Dextromethorphan as a novel nonopioid adjunctive agent for pain control with medication abortion: A randomized controlled trail

Objectives: To evaluate efficacy and satisfaction of dextromethorphan as a non-narcotic adjuvant to cur-rent analgesic regimens for medication abortion.Study Design: We conducted a randomized, double-blinded, placebo-controlled trial. We randomized eli-gible participants (N = 156) 1:1 to adjunctively take dextromethorphan (loading dose 60 mg and two sub-sequent 30 mg doses at 2 and 5 hours after misoprostol administration) or placebo combined with usual-care nonsteroidal anti-inflammatory medications +/- opioids for pain. Participants reported pain scores and satisfaction using a secure texting application at 2, 5, 8, and 24 hours after misoprostol administration. Our primary outcome was worst pain score and total analgesic use. Results: Baseline demographics of enrolled participants were similar between randomization arms. Worst pain scores for participants receiving dextromethorphan versus placebo (8.0 vs 7.0, p = 0.06) did not differ. Total milligram usage of ibuprofen (800 mg vs 610 mg, p =.62), acetaminophen (10 0 0 mg vs 130 0 mg, p = 0.62), and opioids (10 mg vs 15 mg, p = 0.51) did not differ between the randomization groups. Participants randomized to placebo were significantly more likely to be satisfied with their pain control (91% vs 75%, p = 0.02). Conclusion: Dextromethorphan used adjunctively with standard analgesics did not reduce pain associated with medication abortion. Participants who received dextromethorphan reported decreased satisfaction with their pain control.Implications: Dextromethorphan used adjunctively with commonly used analgesic regimens did not re-duce medication abortion associated pain. Many participants did not use analgesics as counseled, and nearly 25% used no analgesia during medication abortion.(c) 2022 Elsevier Inc. All rights reserved.