Dextromethorphan (DM) is a low-affinity, non-competitive
NMDA receptor antagonist that has shown promise in preclinical and preliminary clinical studies for the reduction of
opioid withdrawal symptoms, but when used at higher doses, it is associated with deleterious side effects attributed to its metabolite,
dextrorphan. A clinical trial was therefore conducted to test the withdrawal-suppressant effect of a combination of
dextromethorphan with
quinidine (DM/Q).
Quinidine inhibits the metabolism of
dextromethorphan, reducing
dextrorphan levels.
Opioid-dependent patients were admitted to an inpatient unit, stabilized for three days on
morphine (25 mg, sc, every six hours), and randomly assigned on day 2 to DM/Q (30 mg/30 mg, twice a day) (n = 22) or matching placebo (n = 9) prior to the discontinuation of
morphine on day 4.
Withdrawal symptoms, measured with the Modified Himmelsbach
Opioid Withdrawal Scale (MHOWS), increased significantly on days 4 and 5 (Z = 3.70, p = .0002), and by day 6, 90% of the sample (28/31) had dropped out of the study. There were no differences between treatment groups on either outcome measure. The combination of
dextromethorphan and
quinidine appears ineffective as a primary treatment for
opioid withdrawal. Future studies should examine
dextromethorphan as an adjunct to other anti-withdrawal medications and focus more on the relationship between
dextrorphan levels and withdrawal suppression.