Dextromethorphan controls—too much, too soon!

An FDA panel voted against requiring prescriptions for medicines containing dextromethorphan.

NBC Nightly News (September 14, “‘Robo-tripping’ prompts possible FDA restrictions,” 2:23, Brian Williams) reported that in “a decision that surprised some people late this afternoon,” and “despite an alarming number of teenagers who are using common over-the-counter cough medicines to get high,” an FDA panel “considering whether or not to recommend a prescription to buy them has decided that is not a good idea for now.”

The Associated Press (AP) (September 15, Matthew Perrone) added that the panel “voted 15-9 against a proposal that would require a doctor’s note to buy medicines containing dextromethorphan, an ingredient found in more than 100 over-the-counter medications.” Many FDA panelists also “said making the drugs prescription-only would go too far—creating an enormous amount of extra work for doctors and pharmacists.” The AP also noted that there has been a nearly 70% rise in emergency department visits between 2004 and 2008 due to dextromethorphan.

ABC World News (September 14, 3:39, Richard Besser, MD) added, “The FDA must still decide whether to accept today’s recommendation from their panel to keep these medicines non-prescription. But it’s very likely that they will.”

Bloomberg News (September 15, Molly Peterson) added that DEA asked FDA to review OTC drugs containing dextromethorphan, noting that “DEA can’t add dextromethorphan to its list of controlled substances unless the FDA recommends that it do so.” MedPage Today (September 14, Emily P. Walker), a CNN health blog (September 15, Val Willingham) and the ABC News website (September 15, Jane E. Allen) also covered the story.

As I read this story, I was struck by how many pharmacists deal with this every day, and what contributions we have to make to ensure safe use of “DM.” I side with the advisory panel on this one. Sending DM to Rx-only status is “too much, too soon.” There are better ways to utilize pharmacists in the safe management of cough medicines than to restrict them to prescription use only.