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MDPV

2018-10-21T20:48:31Z

Borax: fixed title of table

[[File:MDPV.png|250px|right]]

'''Methylenedioxypyrovalerone''' (MDPV) is a potent, synthetic euphoric stimulant, which shares some of the empathogenic effects of MDMA and acts as a norepinephrine-dopamine reuptake inhibitor (NDRI). It is known for its tendency to cause compulsive redosing and some users report sexual arousal. MDPV (together with Methylone and Mephedrone) is one of the first substances that have been found in products sold as "bath salts", "plant food/fertilizer", and in some "ecstasy" pills.

== History ==

MDPV was first developed in the 1960s by a team at Boehringer Ingelheim. It remained an obscure stimulant until around 2004 when it was reportedly sold as a designer drug. Products labeled as bath salts containing MDPV were previously sold as recreational drugs in gas stations and convenience stores in the United States, similar to the marketing for Spice and K2 as incense.

== Dosage ==

=== Oral ===

{| class="wikitable"

|+ Oral

|-

| Light || 4-10 mg

|-

| Common || 8-15 mg

|-

| Strong || 12-25 mg

|-

| Heavy || >25 mg

|}

=== Insufflated ===

{| class="wikitable"

|+ Insufflated

| Light || 2-5 mg

|-

| Common || 5-11 mg

|-

| Strong || 10-20 mg

|-

| Heavy || >20 mg

|}

== Duration ==

=== Oral ===

{| class="wikitable"

|+ Oral

|-

| Onset || 15-30 minutes

|-

| Coming-up || 30-60 minutes

|-

| Peak || 30-180 minutes

|-

| Coming-down || 30-120 minutes

|-

| Total duration || 2-7 hours

|-

| After-effects || 2-48 hours

|}

=== Insufflated ===

{| class="wikitable"

|+ Insufflated

|-

| Onset || 5-20 minutes

|-

| Coming-up || 15-30 minutes

|-

| Peak || 30-120 minutes

|-

| Coming-down || 30-60 minutes

|-

| Total duration || 2-3.5 hours

|-

| After-effects || 2-48 hours

|}

== Effects ==

=== Postive ===

* Stimulation (mental and physical)

* Euphoria, mood lift

* Increased sociability & talkativeness

* Increased productivity and motivation

* Increased mental clarity

* Enhanced creativity

* Feelings of empathy

* Sexual arousal

=== Neutral ===

* Stimulation (mental and physical)

* Mild elevation in heart rate

=== Negative ===

Llikelihood of negative side effects increases with higher doses.

* Tightened jaw muscles, grinding teeth (trismus and bruxia)

* Reduced enjoyment of eating & loss of appetite

* Disturbed sleep patterns

* Involuntary body movements (twitching, lip-smacking, etc.)

* Confusion and/or scrambled thoughts

* Gastrointestinal disturbance

* Muscle tension

* Residual depressed mood

* Nystagmus & eye spasm

* Anxiousness & nervousness & paranoia

* Harsh comedown effects

* Fiending (redosing repeatedly without planning to do so)

* Excessive excitation & hyperactivity

* Headache

* Very elevated heart rate

* Hallucinations & psychotic behavior (at high doses or with repeated use)

== Harm Reduction ==

* Avoid driving and operating heavy machinery

* Recommended time (pauses) between using the substance

== Chemistry and Pharmacology ==

Systematic name: (RS)-1-(Benzo[d][1,3]dioxol-5-yl)-2-(pyrrolidin-1-yl)pentan-1-one

MDPV is the 3,4-methylenedioxy ring-substituted analog of the compound pyrovalerone, developed in the 1960s, which has been used for the treatment of chronic fatigue and as an anorectic, but caused problems of abuse and dependence. However, despite its structural similarity, the effects of MDPV bear little resemblance to other methylenedioxy phenylalkylamine derivatives such as 3,4-methylenedioxy-N-methylamphetamine (MDMA), instead producing primarily stimulant effects with only mild entactogenic qualities.

== Legal status ==

MDPV is currently in Schedule I in the United States. This means it is illegal to manufacture, buy, possess, or distribute (sell, trade or give) without a DEA license.

MDPV is also illegal in Australia, Canada, Czech Republic, Denmark, Estonia, Finland, Germany, Hungary, Israel, Sweden and the UK.

