Scientific Poster Session IV - Case Reports

Case Reports
  Tuesday, October 15, 2024
  08:30 AM–10:00 AM

Abstract

Introduction: Limited literature exists detailing characteristics and pharmacotherapy for dextromethorphan use disorder in adults. This case report provides insight in the context of an inpatient psychiatric treatment and subsequent emergency department encounter.

Case: RG is a 49-year-old male with dextromethorphan use disorder, Bipolar I Disorder, and a notable symptom of boredom admitted to the psychiatric ward of the Raymond G. Murphy Medical Center following a dextromethorphan overdose with suicidal intent. After the patient’s acute depressive symptoms subsided, modafinil was prescribed to address the patient’s symptom of boredom, a likely contributor to his dextromethorphan use. Acamprosate was prescribed to treat cravings for dextromethorphan. Approximately one month post-discharge, the patient presented to the emergency room with a 127 beat-per-minute resting pulse, having used dextromethorphan in combination with his modafinil and acamprosate therapy.

Discussion: Due to the limited evidence existing regarding dextromethorphan use disorder and treatment of contributing underlying boredom, pharmacological mechanism was a key consideration in determining pharmacotherapy for this patient. In addition to the patient’s endorsement of prior benefit, acamprosate was selected with the consideration that its NMDA receptor modulation may attenuate the cravings associated with DXM upon discontinuation, which is a NMDA receptor antagonist. Additionally, modafinil was postulated to benefit motivation based on a small randomized-controlled trial (Muller et al.) and combat boredom via dopaminergic pathway signaling observed in human PET scans. The latter likely contributed to tachycardia when the patient resumed dextromethorphan use.

Conclusion: Further investigation and empiric evidence is required to determine if NMDA modulating medications such as acamprosate may provide benefit to adult patients in dextromethorphan use disorder. Additionally, the benefit of modafinil to motivation, as well this possible drug interaction, merits further exploration. The therapy appears promising as, despite the resumption of dextromethorphan use and ensuing tachycardia, the patient remained motivated to continue the therapy.

Presenting Author

Nariman Piri PharmD
New Mexico VA Health Care System

Authors

Ann Nawarskas Pharm.D., C.D.E.