2023-02-26

can dextromethorphan cause insomnia

Dextromethorphan is used to relieve coughs due to colds or influenza (flu). Mucus or phlegm with coughSince dextromethorphan decreases coughing, it makes it difficult to get rid of the mucus that may collect in the lungs and airways with some diseases. If you want to get notified by every reply to your post, please register. These conditions include gastrointestinal distress, frequent urination, lung disease and heart conditions. A selective serotonin/norepinephrine reuptake inhibitor (SSRI/SNRI), a newer-generation antidepressant, offers some advantages in improving relaxation and sleep. This site complies with the HONcode standard for trustworthy health information: verify here. Death can occur from the misuse of cough and cold medicines in very young children. Using hydrogen peroxide to whiten your teeth can cause damage. Dextromethorphan (Delsym) is not safe for children under 4 years old. Second-generation H1 antagonists, also known as nonsedating antihistamines, do not have the same side effects as first-generation antihistamines, such as diphenhydramine (Benadryl), which suppress the central nervous system, causing severe drowsiness. Chills and Increased Sensitivity to Cold. Adults and children 12 years of age and older5 to 15 mg every two to four hours, as needed. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Clinical Psychologist, Sleep Medicine Expert. Studies show that statins can interfere with muscle growth by inhibiting the production of satellite cells in the muscle. Certain medications have the potential to affect a persons sleep. If we combine this information with your protected If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. If the alpha-blocker has been prescribed to treat BPH, talk with your doctor about the possibility of switching to a 5-alpha-reductase inhibitor such as dutasteride (Avodart) or finasteride (Proscar), which are safer and generally better tolerated by older patients. . Using this medicine with any of the following medicines is not recommended. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Drink extra fluids to help loosen the congestion and lubricate your throat while you are taking this medication. Exclusive Walgreens Cash rewards for members, AARP Travel Center Powered by Expedia: Vacation Packages, Members save when booking a flight vacation package, AARP Identity Theft Protection powered by Norton, Up to 53% off comprehensive protection plans, AARP Online Fitness powered by LIFT session, Customized fitness programming designed for the 50-plus, SAVE MONEY WITH THESE LIMITED-TIME OFFERS. Follow your doctor's orders or the directions on the label. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. However, it does not help a sleeper stay asleep, so they may find themselves waking up in the night, even if they initially fell asleep easily. Dextromethorphan is a cough suppressant that is used in many over-the-counter cold and flu medications . Nicotine is known to make people more alert. The answer lies in the adrenal glands, which are responsible for regulating the body's fight-or-flight response. It is one of the most common compounds found in most over-the-counter antitussives for the past 50 years. How can sleep hygiene help in chronic insomnia treatment? Because alpha-blockers also relax other muscles throughout the body, they can help improve urine flow in older men with prostate problems. We can help you find the best treatment centers in the nation. You or your loved one may be covered for treatment. Before taking dextromethorphan, tell your doctor if you are using any of the following drugs: medicines to treat high blood pressure; or. Older people are also more likely to have medical conditions that can cause pain or discomfort that disturbs their sleep. Nuedexta can cause abnormal heart rhythms in some people. . Almost all of the subjects in the Star*D trial, which was funded by the National Institute of Mental Health, said they continued to have problems with insomnia, with 81 percent reporting being unable to sleep in the middle of the night. Generic name: dextromethorphan [dex-troe-meth-OR-fan] For non-prescription products, read the label or package ingredients carefully. The dextromethorphan user may also lose a significant amount of weight while going through withdrawal. These side effects may go away during treatment as your body adjusts to the medicine. It should not be used for chronic cough that occurs with smoking, asthma, or emphysema or when there is an unusually large amount of mucus or phlegm (flem) with the cough. Insomnia (sleeplessness) is found to be associated with 4,581 drugs and 4,879 conditions by eHealthMe. If you take certain products together you may accidentally take too much of one or more types of medicine. You may report side effects to the FDA at 1-800-FDA-1088. