Dextromethorphan (DXM) is a common ingredient in over-the-counter cough medicines, frequently used to alleviate cough symptoms. Atrial fibrillation (Afib) is a prevalent heart condition characterized by an irregular heartbeat. For individuals managing Afib, a question often arises regarding the compatibility and safety of using common medications like DXM.
How Dextromethorphan Works
Dextromethorphan is classified as an antitussive, meaning it works to suppress coughs. This medication primarily acts on the central nervous system, specifically by affecting the cough reflex in the brain. It elevates the threshold required to trigger a cough, thereby reducing the frequency and intensity of coughing.
DXM is found in many cold and cough syrups, as well as in pill form, either alone or in combination with other active ingredients. While it shares structural similarities with opioids, DXM has minimal interaction with opioid receptors at typical doses used for cough suppression.
Understanding Atrial Fibrillation
Atrial fibrillation (Afib) is a heart rhythm disorder where the heart’s upper chambers, the atria, beat irregularly and often rapidly. Instead of coordinated electrical signals, the atria experience disorganized electrical activity, leading to an inefficient pumping of blood. This can result in symptoms such as heart palpitations, fatigue, dizziness, shortness of breath, and chest pain.
Untreated Afib can lead to serious complications, including an increased risk of stroke due to blood clots forming in the atria. It can also contribute to heart failure, where the heart’s ability to pump blood effectively is weakened. Management of Afib often involves medications to control heart rate and rhythm, and blood thinners to reduce stroke risk.
Navigating Dextromethorphan Use with Afib
While dextromethorphan itself is not considered to have a direct contraindication for Afib patients, several considerations are important. One concern is the potential for QTc prolongation, which is a lengthening of the heart’s electrical recharging time. Although DXM alone presents a low risk of QTc prolongation at therapeutic doses, this risk can increase, particularly with high doses or in combination with other medications that also affect the QTc interval.
Another consideration is the risk of serotonin syndrome when DXM is taken alongside certain other medications. DXM can increase serotonin levels in the brain. When combined with other serotonergic drugs, such as some antidepressants (e.g., SSRIs, tricyclic antidepressants) or certain antiarrhythmics like amiodarone, it can lead to serotonin syndrome. Symptoms can include agitation, hallucinations, rapid heartbeat, and changes in blood pressure.
A concern for Afib patients using over-the-counter cold medications containing DXM lies with other ingredients present in multi-symptom formulations. Decongestants like pseudoephedrine and phenylephrine, commonly found in these products, can raise heart rate and blood pressure. These effects can potentially worsen Afib symptoms or interact negatively with Afib medications, making such combination products unsuitable for Afib patients. Therefore, checking the list of ingredients is important.
Safe Medication Practices for Afib Patients
Consulting a healthcare professional is a primary step before taking any new medication, especially over-the-counter drugs, if one has atrial fibrillation. This allows for a personalized assessment of potential interactions with existing Afib medications and overall heart health.
Patients should provide their doctor or pharmacist with a list of all medications they are currently taking. This includes prescription drugs, over-the-counter products, supplements, and herbal remedies. Many common medications can interact with Afib treatments or affect heart rate and blood pressure.
Reading the labels of over-the-counter cold and cough remedies is important. One should look for decongestants like pseudoephedrine or phenylephrine, which are often contraindicated for Afib patients due to their effects on heart rate and blood pressure. Some products are marketed as “HBP” (high blood pressure) formulations, which may be safer as they often exclude decongestants.
For cough relief, non-pharmacological options can be considered. Measures like using honey, warm liquids, or a humidifier may help alleviate cough symptoms without the potential risks associated with certain medications. Recognizing symptoms that warrant immediate medical consultation, such as worsening Afib symptoms or severe side effects, is important.