Dextromethorphan offers no benefit for relieving pain during medication abortion

Dextromethorphan, when used in addition to standard analgesics, falls short of reducing the pain experienced by women undergoing medication abortion, according to a trial.

The randomized, double-blinded, placebo-controlled trial included 156 women who took either dextromethorphan (at a loading dose of 60 mg and two subsequent 30-mg doses at 2 and 5 hours after misoprostol administration) or placebo for as a non-narcotic adjuvant to current analgesic regimens for medication abortion.

All women received the usual-care nonsteroidal anti-inflammatory medications with or without opioids for pain. They were instructed to use a secure texting application to report pain scores and satisfaction with their medication. Reports were made at 2, 5, 8, and 24 hours after misoprostol administration. The primary endpoints were worst pain score and total analgesic use.

Participant demographics at baseline were similar in the treatment groups. There was no significant difference in worst pain scores between the dextromethorphan and placebo groups (8.0 vs 7.0, respectively; p=0.06).

Likewise, total analgesic use was comparable among dextromethorphan and placebo users. The corresponding total milligram usage was 800 vs 610 mg for ibuprofen (p=0.62), 1,000 vs 1,300 mg for acetaminophen (p=0.62), and 10 vs 15 mg for opioids (p=0.51).

Of note, placebo-treated patients were much more likely to be satisfied with their pain control than those treated with dextromethorphan (91 percent vs 75 percent; p=0.02).