Abstract
Background: The widespread availability and accessibility of over-the-counter (OTC)medicines play a vital role in modern healthcare systems, enabling individuals to manage minorhealth concerns independently. However, certain OTC medications possess pharmacological propertiesthat render them susceptible to misuse and abuse, including stimulants, laxatives, sedatives, andopiate-containing products. Misuse involves improper dosage, duration, or indication, while abuseentails non-therapeutic use to achieve psychoactive effects or other illicit purposes, potentially leadingto dependence and addiction. This review explores the risk of developing psychotic symptomsassociated with OTC drug misuse. Synthesizing existing literature, it comprehensively examines therelationship between antihistamines, cough medicines, and decongestants misuse, and the onset ofpsychotic symptoms.
Methods: A systematic literature review was carried out using Pubmed, Scopus and Web of Sciencedatabases through the following search strategy: (“diphenhydramine” OR “promethazine” OR“chlorpheniramine” OR “dimenhydrinate” OR “dextromethorphan” OR “pseudoephedrine” OR codeine-based cough medicines) AND (“abuse” OR “misuse” OR “craving” OR “addiction”) NOT reviewNOT (animal OR rat OR mouse). For data gathering purposes, the Preferred Reporting Itemsfor Systematic Reviews and Meta-Analyses (PRISMA) was followed. Research methods were registeredon PROSPERO (CRD42024527558).
Results: We analysed 46 relevant studies out of an initial pool of 2,677 articles. Key findings indicatethat antihistamines, dextromethorphan, and other OTC drugs can induce psychotic symptoms,such as paranoia, hallucinations, and thought disorders when abused. Dextromethorphan is particularlyassociated with a chronic tendency towards psychosis, whereas other substances more commonlyresult in acute substance-induced psychosis.
Conclusion: The study underscores the necessity for increased awareness and specific interventionsto address the misuse of OTC drugs and their potential to cause significant psychiatric disorders, emphasizingthe broader public health implications of such misuse.
Keywords:Drug abuse, drug misuse, pharming, drug diversion, over-the-counter drug misuse, addiction, OTC, psychosis, schizophrenia, substance-induced-psychosis.
Current Neuropharmacology
Title:Over-the-counter Psychosis: A Systematic Review of the Misuse of Antihistamines, Cough Medicines, and Decongestants and the Risk of Developing Psychosis
Volume: 23Issue: 8
Author(s):Alessio Mosca*, Stefania Chiappini, Gianluca Mancusi, Andrea Miuli, Carlotta Marrangone, Rita Allegretti, Serena Panichella, Clara Cavallotto, John Martin Corkery, Mauro Pettorruso, Giovanni Martinotti and Fabrizio Schifano
Affiliation:
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D’Annunzio" University, 66100, Chieti, Italy
Keywords:Drug abuse, drug misuse, pharming, drug diversion, over-the-counter drug misuse, addiction, OTC, psychosis, schizophrenia, substance-induced-psychosis.
Abstract:
Background: The widespread availability and accessibility of over-the-counter (OTC)medicines play a vital role in modern healthcare systems, enabling individuals to manage minorhealth concerns independently. However, certain OTC medications possess pharmacological propertiesthat render them susceptible to misuse and abuse, including stimulants, laxatives, sedatives, andopiate-containing products. Misuse involves improper dosage, duration, or indication, while abuseentails non-therapeutic use to achieve psychoactive effects or other illicit purposes, potentially leadingto dependence and addiction. This review explores the risk of developing psychotic symptomsassociated with OTC drug misuse. Synthesizing existing literature, it comprehensively examines therelationship between antihistamines, cough medicines, and decongestants misuse, and the onset ofpsychotic symptoms.
Methods: A systematic literature review was carried out using Pubmed, Scopus and Web of Sciencedatabases through the following search strategy: (“diphenhydramine” OR “promethazine” OR“chlorpheniramine” OR “dimenhydrinate” OR “dextromethorphan” OR “pseudoephedrine” OR codeine-based cough medicines) AND (“abuse” OR “misuse” OR “craving” OR “addiction”) NOT reviewNOT (animal OR rat OR mouse). For data gathering purposes, the Preferred Reporting Itemsfor Systematic Reviews and Meta-Analyses (PRISMA) was followed. Research methods were registeredon PROSPERO (CRD42024527558).
Results: We analysed 46 relevant studies out of an initial pool of 2,677 articles. Key findings indicatethat antihistamines, dextromethorphan, and other OTC drugs can induce psychotic symptoms,such as paranoia, hallucinations, and thought disorders when abused. Dextromethorphan is particularlyassociated with a chronic tendency towards psychosis, whereas other substances more commonlyresult in acute substance-induced psychosis.
Conclusion: The study underscores the necessity for increased awareness and specific interventionsto address the misuse of OTC drugs and their potential to cause significant psychiatric disorders, emphasizingthe broader public health implications of such misuse.
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Cite this article as:
Mosca Alessio*, Chiappini Stefania, Mancusi Gianluca, Miuli Andrea, Marrangone Carlotta, Allegretti Rita, Panichella Serena, Cavallotto Clara, Corkery Martin John, Pettorruso Mauro, Martinotti Giovanni and Schifano Fabrizio, Over-the-counter Psychosis: A Systematic Review of the Misuse of Antihistamines, Cough Medicines, and Decongestants and the Risk of Developing Psychosis, Current Neuropharmacology 2025; 23 (8) .https://dx.doi.org/10.2174/011570159X344365250114064248
| DOI https://dx.doi.org/10.2174/011570159X344365250114064248 | Print ISSN 1570-159X |
| Publisher Name Bentham Science Publisher | Online ISSN 1875-6190 |
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