A 57-year-old patient comes to the physician for progressive cough with a large amounts of yellow sputum. He has a history of mild upper respiratory illness which resolved spontaneously. The patient has had no shortness of breath or chest pain. She took unexpired, leftover dextromethorphan for 2 days. The patient's only other medical condition is major depression, for which she takes sertraline. She does not use tobacco, alcohol, or illicit drugs. Vital signs and physical examination show no abnormalities. Use of dextromethorphan is most concerning for which of the following in this patient?

Question

A 57-year-old patient comes to the physician for progressive cough with a large amounts of yellow sputum. He has a history of mild upper respiratory illness which resolved spontaneously. The patient has had no shortness of breath or chest pain.  She took unexpired, leftover dextromethorphan for 2 days.  The patient's only other medical condition is major depression, for which she takes sertraline.  She does not use tobacco, alcohol, or illicit drugs.  Vital signs and physical examination show no abnormalities.  Use of dextromethorphan is most concerning for which of the following in this patient?

Quizplus · Accepted Answer

Eductional Objective: Dextromethorphan (DXM) is a popular over-the-counter antitussive agent that acts on sigma receptors to suppress the medullary cough center.  DXM also has an off-target action on serotonin transports and receptors in the CNS.  Overdose or accidental interaction with other serotonergic medications (eg, selective serotonin reuptake inhibitors, antidepressants) can precipitate serotonin syndrome.

A 57-Year-Old Patient Comes to the Physician for Progressive Cough