Robotripping means taking large amounts of cough medicine that contains dextromethorphan (DXM) to get high. At high doses, DXM can cause hallucinations, a detached “out-of-body” feeling, a racing heart, vomiting, seizures and dangerous overheating. It’s most common among teens and young adults, partly because DXM is sold over the counter.
Worried about DXM or other drug use? Call (407) 680-1226 or verify your insurance. Orlando Recovery Center treats adults 18 and older. If you’re worried about a teen, see the signs for parents below.
What is robotripping?
The name comes from Robitussin, a well-known cough syrup brand, and “tripping.” Other slang terms include “robo,” “dexing,” “skittling” and “Triple C.”
DXM is a cough suppressant found in many over-the-counter cough and cold products, including syrups, gel caps and tablets. Labels often include “DM” or “cough.” At the recommended dose, it’s safe for most people. In large amounts, it acts on the brain much like ketamine and PCP, blocking NMDA receptors and causing a dissociative high.
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DXM isn’t a federally controlled substance, but many states limit sales of DXM products to people under 18.
What are the DXM plateaus?
People who misuse DXM describe its effects in four “plateaus” that grow stronger as the amount taken goes up. Every plateau involves amounts far above what the label allows, and every one carries real risk.
- First plateau: restlessness, mild euphoria and a feeling similar to being drunk.
- Second plateau: stronger intoxication, slurred speech, poor coordination, changes in vision and hearing, and mild hallucinations.
- Third plateau: a dissociative state with distorted senses, confusion, trouble moving or speaking and a feeling of being detached from the body.
- Fourth plateau: complete dissociation, similar to ketamine anesthesia, with a high risk of injury, dangerous heart and breathing effects, seizures and overdose.
Effects usually begin within 15 to 60 minutes and can last six hours or more. How strongly DXM hits varies a lot from person to person. Some people’s bodies break it down slowly because of their genes, so an amount one person tolerates can be dangerous for another. Other ingredients in the product, and other drugs, make the effects even less predictable.
Signs of robotripping parents should watch for
DXM misuse is easy to hide because cough medicine is in most homes. Watch for these signs.
Physical and behavior signs
- Slurred speech, stumbling or a stiff, “robotic” way of walking
- Rapid, involuntary eye movements
- Confusion, seeming “out of it” or detached, or seeing and hearing things that aren’t there
- Nausea, vomiting, sweating, flushed skin or a fast heartbeat
- Unusual drowsiness, or agitation and irritability
- Changes in grades, friends, sleep or mood, and more secrecy
Signs around the house
- Empty cough medicine bottles or blister packs in the trash, a backpack, a car or a bedroom
- Cough medicine disappearing from the cabinet, or being bought often when no one is sick
- Packages of unfamiliar pills or powders ordered online
- Slang such as “robo,” “dex,” “skittles,” “Triple C” or “tussin” in texts or on social media
What parents can do
Stay calm and talk openly. Ask questions without accusing. Keep cough and cold medicines where you can keep track of them.
Your child’s pediatrician or a school counselor can help with screening and point you to adolescent treatment options. If your teen shows signs of an overdose, call 911 or Poison Control right away.
Can DXM cause serotonin syndrome?
Yes. DXM raises serotonin levels in the brain. Combining it with other drugs that affect serotonin can cause serotonin syndrome, a reaction that can be life-threatening. The risk is highest with:
- SSRI antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil);
- SNRI antidepressants, such as venlafaxine (Effexor) and duloxetine (Cymbalta);
- MAO inhibitors (MAOIs). Never take DXM with an MAOI or within two weeks of stopping one;
- other drugs that raise serotonin, such as tramadol, some migraine medicines, MDMA (ecstasy) and St. John’s wort.
Some antidepressants, including fluoxetine and paroxetine, also slow the breakdown of DXM, which makes its effects stronger and longer. This matters for teens and adults who take an antidepressant.
Signs of serotonin syndrome include agitation or confusion, a fast heartbeat, high blood pressure, dilated pupils, muscle twitching or stiffness, heavy sweating, shivering, diarrhea and a high fever. Severe cases can cause seizures. Call 911.
What does a DXM overdose look like?
Call 911 if someone has taken a large amount of DXM and has:
- extreme drowsiness, or can’t be woken up;
- slow, shallow or labored breathing;
- a very high body temperature or hot, flushed skin;
- a very fast heartbeat;
- a seizure;
- severe confusion, agitation, paranoia or hallucinations;
- repeated vomiting.
For questions about a possible poisoning, call Poison Control at 1-800-222-1222. It’s free, confidential and open 24/7. Stay with the person, and if they’re vomiting or drowsy, turn them onto their side.
Why combination cold medicines are even more dangerous
Many cough and cold products combine DXM with other ingredients that become toxic in large amounts:
- Acetaminophen can cause severe liver damage.
- Antihistamines such as chlorpheniramine or diphenhydramine can cause seizures, heart rhythm problems and dangerous overheating.
- Decongestants such as pseudoephedrine or phenylephrine can raise blood pressure and strain the heart.
Mixing DXM with alcohol, cannabis or other drugs also raises the risk of overdose and injury.
Treatment for DXM misuse
Regular DXM misuse can lead to tolerance, cravings and a pattern of use that’s hard to stop. It often goes along with depression, anxiety or other substance use, and treatment addresses both.
At Orlando Recovery Center, adults 18 and older can receive medical detox when needed, residential treatment and partial hospitalization (PHP), along with care for co-occurring mental health conditions and aftercare planning. Intensive outpatient care (IOP) is available at our sister facility, Orlando Outpatient Center in Maitland.
We’re in network with several insurers for substance use treatment, including Aetna, Cigna, Florida Blue (BCBS), Humana and UnitedHealthcare/Optum. Coverage depends on your plan, so verify your insurance or call (407) 680-1226.
If your child is under 18, their pediatrician or a local adolescent treatment program is a good place to start.
Robotripping FAQs
Is Robitussin an opioid?
No. DXM is chemically related to opioids, but it doesn’t relieve pain or act like opioid painkillers, and it isn’t classified as an opioid. Some prescription cough syrups do contain codeine or hydrocodone, which are opioids, so always check the label.
How long does a robotripping high last?
Effects usually start within 15 to 60 minutes and can last six hours or more. Fatigue, low mood and trouble concentrating can continue into the next day.
Can you get addicted to DXM?
Yes. People who misuse DXM regularly can develop tolerance, cravings and a pattern of compulsive use. Stopping after heavy use may bring fatigue, low mood, trouble sleeping and cravings for a while.
Does DXM show up on a drug test?
Standard drug panels don’t test for DXM. However, DXM can cause a false-positive result for PCP on some screening tests. A lab confirmation test can tell the difference.