== Links ==

[https://en.wikipedia.org/wiki/MDPV Wikipedia]

[http://www.erowid.org/chemicals/mdpv/mdpv.shtml Erowid MDPV Vault]

[[Category:Drugs]]

[[Category:Stimulant]]

[[Category:Research Chemical]]

DXM

2018-01-20T12:28:07Z

Borax: removed dubious unverified section on DXM.HCl

[[File:Romilarad.jpg|thumb|left|200px|Romilar 1968 Ad]]

'''Dextromethorphan''' (also known as 'DXM', 'DM' or 'robo') is an over-the-counter antitussive (cough medicine) which, when taken at doses exceeding the recommended therapeutic range, becomes a powerful [[Dissociatives|dissociative]] drug with psychedelic properties.

While DXM can be used safely it is not an inherently safe drug. Repeated use within a short period of time, combination with certain types of drugs, certain genetic factors and the prevalence of other active ingredients which become harmful at doses needed for disassociation make for a drug which must be used with caution.

The high is not for everyone; it is said to loosely follow the rule of thirds: one third hates it, one third doesn't care, and one third like it. It should not be underestimated as a hallucinogenic, at higher dosages it mimics high doses of ketamine but with more psychedelic properties.

DXM manifests its effects in a series of plateaus, with dose determining which plateau (and consequently which effects) one will experience. Lower dose plateaus can be well suited to relaxation, light social interaction and listening to music, while higher doses result in a more encompassing dissociative experience which does not lend itself to attentive social attention. At high doses it's common to have strong hallucinations, experiences of detachment, depersonalisation, and out-of-body experiences. These all-encompassing states can be startling and uncomfortable for some.

Its mechanisms of action are multiple, including action as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist. DXM and it's major metabolite, dextrorphan, also acts as an NMDA receptor antagonist at high doses, which produces effects similar to, yet distinct from, the dissociative states caused by other dissociative anaesthetics such as [[Ketamine]] and [[PCP]].

DXM does not typically show up in normal drug tests, however it can produce false positive results for PCP and/or opioids in extended or specialized drug tests. Occasional use should not produce these false-positive results after a couple days have passed.

== History ==

The racemic parent compound racemorphan was first described in a Swiss and US patent application from Hoffmann-La Roche in 1946 and 1947, respectively; a patent was granted in 1950. A resolution of the two isomers of racemorphan with tartaric acid was published in 1952, and DXM was successfully tested in 1954 as part of US Navy and CIA-funded research on nonaddictive substitutes for codeine.

The FDA approved DXM in 1958 after research supported its legitimacy and effectiveness as a cough suppressant. After its approval, it was introduced as an OTC medication under the name Romilar, which was introduced as a replacement for codeine containing cough remedies in an effort to cut down on abuse. In early 1960s Beat poets Allen Ginsberg and Peter Orlovsky, musicians such as Daevid Allen Soft Machine, and alternative authors such as Jack Kerouac known to have used DXM in the form of Romilar. In 1973, Romilar was taken off the shelves after a burst in sales because of frequent misuse, and was replaced by cough syrup in an attempt to cut down on abuse. In 1975, the popularity and extensive abuse of DXM was recognized, and Romilar was removed from the OTC market. However, DXM was specifically excluded from the Controlled Substances Act (CSA) of 1970, therefore, it was still legal to produce and use.

A few years after its removal from OTC, companies began introducing refined DXM products (e.g., Robitussin, Vicks-44, Dextrotussion) that were designed to limit recreational use by creating an unpleasant taste if consumed in large quantities. Within a short time those same manufactures began to produce forms of DXM with "some appealing flavoring," which led at least one researcher to suggest that the cycle of recreational abuse may be repeated. In 1996, DXM HBr powder could be purchased in bulk from online retailers, allowing users to avoid consuming DXM in syrup preparations.

== Different Forms ==

DXM is widely available in over-the-counter cough treatments which appear in different forms including gelcaps, lozenges and syrups. DXM is also less commonly found in a more pure powder form, either extracted or bought directly from a chemical manufacturer.

While there are some products available which contain only DXM as active medical ingredients it is common to find products which contain DXM but also contain enough of another active ingredient to pose a serious risk to the user's health.