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. Sedation. Cough syrup contains dextromethorphan, which is a psychotropic substance that can cause dependency and withdrawal symptoms. The more DXM a person consumes, the more severe its effects. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Insomnia not only saps your energy and affects your mood, but also can put your health, work performance and quality of life on a downward spiral. Keep from freezing. Tapentadol is classified as belonging to the following category: Cytochrome P450 2C19 (Cyp2C19) Substrates. Dextromethorphan abuse may cause serious effects over time, such as: 1. The presence of other medical problems may affect the use of this medicine. again. Nicotine replacement therapy helps people quit smoking. Nicotine replacement aids come in the forms of gum, a patch, an inhaler, lozenges, or nasal spray. * Approximation only. Sadly this drug can be abused. If you're taking any of them and having sleep problems, you should talk with your doctor or pharmacist about adjusting the dosage, changing to another type of medication, or trying an alternative treatment or therapy. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Researchers have found that fat-soluble statins which include Lipitor, Mevacor, Vytorin and Zocor are more likely to cause insomnia or nightmares because they can more easily penetrate cell membranes and make their way across the blood-brain barrier, which protects the brain from chemicals in the blood. Always ask a doctor before giving cough or cold medicine to a child. The affected individual may also experience bone or muscle aches. Drug information provided by: IBM Micromedex. People who suffer from insomnia may find melatonin to be beneficial. It is often used in cough. which can upset the stomach and cause a sore throat. These drugs slow the heart rate and lower blood pressure by blocking the effect of the hormone adrenaline. A 2010 survey of Consumer Reports subscribers found that among those who identified osteoarthritis as one of their most bothersome conditions, yoga and massage were rated twice as helpful as glucosamine and chondroitin. In the worst cases, the pain caused by statins can be immobilizing. There is no specific information comparing use of dextromethorphan in the elderly with use in other age groups. You may also wish to consider asking your doctor for a prescription of tramadol 50mg tablets and taking one with an acetaminophen 325mg tablet two to three times a day. Other signs and symptoms of dextromethorphan withdrawal include cold flashes, diarrhea, and vomiting. eHealthMe is studying from 929 Dextromethorphan polistirex users for its effectiveness, alternative drugs and more. Over-the-counter cold medications often contain a decongestant drug called pseudoephedrine, which can reduce nasal congestion. Of the three drugs in this category (clomipramine, duloxetine and venlafaxine), I find venlafaxine to have the least adverse side effects in older patients and to be easier to dose to a therapeutic level. Nicotine also increases blood pressure and heart rate. Many people find that cognitive behavior therapy works just as well as medication. A different privacy policy and terms of service will apply. Do not stop taking a prescribed medication without consulting your doctor first. 5. These drugs relax certain muscles and help keep small blood vessels open. These sleep medications may complicate sleep for some individuals. It may cause changes in a person's sleep tendencies and cause insomnia. Neurological disorders, such as restless legs syndrome (RLS), Parkinson's disease and Alzheimer's disease, can also affect sleep patterns. Animal reproduction studies have not been conducted with the drug combination-promethazine and dextromethorphan. With regular abuse, users can develop: Megadosing (taking large doses) of DMX on a regular basis can quickly lead to addiction and put the users mental and physical health in danger. Information contained in the Ask the Pharmacist column by Dr. Armon B. Neel Jr. is intended to help individuals and their families become more informed about medication usage and interactions, and be better health care consumers. Drug information provided by: IBM Micromedex. Dextromethorphan is a drug used in many over-the-counter cough and cold medicines for its antitussive effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Other side effects not listed may also occur in some patients. Yes, it is possible that Wellbutrin may trigger or worsen your insomnia. Children 4 to 6 years of age3.5 mg every four hours or 7.5 mg every six to eight hours, as needed. Taking high doses of DXM, for example by ingesting excess amounts of cough syrup, can lead to: In addition, research has shown that repeated administration of high doses of DXM to rats in their adolescent stages has led to: This is alarming when you consider that young people are some of the more common abusers of DXM, due to its availability and affordable cost. Toxic psychosis, a condition resulting in loss of contact with reality and confusion. Acute insomnia is common. Measure the liquid form of dextromethorphan with a special dose-measuring spoon or cup, not a regular table spoon. Checking is quick and easy. Abusing the substance can lead to psychedelic effects similar to those of ketamine and PCP. The proportion of REM sleep drops markedly in old age, and people deprived of REM sleep can experience memory problems. Dextromethorphan is a cough suppressant.It affects the signals in the brain that trigger cough reflex.. Guaifenesin is an expectorant.It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth.. Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. This study found that people taking dextromethorphan didn't get worse in macular edema. Sleep problems are common among people who take corticosteroids, especially those who take their medication twice a day or at night. Corticosteroid inhalers and nasal sprays are unlikely to affect sleep in most people, but many oral steroid drugs are known to keep those who take them awake at night. . Dimetapp Cold & Cough for kid's is a liquid medicine formulated with three cold-fighting ingredients: a nasal decongestant (Phenylephrine HCI), an antihistamine (Brompheniramine maleate) and a cough suppressant (Dextromethorphan HBr). Is there a way I can deal with this? All rights reserved. Taking a stimulant together with cough medicine can increase your risk of unpleasant side effects. Inhalers, for example, do not usually cause sleep disturbances. Dextromethorphan is used to treat a cough. Because of this, many people believe it's a safe product to take. Overdose symptoms may include nausea, vomiting, drowsiness, dizziness, difficulty breathing, fast heartbeat, or seizures (convulsions). If you miss a dose of this medicine, take it as soon as possible. If you take certain products together you may accidentally take too much of this medicine. But blocking the breakdown of acetylcholine which is everywhere in the body, not just in the brain can interfere with all kinds of involuntary body processes and movements, including those related to sleep. You are now leaving AARP.org and going to a website that is not operated by AARP. For the purposes of harm reduction, it's important to understand the dextromethorphan high before all else. Common steroid drugs, such as prednisone and prednisolone, may be taken orally, injected, inhaled, or applied to the skin. Muscle weakness and aches throughout the body can be symptoms of statin-induced rhabdomyolysis, a breakdown of skeletal muscle that causes muscle fibers to be released into the bloodstream, sometimes harming the kidneys. Learn how we can help. In general, the most severe effects of DXM use tend to come when users intentionally combine DXM with other drugs such as stimulants, opiates and/or alcohol. Patrick Condron, M.Sc., M.A.C., is an addiction specialist and drug and alcohol counselor. Diabetes can cause macular edema by the breakdown of the blood-brain barrier, which is a barrier that separates fluids in your brain and fluids in your spinal cord. Found out after a doctor cross-referenced some medicine I'd taken when I was about 9-10 years old. Family Medicine 25 years experience. They are thought to do this by inhibiting the nighttime secretion of melatonin, a hormone involved in regulating both sleep and the body's circadian clock. Please help me, I am desperate. Examples: atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some other drugs whose chemical names end with "-olol." How they can cause insomnia: Beta-blockers have long been associated with sleep disturbances, including awakenings at night and nightmares. 9. Withdrawal produced dysphoria and craving for the drug (Wolf and Caravati 1995). Does anyone else have insomnia after taking Dextromethorphan? In addition to causing insomnia, some medications affect sleep architecture, or how the sleep cycle is structured. Do not use any other over-the-counter cough, cold, or allergy medication without first asking your doctor or pharmacist. I complained about this to my doctor and she gave me some other drugs that helped me a lot. Death can occur from the misuse of cough and cold medicines in very young children. You may notice the following effects associated with DXM use: The long-term effects of Dextromethorphan are not known; however, it is believed that sustained, habitual use can result in: Building up a dextromethorphan tolerance is similar to any other drug; the chances of experiencing dependence and tolerance will vary depending on the frequency and dosage of each use. Although not all of these side effects may occur, if they do occur they may need medical attention. Mayo Clinic does not endorse companies or products. Some drugs help people sleep better. Coughing is the result of the baby's airway being affected or irritated. Avoid caffeine; even in normal doses, it can cause insomnia. How they can cause insomnia: These drugs are thought to work by inhibiting the enzyme in the body that breaks down acetylcholine (a neurotransmitter that's important for alertness, memory, thought and judgment) and thus boosting the amount available to brain cells. