PrepperMed 101: Prescription Medication Substitutions?

We can stock up many things we might need for disaster situations, but prescription medication usually can’t be stocked in depth. That’s a problem, since the majority of Americans are on prescription meds, and many of us are on more than one. Is there a way to find substitutes?

This post is about one possibility. More than that, it’s about the process for finding substitutions, and the problems with the process.

A potential substitute medication

I was reading a book on animal psychology (1) when the author mentioned that some vets were using dextromethorphan (DXM)  as a remedy for OCD (obsessive-compulsive disorder) in their animal patients. This perked my ears up, as DXM is the most common over-the-counter cough medication. An OCD treatment a prepper could pick up in any dollar store and stock up on?

Why would cough medication help with a psychiatric problem?

Looking into how DXM works, it sounds completely plausible. Brain cells talk to one another using chemicals called neurotransmitters. A common neurotransmitter used to activate other brain cells is glutamate. The cells receiving the message need to have receptors for the neurotransmitter. The NMDA receptor is found in many brain cells to receive the message of glutamate.

It turns out that DXM works as a cough medication by blocking those NMDA receptors. So some of the things glutamate normally does by landing on NMDA receptors can be stopped by DXM. Too much action of glutamate on NMDA receptors on particular brain cells is thought to cause OCD (3).

Even more promise for the cough medication

As I read more, the story got even more intriguing. The glutamate-landing-on-NMDA-receptors is one of your brain’s favorite combinations; many brain circuits use it. NMDA blocking medications of various descriptions are used to treat several important psychiatric issues. OCD is just one.

Parkinson’s disease, for example. Parkinson’s is best known as a movement disorder, but it very frequently causes depression as well.  A different NMDA blocker works to both improve the movement and improve the mood in people with Parkinson’s. (2)

Autism-spectrum disorders are also very common; and some aspects of this set of problems uses the NMDA/glutamate system as well. (4) So does non-Parkinson’s depression, and the problem of exaggerated moods found in some persons with brain damage, including from Alzheimer’s disease. (5)

That means there’s good reason to hope that DXM could be a medication for all of these conditions.

But does the cough medication work for these psych problems?

The problem is that there are lots of subtle differences in both receptor types and the drugs that interact with them. Knowing you’ve got the right receptor system and a blocker for the receptor doesn’t mean it will work on a particular brain circuit. If the drug would work, there’s also the problem of figuring out how much it takes. The dose that’s good to stop a cough wouldn’t necessarily be right for a different problem.

This is where the story got less encouraging. There were only a small number of studies that I could find using DXM as a psychiatric medication. That’s not surprising; cheap generic drugs only get tested for new uses by people with government grants. The studies are super expensive and drug companies won’t pay for them because they don’t make enough profit from a generic over the counter drug.

And the results were…

So we had a few, small studies that guessed at one dose of DXM to try and looked for effects. Most of them didn’t have the result we’d hope for. 90-100 mg/day dextromethorphan (open label) didn’t improve psych of PD mentation, behavior, mood. (2) DXM didn’t help with autism spectrum disorder symptoms. (4) Alcohol withdrawal syndrome patients weren’t impressed with the drug either, at 360 mg/day. (6)

The medication did show benefit in some situations though.DXM taken with another drug to prolong its effect found useful for the exaggerated moods found with some brain damage, Alzheimer’s and Parkinson’s. (5)

Adding up the score

Does DXM work for these psych disorders? Maybe. At the right dosage. I’m not convinced one way or another by available evidence. I am not a physician, so I’m not going to make recommendations. I will say if I had Parkinson’s, well, I’d be checking out the shelf stability of DXM; but I wouldn’t have a lot of confidence that my problem was solved.

The problems with substituting medications

If a prepper is forced by circumstance to try substitutions such as there, there are some things that are good to keep in mind. One is that a medication that is safe taken as directed for a limited time (like a cough medication) isn’t necessarily safe for long-term use and with other drugs.

DXM, for example, can have interactions with other drugs that work on the same receptor system. Serotonin syndrome is what it’s called when a person has too much blocking of NMDA receptors by a combination of different drugs. A list of the drugs to look out for can be found here.  I noticed that St. John’s Wort is on the list. St. John’s Wort is of particular interest to preppers since it’s an herb preppers can grow that helps with depression. I have a post on it here. 

Another concern whenever we stock drugs is the potential for abuse. Drugs of abuse attract criminals, and might cause problems in your own family. Times of stress raise the risk of that. DXM, in combination with other cold meds, are sometimes abused by people taking super high doses to, well, trip. (7)

Shelf life is also worth considering. I couldn’t find good information on it for DXM. Not surprising, that information often is not published. You’re just supposed to trust the expiration dates on the packages. So I just don’t know for DXM; although I would absolutely go with pills over liquids if I was trying to stock the stuff. They last better, generally.

Bigger lessons

Prescription medication substitutions for preppers is a sticky issue. The subs we can get readily tend to be unproven (as DXM largely is). We don’t have the help with dosing and side effects that we’d like. Shelf life and storage are items of concern.

Still, it may be worth looking into for those of us who have conditions that require prescription medication that we can’t stock in bulk. In some cases, a jury-rigged solution is better than no solution at all. Best wishes!

References

1) Dodman, N. (2016) Pets on the Couch: Neurotic Dogs, Compulsive Cats, Anxious Birds, and the New Science of Animal Psychiatry. Simon and Scheuster

2) Brigitte Vanle, William Olcott, Jaime Jimenez, Luma Bashmi, Itai Danovitch & Waguih William IsHak. NMDA antagonists for treating the non-motor symptoms in Parkinson’s disease. Translational Psychiatryvolume 8, Article number: 117 (2018)

3) Grant, P. J., Joseph, L. A., Farmer, C. A., Luckenbaugh, D. A., Lougee, L. C., Zarate, C. A., & Swedo, S. E. (2014). 12-Week, Placebo-Controlled Trial of Add-on Riluzole in the Treatment of Childhood-Onset Obsessive–Compulsive Disorder. Neuropsychopharmacology, 39(6), 1453–1459. http://doi.org/10.1038/npp.2013.343

4) Farmer C, Thurm A, Grant P. Pharmacotherapy for the core symptoms in autistic disorder: current status of the research. Drugs. 2013 Mar; 73(4):303-14.

5) Yang, L., & Deeks, E. (2015). Dextromethorphan/Quinidine: A Review of Its Use in Adults with Pseudobulbar Affect. Drugs, 75(1), 83–90. https://doi.org/10.1007/s40265-014-0328-z

6) Huang, M., Chen, C., Pan, C., & Lin, S. (2014). Lack of efficacy of dextromethorphan in managing alcohol withdrawal: A preliminary report of a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychopharmacology, 34(1), 149.

7) Stanciu, C. N., Penders, T. M., & Rouse, E. M. (2016). Recreational use of dextromethorphan, “Robotripping”-A brief review. American Journal on Addictions, 25(5), 374–377. https://doi.org/10.1111/ajad.12389