A 60-year-old woman with agitation and psychosis following ingestion of dextromethorphan and opioid analgesics

Abstract

A patient presented with agitation, paranoia, and psychosis following ingestion of dextromethorphan, propoxyphene, and hydrocodone, a previously unreported combination. Symptoms resolved with antipsychotics and cessation of offending drugs. The pharmacodynamics of dextromethorphan and the opioids, including drug interactions are discussed, and several potential mechanisms for the production of the patient’s symptoms are proposed.

Keywords

delirium dextromethorphan pharmacodynamics propoxyphene serotonin

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