NIDA for Teens: The Science Behind Drug Abuse
Drug Facts

Cough and Cold Medicine (DXM and Codeine Syrup)

What Are Cough and Cold Medicines?

 A bottle of cough syrup being poured into a teaspoon.

Also known as: robotripping, robo, tussin, triple c, dex, skittles, candy, velvet, and drank

Millions of Americans take cough and cold medicines each year to help with symptoms of colds, and when taken as instructed, these medicines can be safe and effective. However, several cough and cold medicines contain ingredients that are psychoactive (mind-altering) when taken in higher-than-recommended dosages, and some people may abuse them. These products also contain other ingredients that can add to the risks.

Two commonly abused cough and cold medicines are:

  • Cough syrups and capsules containing dextromethorphan (DXM). These over-the-counter (OTC)—meaning they can be bought without a prescription—cough medicines are safe for stopping coughs during a cold if you take them as directed. Taking more than the recommended amount can produce euphoria (a relaxed pleasurable feeling) and dissociative effects (like you are detached from your body).
  • Promethazine-codeine cough syrup. These prescription medications contain an opioid drug called codeine, which stops coughs, but when taken in higher doses produces euphoria.


How Are Cough and Cold Medicines Abused?

Cough and cold medicines are usually sold in liquid syrup, capsule, or pill form. They may also come in a powder. Young people are more likely to abuse cough and cold medicines containing DXM because these medicines can be purchased without a prescription. Some people mix promethazine-codeine cough syrup with soda or alcohol and flavor the mixture by adding hard candies.

How Do Cough and Cold Medicines Affect the Brain?

When cough and cold medicines are taken as directed, they safely treat symptoms caused by colds and flu. But when taken in higher quantities or when such symptoms aren’t present, they may affect the brain in ways very similar to illegal drugs.

DXM acts on the same brain cell receptors as drugs like ketamine or PCP. A single high dose of DXM can cause hallucinations (imagined experiences that seem real). Ketamine and PCP are called "dissociative" drugs, which means they make you feel separated from your body or your environment, and they twist the way you think or feel about something or someone.

Codeine attaches to the same cell receptors as opioids like heroin. High doses of promethazine-codeine cough syrup can produce euphoria similar to that produced by other opioid drugs. Also, both codeine and promethazine depress activities in the central nervous system (brain and spinal cord), which produces calming effects.

Both codeine and DXM cause an increase in the amount of dopamine in the brain’s reward pathway. Extra amounts of dopamine increase the feeling of pleasure and at the same time cause important messages to get lost, causing a range of effects from lack of motivation to serious health problems. Repeatedly seeking to experience that feeling can lead to addiction.


What Are the Other Effects of Cough and Cold Medicines?

DXM abuse can cause:

  • Loss of coordination
  • Numbness
  • Feeling sick to the stomach
  • Increased blood pressure
  • Faster heart beat
  • In rare instances, lack of oxygen to the brain, creating lasting brain damage, when DXM is taken with decongestants

Promethazine-codeine cough syrup can cause:

  • Slowed heart rate
  • Slowed breathing (high doses can lead to overdose and death)

Also, cough and cold medicines are even more dangerous when taken with alcohol or other drugs.

Can You Get Addicted to Cough and Cold Medicines?

Yes, high doses and repeated abuse of cough and cold medicines can lead to addiction. That’s when a person seeks out and takes the drug over and over even though they know that it is causing problems with their health and their life.

Can You Die If You Abuse Cough and Cold Medicines?

Yes. Abuse of promethazine-codeine cough syrup slows down the central nervous system, which can slow or stop the heart and lungs. Mixing it with alcohol greatly increases this risk. Promethazine-codeine cough syrup has been linked to the overdose deaths of a few prominent musicians.

How Many Teens Abuse Cough and Cold Medicines?

NIDA’s Monitoring the Future study collects data on teen abuse of cough medicines:

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Cough Medicine (non-prescription) for 8th Graders, 10th Graders, and 12th Graders; 2014 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Cough Medicine (non-prescription) Past Year [2.00] 3.70 4.10



What Should I Do If Someone I Know Needs Help?





For More Information on Cough and Cold Medicine

Drug Facts


Statistics and Trends


Monitoring the Future (University of Michigan):

Substance Abuse and Mental Health Services Administration: