Information last updated: May 2023
Most pregnancies result in healthy babies, but there are chances of complications and unexpected outcomes. These chances are called baseline risks. In Canada, the baseline risk of major birth defects is 3-5%. This means that 3-5 out of 100 babies born in the general population in Canada will be born with a major birth defect. There are also baseline risks for miscarriages (15-25 out of 100 pregnancies), premature birth and other outcomes. The information provided will summarize if taking this drug is likely to change these risks.
Summary: Approximately 1500 pregnancies with exposure to dextromethorphan were included in published studies. Based on these studies it is not expected that taking dextromethorphan during pregnancy will cause more babies to be born with birth defects than in the general population.
This information about dextromethorphan is of a general nature and about medical use and does not replace the medical care and advice from your healthcare provider. For questions on dose, timing, side effects, interactions, etc. please consult your healthcare provider. If you are using dextromethorphan or other drugs or medications for non-medical reasons or beyond what was recommended by a healthcare provider, please see Harm Reduction section.
Although participants in the studies may have used dextromethorphan in various combinations, the studies usually do not provide detailed information on drug combinations. This makes it challenging to comment on the safety of using this medication in combination with others during pregnancy or lactation.
Dextromethorphan helps to prevent or stop a cough. This type of medication is called a cough suppressant.
It is found in many cough and cold preparations.
If the product you are using contains other active ingredients, please check our Exposures A to Z for available information on the ingredient(s).
For more information on treating cough and cold while pregnant or providing breastmilk to an infant please see Treating the Common Cold in Pregnancy and Lactation.
Pronunciation
(deks troe meth OR fan)
Please check back. We are in the process of reviewing if there is available information on the pre-pregnancy effects of dextromethorphan.
There have been several studies reporting on over 1500 exposures of dextromethorphan in pregnancy. Six studies reported no increased risk. One study suggested there may be a very small risk for some birth defects. However, due to the study design, these findings could have happened by chance and are unlikely to represent a real risk. Even if the findings were real, the chance of these birth defects occurring remains low (approximately 1 in 1000 or lower).
One small study found no increased risk for miscarriages with exposure to dextromethorphan in pregnancy.
No published studies were found addressing prematurity or other pregnancy outcomes with use of dextromethorphan in pregnancy.
Please check back. We are in the process of reviewing if there is available information on the effects of paternal exposure to dextromethorphan.
We did not find published studies on the effects of dextromethorphan use in pregnancy on the newborn. We will update this section if studies become available.
If you are taking medications and you notice any new health concerns or symptoms in your nursing infant, please contact their health care provider. In case of emergency, please go to the emergency room or call 911.
People who are taking a medication or substance while providing their breastmilk to an infant need to know how much of the medication or substance is passing into their milk. One of the commonly used measurements to estimate this is the Relative Infant Dose (RID). The RID is estimated by comparing the dose of drug taken in by the infant through breastmilk to the dose that the nursing parent takes. Most medications with an RID of less than 10% are usually compatible with nursing a healthy infant. The RID does not need to be calculated for each person because most of the time it is expected to be similar to what has been found in research studies. We will provide the RID in the information below, when available.
Based on the available information, dextromethorphan passes into breastmilk in small amounts and is not expected to affect the nursing infant. The estimated RID is less than 1%.
We did not find information on if taking dextromethorphan can affect breastmilk supply.
We did not find published studies on the effects of dextromethorphan use in pregnancy on long-term child/adult health outcomes. We will update this section if studies become available.
Costs of some medications are covered for eligible people under provincial or national Indigenous drug benefit plans. Please visit the Ontario Drug Benefit (ODB) program Check medication coverage or the Non-Insured Health Benefits (NIHB) program Drug Benefit List to check if dextromethorphan is covered for you.
One of the largest studies from the United States including 25,000 infants (680 exposed to dextromethorphan during pregnancy) provided information on maternal race/ethnicity of the study population: non-Hispanic white (57.4-62.5%), non-Hispanic black (8.4-11%), Hispanic (25.1-34.1%) and other (6.1-6.7%). However, they did not examine differences in the outcomes between these groups.
Dextromethorphan (DM) in high doses, or if taken in combination with other substances has the potential for problematic use because it can produce euphoria (a very strong feeling of well-being, happiness, or excitement) and cause a person to see, hear, smell, touch, and taste things that are not really there. It may be used to self-medicate and in party scenes, specific to early teens onward, as an unadulterated substance.
Pill or dried powder forms from the internet often contain a higher dose than in regulated/over the counter formulations. Pills, powder and gel caps which are not approved by Health Canada may be contaminated with fillers or other substances (including methamphetamine or substances that can change how our senses interpret reality) and may not contain the ingredients and/or doses claimed. DM may also be mixed with other ingredients like candy, promethazine, alcohol, pop and codeine. This mixture of substances is sometime called ‘Drank’ or ‘Purple Drank’ and is often consumed in white Styrofoam cups.
There have been no studies looking at problematic use of dextromethorphan in pregnancy.
Medications, if not taken as prescribed, if taken beyond the prescribed amount, or if taken in combination with certain other drugs may cause harm to you and/or your pregnancy or your nursing child.
If you are using dextromethorphan or other drugs or medications for non-medical reasons or beyond what was recommended by a healthcare practitioner and you are pregnant, providing your breastmilk to an infant, or parenting click here Harm Reduction for additional information. In case of emergency, please go to the emergency room or call 911.
Using drugs beyond what your clinician prescribes during pregnancy or parenting in a way that harms you or your baby may result in a community member or care provider contacting child protective services.
Pregnancy:
Approximately 1500 pregnancies with exposure to dextromethorphan were included in published studies. Based on the available information, the use of dextromethorphan during pregnancy is not expected to increase the risk for major birth defects above the baseline risk.
One case-control study including 680 exposed pregnancies examined the risk of 19 major congenital malformations. They reported statistically significant associations between exposure to dextromethorphan with atrioventricular septal defect (7 cases, OR 2.9, 95% CI 1.3-6.5) and transverse limb deficiency (18 cases, aOR 1.8, 95% CI 1.1-3.0). In addition, they reported that exposure to both guaifenesin and dextromethorphan during the first trimester was associated with increased risk of gastroschisis (13 cases, aOR 3.2, 95% CI 1.5- 6.9). They also reported a non-significant association with hydrocephalus (10 cases, aOR 1.9, 95% CI 1.0-3.7). Although associations were detected, the evidence is considered weak because there was no adjustment for multiple associations analyzed and therefore the results may be chance findings. As well, there was no comparison to infants with other malformations to address the risk of recall bias which is inherent to such a study. Even assuming the reported associations are true the chance of these birth defects occurring is rare (≤ 1 in 1000).
One small study including 128 pregnancies exposed to dextromethorphan in the first trimester of pregnancy did not find an increased risk for miscarriage above the baseline risk in the general population.
No published studies were found addressing prematurity or other pregnancy outcomes with use of dextromethorphan in pregnancy.
Lactation:
One of the factors that helps to determine if a medication is compatible with nursing is the Relative Infant Dose (RID). The RID provides an estimate of infant’s exposure to a medication through breastmilk. It is the ratio between the infant’s and the nursing individual’s weight-adjusted doses. The infant weight adjusted dose is estimated based on the concentration of medication in breastmilk, and an assumption of infant daily milk consumption of 150 ml/kg/day. In general, for infants with normal growth and development, most medications with an RID of less than 10% are considered compatible with nursing. The RID does not account for infant’s drug metabolism, clearance, or infant blood levels. Although some variability may exist in the RID, in most cases the estimated RID is adequate for clinical purposes and does not need to be calculated for each individual. We will provide the RID in the information below, when available.
Based on the available information, the estimated RID for dextromethorphan is less than 1%, thus it is not expected to cause adverse effects in the nursing infant.
