Dextrorphan (DXO)

Dextrorphan, also known as DXO, is the active metabolite of dextromethorphan (DXM). While its pharmacology is similar to dextromethorphan, it is a far more potent NMDA receptor antagonist yet much less effective as a serotonin reuptake inhibitor. Its chemical formula is C17H23NO with a molecular mass of 257.371 g/mol.

In the US, it is a schedule I controlled substance, meaning it has a high potential for abuse, has currently no medical use in treatment, and a lack of safety for use under medical supervision.

In terms of effects, dextrorphan produces stronger dissociative and intoxicating effects while having less of an effect on stimulation, cognitive alterations, and psychosis-like effects which are more prominent with dextromethorphan. High levels of dextrorphan can produce dysphoria, causing the high to be unpleasant to very disturbing.

As DXM is metabolized to DXO by the liver enzyme CYP2D6, those who are deficient in this enzyme will experience the effects of DXM more than DXO. This is because more of the DXM will be metabolized by the enzyme CYP3A4 to 3-Methoxymorphinan. Approximately 1 in 10 of the Caucasian population have little or no CYP2D6 enzyme activity leading to prolonged effects of DXM. This is why it is important to start with a low dose of DXM to test for CYP2D6 deficiency.

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