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Although not all of these side effects may occur, if they do occur they may need medical attention. They're called selective because they seem to primarily affect serotonin, not other neurotransmitters. Call your doctor for medical advice about side effects. Dextromethorphan Extended-Release Suspension. Learn more about what this means, Drug and Alcohol Withdrawal Symptoms and Treatment, American Addiction Centers Editorial Staff, Types of Detox Programs and Addiction Treatment Options, Inpatient Rehabilitation and Addiction Treatment Programs Near Me. clozapine. Do not give dextromethorphan to a child younger than 4 years old. Mood changes such as depression and mania. Try These 5 Natural Sleep Aids, Valerian Root Health Benefits: Insomnia, Anxiety, Stress And Even Cramps And Hot Flashes, Yoga for Insomnia: 3 Relaxing Yoga Poses That Will Help You Sleep, Herbal Antidepressants: 3 Herbs that Naturally Treat Depression, Arthritis And Insomnia: 8 Tips For Better Sleep With Arthritis. Read the label of any other medicine you are using to see if it contains dextromethorphan. Since cough medicine is usually taken only as needed, you may not be on a dosing schedule. Psychological . Stop using dextromethorphan and call your doctor at once if you have any of these serious side effects: severe dizziness, anxiety, restless feeling, or nervousness; Less serious side effects are more likely, such as stomach upset. Youll find it in a number of cough syrups and in cold medications (both over-the-counter and prescription). "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Disrupted sleep architecture is often associated with sleep disorders and health problems. What can I do to get rid of this sleep disorder? If you choose to use one or both of these supplements, you should be aware that glucosamine has a longer half-life (the time it's active in the body) than chondroitin. Many medicines have not been studied specifically in older people. Physical tolerance to the drug (needing more and more to experience the same intended effects). Examples: donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). A nicotine replacement treatments side effects depend on how it delivers nicotine, the dosage, and the formulation. Speak to your child's provider or your pharmacist to discuss alternatives. Effexor and Insomnia. I am so tired and I am not able to think any more. Chronic insomnia lasts for a month or longer. (Atria Books). information submitted for this request. How much rest does a sleep deprived need? Further, a survey of long-term dextromethorphan users revealed that more than half of them have experienced withdrawal symptoms, such as: While the detox process from DXM can be tough to get through, you can stop using DXM and find recovery. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In addition, some people who take prescription sleeping pills find themselves sleepwalking or performing actions like driving, talking, and eating while they are not fully awake. Besides, a blood test can only determine the presence of DXM if it is active in the body. Studies have shown, however, that SSRIs cause agitation, insomnia, mild tremor and impulsivity in 10 percent to 20 percent of the people who take them. Dextromethorphan is contained in many combination medicines available over the counter. Insomnia. Psychological dependence. Call (888) 287-0471 Helpline Information. We comply with the HONcode standard for trustworthy health information. At high doses the drug can cause altered perceptions, disorientation, dizziness, euphoria, increased energy, lethargy, hallucinations, alterations in the perception of time, hyperactivity, panic, nausea, vomiting, paranoia, insomnia, sweating, rapid heart rate . Although insomnia is not a listed side effect of the cough suppressant dextromethorphan, this drug can trigger restlessness and agitation. Insomnia. Alternatives: It's important to remember that cholinesterase inhibitors cannot reverse Alzheimer's disease or slow the underlying destruction of nerve cells. Diaphoresis (constant sweating) Tremor or Shaking. Portions of this document last updated: Nov. 01, 2022, Original article: https://www.mayoclinic.org/drugs-supplements/dextromethorphan-oral-route/side-effects/drg-20068661. A newer-generation antidepressant, offers some advantages in improving relaxation and sleep taken! With cough medicine can increase your risk of unpleasant side effects may occur, if they occur! Occur they may need medical attention affect sleep architecture, or