We did not find information on whether or not dextromethorphan affects milk supply.
Harm Reduction:
Dextromethorphan in very high doses, or in combination with other substances has the potential for problematic use because it can produce euphoria and hallucinations. Unauthorized products may be contaminated with other substances and not be in typical doses.
If your patient may be using dextromethorphan or other drugs or medications not as indicated during pregnancy, while providing breastmilk to an infant, or parenting please click here Harm Reduction for additional information. In case of emergency, please advise them to go to the emergency room or call 911.
For additional resources see
Aselton P, Jick H, Milunsky A. First-trimester drug use and congenital disorders. Obstetrics and Gynecology. 1985;65(4):451-5.[PMID: 15099137].
Cao Y, Rhoads A, Burns T, Carnahan RM, Conway KM, Werler MM, et al. Maternal use of cough medications during early pregnancy and selected birth defects: A US multisite, case-control study. BMJ Open. 2021;11(12):e053604.[PMID: 636846595].
Einarson A, Lyszkiewicz D, Koren G. The safety of dextromethorphan in pregnancy : results of a controlled study. Chest. 2001;119(2):466-9.[PMID: 11171724].
Heinonen OP, Slone D, S. S. Birth defects and drugs in pregnancy. Littleton, Massachusetts, USA: Publishing Sciences Group Inc; 1977.
Lieberman D, O’Brien D, Meyers R, Gottshall L, Yohn C, Siemiatkowska A, et al. Assessment of dextromethorphan concentration in human breast milk. American Journal of Obstetrics and Gynecology. 2023;228(1 Supplement):S119.[PMID: 2022102068].
Lind JN, Tinker SC, Broussard CS, Reefhuis J, Carmichael SL, Honein MA, et al. Maternal medication and herbal use and risk for hypospadias: data from the National Birth Defects Prevention Study, 1997-2007. Pharmacoepidemiol Drug Saf. 2013;22(7):783-93.[PMID: 23620412].
Martinez-Frias ML, Rodriguez-Pinilla E. Epidemiologic analysis of prenatal exposure to cough medicines containing dextromethorphan: no evidence of human teratogenicity. Teratology. 2001;63(1):38-41.[PMID: 11169553].
Public Health Agency of Canada. Congenital Anomalies in Canada: 2022. Public Health Infobase. [Internet] Ottawa: Public Health Agency of Canada; 2022 Oct 3 [cited 2023 September 8]. Available from: https://health-infobase.canada.ca/congenital-anomalies/data-tool/
Public Health Agency of Canada. Congenital Anomalies in Canada 2013: A Perinatal Health Surveillance Report. [Internet]. Ottawa: Public Health Agency of Canada; 2013 Sept [cited 2023 September 8]. Available from: https://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf
Public Health Agency of Canada. Family-centred maternity and newborn care: National guidelines Chapter 7: Loss and grief. [Internet]. Ottawa: Public Health Agency of Canada; 2022 Aug 10 [cited 2023 September 9]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-7.html
Shum S, Yadav A, Fay E, Moreni S, Mao J, Czuba L, et al. Infant Dextromethorphan and Dextrorphan Exposure via Breast Milk From Mothers Who Are CYP2D6 Extensive Metabolizers. J Clin Pharmacol. 2022;62(6):747-55.[PMID: 34889461].
Verstegen RHJ, Anderson PO, Ito S. Infant drug exposure via breast milk. Br J Clin Pharmacol. 2022 Oct;88(10):4311-4327. doi: 10.1111/bcp.14538. Epub 2020 Sep 13. PMID: 32860456
Polifka JE, Shepard TH. The teratogenicity of N-methyl-D-aspartate (NMDA) receptor antagonists. Pediatr Res. 1998;44(3):415; author reply 6-7.[PMID: 9727723].
Werler MM, Sheehan JE, Mitchell AA. Maternal medication use and risks of gastroschisis and small intestinal atresia. American Journal of Epidemiology. 2002;155(1):26-31.[PMID: 34042429].
