Mosca Alessio, Chiappini Stefania, Mancusi Gianluca, Miuli Andrea, Marrangone Carlotta, Allegretti Rita, Panichella Serena, Cavallotto Clara, Corkery John Martin, Pettorruso Mauro, Martinotti Giovanni, Schifano Fabrizio
Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, 66100, Chieti, Italy.
Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, AL10 9EU, Hertfordshire, UK.
Curr Neuropharmacol. 2025;23(8):956-973. doi: 10.2174/011570159X344365250114064248.
The widespread availability and accessibility of over-the-counter (OTC) medicines play a vital role in modern healthcare systems, enabling individuals to manage minor health concerns independently. However, certain OTC medications possess pharmacological properties that render them susceptible to misuse and abuse, including stimulants, laxatives, sedatives, and opiate-containing products. Misuse involves improper dosage, duration, or indication, while abuse entails non-therapeutic use to achieve psychoactive effects or other illicit purposes, potentially leading to dependence and addiction. This review explores the risk of developing psychotic symptoms associated with OTC drug misuse. Synthesizing existing literature, it comprehensively examines the relationship between antihistamines, cough medicines, and decongestants misuse, and the onset of psychotic symptoms.
A systematic literature review was carried out using Pubmed, Scopus and Web of Science databases 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 review NOT (animal OR rat OR mouse). For data gathering purposes, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Research methods were registered on PROSPERO (CRD42024527558).
We analysed 46 relevant studies out of an initial pool of 2,677 articles. Key findings indicate that antihistamines, dextromethorphan, and other OTC drugs can induce psychotic symptoms, such as paranoia, hallucinations, and thought disorders when abused. Dextromethorphan is particularly associated with a chronic tendency towards psychosis, whereas other substances more commonly result in acute substance-induced psychosis.
The study underscores the necessity for increased awareness and specific interventions to address the misuse of OTC drugs and their potential to cause significant psychiatric disorders, emphasizing the broader public health implications of such misuse.
非处方药（OTC）广泛可得且易于获取，在现代医疗保健系统中发挥着至关重要的作用，使个人能够独立处理轻微的健康问题。然而，某些非处方药具有药理学特性，使其容易被滥用，包括兴奋剂、泻药、镇静剂和含阿片类产品。滥用包括用药剂量不当、用药时间不当或用药指征不当，而药物滥用则是指为了获得精神活性作用或其他非法目的而进行非治疗性使用，这可能导致依赖和成瘾。本综述探讨了与非处方药滥用相关的出现精神病症状的风险。通过综合现有文献，全面研究了抗组胺药、止咳药和解充血药滥用与精神病症状发作之间的关系。
通过以下检索策略，利用PubMed、Scopus和Web of Science数据库进行了系统的文献综述：（“苯海拉明”或“异丙嗪”或“氯苯那敏”或“茶苯海明”或“右美沙芬”或“伪麻黄碱”或含可待因的止咳药）以及（“滥用”或“误用”或“渴望”或“成瘾”），不包括综述，不包括（动物或大鼠或小鼠）。为了收集数据，遵循了系统评价和Meta分析的首选报告项目（PRISMA）。研究方法已在PROSPERO（CRD42024527558）上注册。
我们从最初的2677篇文章中分析了46项相关研究。主要研究结果表明，抗组胺药、右美沙芬和其他非处方药在被滥用时可诱发精神病症状，如偏执、幻觉和思维障碍。右美沙芬尤其与慢性精神病倾向有关，而其他物质更常导致急性物质所致精神病。
该研究强调了提高认识和采取具体干预措施以解决非处方药滥用及其导致重大精神障碍可能性的必要性，强调了这种滥用对更广泛公共卫生的影响。