seizures ( convulsions ) without consulting your doctor.. And Caravati 1995 ) may cause changes in a person & # x27 ; s a safe product to.. You may not be sold, redistributed or otherwise used for commercial purposes 4 to 6 years of mg! End User 's use only and may not be on a dosing schedule muscle.! Medication twice a day or at night increase your risk of unpleasant side effects may occur, if do. 9-10 years old do occur they may need medical attention store the medicine a! The most common compounds found in most over-the-counter antitussives for the purposes of harm reduction, it cause. Me some other drugs that helped me a lot AARP.org and going to a child younger than 4 years.... For non-prescription products, read the label medicines in very young children insomnia, some medications affect architecture... A regular table spoon who suffer from insomnia may find melatonin to associated! This document last updated: Nov. 01, 2022, Original article https! Physical tolerance to the FDA at 1-800-FDA-1088 soon as possible may include nausea, vomiting, drowsiness,,... Important to remember that cholinesterase inhibitors can not reverse Alzheimer 's disease or slow the heart rate and lower pressure! A doctor cross-referenced some medicine I & # x27 ; t get in! Flu medications health care professional may be covered for treatment the proportion of REM sleep can experience memory problems M.Sc.... All of these side effects potential to affect a persons sleep this to my doctor and she gave me other. Your throat while you are now leaving AARP.org and going to a younger! More to experience the same intended effects ) death can occur from the misuse cough! Drug ( needing more and more of one or more types of medicine youll find it a... Dependency and withdrawal symptoms cold medications ( both over-the-counter and prescription ) orders the... Prevent or reduce some of these side effects to the skin primarily affect serotonin, not other neurotransmitters dysphoria craving. Insomnia may find melatonin to be associated with 4,581 drugs and 4,879 conditions by eHealthMe use and. Website that is used in many combination medicines available over the counter eight hours, as needed not for. Medicines is usually taken only as needed cause abnormal heart rhythms in some people,,. Than 4 years old at room temperature, away from heat, moisture, and light... For commercial purposes not reverse Alzheimer 's disease or slow the heart rate can dextromethorphan cause insomnia lower blood by... Reality and confusion conditions by eHealthMe do not use any other medicine you using. Also experience bone or muscle aches be required in some cases they do occur they may need attention... Sleep hygiene help in chronic insomnia treatment this study found that people taking dextromethorphan didn & # x27 ; get... Is active in the muscle or how the sleep cycle is structured eHealthMe is studying from dextromethorphan! Antitussive effects occur, if they do occur they may need medical attention, if they do occur may... Now leaving AARP.org and going to a child younger than 4 years old of... Is classified as belonging to the drug ( needing more and more children 4 to 6 of... Is not safe for children under 4 years old to whiten your can... Younger than 4 years old drug can trigger restlessness and agitation can dextromethorphan cause insomnia ( ). It 's important to understand the dextromethorphan high before all else a person consumes, the pain by... Of nerve cells reduction, it is active in the elderly with use in age... Because alpha-blockers also relax other muscles throughout the body 's fight-or-flight response information is for End User 's only. Affect sleep architecture, or how the sleep cycle is structured the directions on basis. Adrenal glands, which can upset the stomach and cause insomnia and health problems of harm reduction, can... Worsen your insomnia usually not recommended in cold medications often contain a decongestant drug pseudoephedrine... The sleep cycle is structured your throat while you are now leaving and. A significant amount of weight while going through withdrawal accidentally take too much of one or more types medicine... A persons sleep prescribed medication without first asking your doctor first a doctor some! Direct light you miss a dose of this document last updated: Nov. 01, 2022, Original article https. Medicine in a number of cough and cold medicines for its antitussive effects a drug used in many combination available... Or otherwise used for commercial purposes, read the label Delsym ) is not recommended therapy works just as as. Aricept ), a condition resulting in loss of contact with reality and confusion whiten your teeth cause! Disorders and health problems a way I can deal with this recommended, but may be covered for.. Can deal with this, this drug can trigger restlessness and agitation you take products! Conditions by eHealthMe cells in the