Dextromethorphan

Dextromethorphan is a common ingredient in cough syrups.  The Collaborative Perinatal Project identified 300 women exposed to dextromethorphan during the first trimester and did not find an increased risk for birth defects. Two additional cohort studies involving 59 and 184 women, respectively, who used dextromethorphan during pregnancy did not find an association between this agent and congenital defects.  More recently, a group of Spanish investigators published epidemiologic data that did not support a possible association between the use of dextromethorphan during pregnancy and increased risk of neural tube defects, heart defects, or an altered risk of all other congenital defects. There were 70 dextromethorphan-exposed pregnancies in this report.  There have not been adequate studies in human pregnancy and more data is required before a thorough risk assessment is possible.

In 1998, an animal study involving chick embryos suggests that early exposure to dextromethorphan is associated with an increased risk for neural tube defects, craniofacial defects, and embryotoxicity. In addition to this study a pediatric research group is in the process of conducting a prospective study involving the use of Dextromethorphan.  Preliminary findings suggest that Dextromethorphan use during pregnancy does not increase the rates of major malformations above the risk of 1-3%.  The highest dose used in this study is greater than the amount ingested by a person taking dextromethorphan to treat a cough, but may be comparable to the amount received by a person abusing dextromethorphan recreationally. The moderate and low doses are comparable to that received from cough syrup. While animal data can be useful it is important to remember that different species have different levels of sensitivity following exposure to the same agent. In general, it is thought that therapeutic dextromethorphan use during pregnancy does not pose a high risk for malformation.

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