calm states of being.

C) Green Vein Kratom

Green vein kratom can be found right at the middle of the spectrum. Green-veined strains have a healthy balance of all of kratom’s benefits. 

However, this benefit is also a drawback in the sense that green vein strains sacrifice the targeted experience of a white or red strain.

D) Yellow Vein Kratom

The mysterious yellow-veined kratom strains are thought to arise out of a mixture of red and white strains, although this depends on the vendor. Yellow strains are a combination of multiple different types of kratom to produce the desired effect profile according to the vendor. 

In any case, yellow vein kratom users report this strain as being closely connected to green vein kratom in terms of its effects. 

The one significant difference is that yellow vein kratom is supposedly milder than green, which makes it a perfect choice for beginners.

Kratom (Mitragyna speciosa) leaves, powder and capsules isolated in white background.

Key Takeaways: Is it Safe to Mix Kratom & DXM?

Simply stated: if you’re taking both compounds responsibly and in proper dosages, then yes, it’s perfectly safe.

However, it’s not wise to take DXM as a potentiator for kratom in higher doses. While it certainly works for this application, you’ll significantly increase the risk of side effects in the process. 

Mainly you just need to be aware of the inhibitory effects of kratom on the metabolization of DXM. In most cases, this will not be an issue, as DXM is taken occasionally when cold symptoms arise.

If, for some reason, you find yourself consuming both compounds regularly, ask your doctor about how to best manage these substances together.

Do not ingest large amounts of DXM for recreational purposes.

References

  1. Schadel, M., Wu, D., Otton, S. V., Kalow, W., & Sellers, E. M. (1995). Pharmacokinetics of dextromethorphan and metabolites in humans: influence of the CYP2D6 phenotype and quinidine inhibition. Journal of clinical psychopharmacology, 15(4), 263-269.
  2. Yu, A., & Haining, R. L. (2001). Comparative contribution to dextromethorphan metabolism by cytochrome P450 isoforms in vitro: can dextromethorphan be used as a dual probe for both CYP2D6 and CYP3A activities?. Drug Metabolism and Disposition, 29(11), 1514-1520.
  3. Hanapi, N. A., Ismail, S., & Mansor, S. M. (2013). Inhibitory effect of mitragynine on human cytochrome P450 enzyme activities. Pharmacognosy Research, 5(4), 241.
  4. Woodworth, J. R., Dennis, S. R. K., Moore, L., & Rotenberg, K. S. (1987). The polymorphic metabolism of dextromethorphan. The Journal of Clinical Pharmacology, 27(2), 139-143.
  5. Bem, J. L., & Peck, R. (1992). Dextromethorphan. Drug Safety, 7(3), 190-199.
  6. Mutschler, J., Koopmann, A., Grosshans, M., Hermann, D., Mann, K., & Kiefer, F. (2010). Dextromethorphan withdrawal and dependence syndrome. Deutsches Ärzteblatt International, 107(30), 537.