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Related Experiment Video

Updated: Oct 22, 2025

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Fatal cold medication poisoning in an adolescent.

Sam Ontiveros¹, Lee Cantrell²

¹UC San Diego Medical Center, Dept. of Emergency Medicine, 200 W. Arbor Drive, San Diego, CA 92103-8676, USA.

The American Journal of Emergency Medicine

|August 29, 2021

Summary

Adolescent misuse of over-the-counter cold medicines containing dextromethorphan and chlorpheniramine can be fatal. This case highlights the rare but severe risks associated with intentional dextromethorphan and chlorpheniramine abuse.

Keywords:

Chlorpheniramine Dextromethorphan Fatal Poisoning

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Area of Science:

Forensic Toxicology
Adolescent Medicine
Public Health

Background:

Over-the-counter (OTC) cold products are frequently misused by adolescents.
Dextromethorphan (DXM) is a common ingredient in misused OTC products, sought for its psychoactive effects.
Co-formulated ingredients like acetaminophen, pseudoephedrine, and antihistamines can exacerbate toxicity.

Observation:

A case involving an adolescent with fatal intentional misuse of OTC cold products is presented.
Elevated postmortem blood concentrations of chlorpheniramine (CPA) and dextromethorphan (DXM) were detected.
No other cause of death was identified, suggesting toxicity from the ingested substances.

Findings:

The decedent exhibited markedly elevated blood concentrations of both chlorpheniramine and dextromethorphan.
The combination of DXM and CPA contributed to the fatal outcome.
This case underscores the potential lethality of abusing OTC cold medications.

Implications:

Healthcare providers should be aware of the potential for fatal toxicity from OTC cold product misuse in adolescents.
Public health initiatives may be needed to address adolescent misuse of OTC medications.
Toxicological analysis in postmortem cases should consider the potential contribution of commonly available OTC drug ingredients.