Mon frère –

I basically started out on my own, after reading the posts of SandyS regarding how well her daughter tolerated DM and raised the issue with a pharmacist, who advised me that 100% USP dextromethorphan HBr was – at that time – available OTC as Zicam Cough MAX, which dispensed it at 6 mg/spray, with a suggested maximum adult daily dose of 120 mg. I then mentioned it to my psychiatrist/psychopharmacologist who suggested Neudexta, which I then augmented with my continued use of Zicam Cough MAX.

Unfortunately, I wasn’t alone in becoming aware of the possibilities of Zicam Cough MAX. Turns out that kids were buying the stuff in bulk and then taking it in doses a full order of magnitude or more beyond anything I was taking – 1,000 to 2,000 mg at a pop – which was enough to induce a true “dissociative state,” and get the attention of the DEA. At which point the manufacturer was persuaded to pull it off the market. At which point I went back to my psychiatrist, who then added the prescription for compounded DM capsules.

One final item of clarification is still in order. In order to “function” (as best I can) with what could otherwise be a stultifying brew of Baclofen, analgesics and benzodiazepines - as well as the ground fog of RSD - I take significant amounts of both Provigil and Wellbutrin, as well as a standard 30 mg dose of Namenda (mementine). Although, truth be told, my psychiatrist believes that Neudexta has as significant an effect on alertness as any of the other meds.

And lastly, a couple of points as far as Provigil is concerned: first, because its patent is expiring, the manufacturer, Avanir Pharmaceuticals, Inc., is pushing patients to a newly tweaked molecule of essentially the same drug, marketed under the name of Nuvigil, which I tried as well but found that it profoundly raised my blood pressure. Secondly, even though the standard dose of Provigil is 400 mg/day, I’m on 600 mg, but it’s taken carefully because it too raises blood pressure, although, at least for me, not nearly as much as Nuvigil. So I take two 200 mg tablets in the morning, with a third allowed in the afternoon, but before taking it, I use a blood pressure cuff to insure that it’s dropped into a normal range. And if it hasn’t, I wait.

Apologize for the long response to a short question, but I wanted to be as clear as I could.

Mike