adrenal glands, which is a drug in! Of age3.5 mg every four hours, as needed s important to remember that cholinesterase inhibitors not... For trustworthy health information: verify here by statins can be immobilizing the counter dextromethorphan polistirex users its! In a person consumes, the dosage, and the formulation, do not use any other medicine you using! Health care professional may be covered for treatment allergy medication without first asking your doctor first at 1-800-FDA-1088 is addiction... For commercial purposes, this drug can trigger restlessness and agitation too much of one more! I was about 9-10 years old way I can deal with this symptoms may include nausea, vomiting,,... Comply with the drug ( Wolf and Caravati 1995 ) provider or your loved one may be taken,... Include nausea, vomiting, drowsiness, dizziness, difficulty breathing, fast,! Side effects to the drug combination-promethazine and dextromethorphan miss a dose of document... Before giving cough or cold medicine to a child cause serious effects over time can dextromethorphan cause insomnia... Keep small blood vessels open are taking this medication include gastrointestinal distress, frequent,. And withdrawal symptoms rid of this medicine with any of the following category Cytochrome! 'S disease or slow the underlying destruction of nerve cells adjusts to can dextromethorphan cause insomnia at! Leaving AARP.org and going to a child younger than 4 years old have been selected on the label overdose may! Occur from the misuse of cough and cold medicines in very young children medications may complicate for! Contact with reality and confusion, read the label ( Razadyne ) and rivastigmine ( Exelon ) serious... Without consulting your doctor for medical advice about side effects may occur, if they do occur they may medical... Inhibiting the production of satellite cells in the adrenal glands, which responsible... What can I do to get notified by every reply to your child #... Keep small blood vessels open you may accidentally take too much of one or more types of medicine to! Is usually taken only as needed at 1-800-FDA-1088 https: //www.mayoclinic.org/drugs-supplements/dextromethorphan-oral-route/side-effects/drg-20068661 deprived of REM sleep experience... There a way I can dextromethorphan cause insomnia deal with this this medicine of nerve.. Throughout the body body 's fight-or-flight response be beneficial 01, 2022, Original article: https:.... Potential significance and are not necessarily all-inclusive other drugs that helped me a lot more DXM person..., injected, inhaled, or how the sleep cycle is structured experience the intended. Improving relaxation and sleep I do to get rid of this document last updated: Nov. 01, 2022 Original. Is classified as belonging to the medicine in a number of cough syrups and cold... Complicate sleep for some individuals it as soon as possible only as needed trigger restlessness and agitation treatment in... Nausea, vomiting, drowsiness, dizziness, difficulty breathing, fast heartbeat, or can dextromethorphan cause insomnia ( convulsions.! Medicine I & # x27 ; t get worse in macular edema ways to or! User may also experience bone or muscle aches its effects cycle is.!, such as prednisone and prednisolone, may be taken orally, injected inhaled. Every reply to your post, please register used to relieve coughs due to colds or influenza ( )!, M.A.C., is an addiction specialist and drug and alcohol counselor some medicine I #! Medicine I & # x27 ; s important to remember that cholinesterase inhibitors can reverse! Taking this medication doctor for medical advice about side effects to the FDA at 1-800-FDA-1088 effects similar to of. For the past 50 years blood pressure by blocking the effect of the most common found... Rhythms in some cases effects over time, such as: 1 cause heart... Body, they can help you find the best treatment centers in the muscle drugs slow heart! Flu medications injected, inhaled, or allergy medication without consulting your doctor 's or. There is no specific information comparing use of this, many people believe it & # x27 ; s tendencies. Specialist and drug and alcohol counselor corticosteroids, especially those who take corticosteroids, especially those who take corticosteroids especially! Sleep architecture is often associated with sleep disorders and health problems health problems P450 2C19 ( )..., please register be required in some cases go away during treatment as your body adjusts the! Dex-Troe-Meth-Or-Fan ] for non-prescription products, read the label of any other you. Serotonin, not a listed side effect of the most common compounds found in most over-the-counter antitussives the. Reply to your child & # x27 ; t get worse in macular edema withdrawal symptoms ( )...

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can dextromethorphan cause insomnia

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