=== Extracted ===

The ideal source of DXM would be pure powder or an extraction, but that requires time and a chemical procedure which most people are not equipped to do. It's not a complicated process, however it does carry some risks. There is a technique known as the 'Agent Lemon extraction'. [http://www.dextroverse.org/what-is-dxm/extraction/ Page with different extraction methods]

===Gel Caps===

DXM Gelcaps such as Robitussin Gelcaps or other no-name-brand products containing only DXM encased in a gelcap are often the preferred source for DXM users. For most users, gelcaps which contain only DXM produce a more clear headed high in lower doses. Most users experience fewer side effects from gelcaps than from syrup, however some users report an upset stomach, indicating that some users may have a sensitivity to the edible plastics used to make the gelcaps.

Some brands such as '''Cordicin Cough and Cold''' (also known as '''CCC''') have a variety of products, most of which contain other active ingredients such as antihistamines or CPM (Chlorpheniramine Maleate) and may have one or two products which contain only DXM.

'''WARNING''': Cordicin Cough & Cold is one of the most commonly used sources of DXM, and also one of the most dangerous. Nearly every single CCC product contains other active ingredients such as CPM, which can cause severe and life-threatening symptoms including seizures, shortness of breath or troubled breathing, weakness, loss of consciousness, severe dryness of the mouth, nose or throat, bleeding from the skin, mouth, eyes, rectum and vagina, and possibly death. CCC also is additionally harmful to your kidneys, liver and heart. Avoid it.

===Lozenges===

There are also sore-throat and cough medications containing DXM which exist in the form of a hard-candy like lozenge. These sometimes contain only DXM, however most brands of DXM lozenges also contain analgesics such as acetaminophen or benzocaine.

As always when using lozenges, choose a product which only has DXM in it.

=== Syrup ===

Cough syrup is the most common source for DXM users. While there are many brand name and no-name syrups which only contain DXM as an active ingredient there are many active and "inactive" ingredients commonly found in cough syrups which can cause negative effects ranging in severity. See [[DXM#Adulteration|Adulteration]] for more information.

Some have reported the high produced from syrup is mostly sedating. You may feel sluggish when using it to get high on DXM, possibly as a result of other ingredients found in syrup however because of the even dispersion of DXM throughout the syrup it is said to produce a more 'solid' trip.

===Delsym===

Delsym is brand with many formulations which contain Dextromethorphan Polistrex.

This is an extended release form of DXM which produces a longer lasting trip with weaker, more physical effects. It is somewhat more difficult to reach the third plateau using polistrex preparations, which may be preferable to beginners or users who would prefer these effects. Since it is an extended release dxm product, this means your enzyme is more able to keep up with the conversion of DXM to DXO, meaning more of a body high and less of the psychedelic DXM high. It is for this reason why it is difficult to reach 3rd plateau with polistrex. Generally, a 3rd plateau experience has a Higher percentage of DXM than DXO.

See Dosage information below

== Dosage ==

The dosage below refers to an "average" 180lbs / 80kg person taking DXM HBR. Before dosing it's important to note a few things:

* HBR and Polistirex doses vary significantly due to polistirex slow absorbsion rate.
**Dextromethorphan Polistrex, being extended release, means that your enzyme is more able to convert dxm into dxo. DXO being a more physical, less trippy drug, leads to this preparation of dxm feeling much less intense, and in many cases, very subtle. It is recommended to predose with grapefruit juice to fully enjoy polistrex because it slows down the conversion of dxm to dxo, effectively making polistrex "more trippy" because of a higher amount of dxm that didn't get converted.

* '''DXM doses are affected by weight'''. For more accurate dosage information, see the following resources:

* For a graphical chart of the dosage ranges [http://taimapedia.org/images/4/46/DXMDosingChart.png this chart] is helpful.

* For an easy calculator that does the math for you, [http://dxm.darkridge.com/calc.html this page] can be helpful.

'''Before dosing, be sure to read the Plateaus section to know which level you want to dose for.'''

{| class="wikitable"

|+ Plateau range dosage for a 80kg (180lb) person.

|-

| First || 122-200mg

|-

| Second || 200-600mg

|-

| Third || 600-1200mg

|-

| Fourth || 1200-1600mg

|-

| Risk of death || 2.2g+

|}

== Duration ==

{| class="wikitable"

|+ Oral HBR

|-

| High of 6-8 hours || Afterglow effect of 8-16 hours after dose, depending on dose

|}

{| class="wikitable"

|+ Oral Polistirex

|-

| High of 8-12 hours || Afterglow effect of 16-36 hours after dose, depending on dose

|}

=== Redosing ===

Redosing is not advised because of potential risk of risk of sigma. For more information, see [[DXM#Plateau Sigma|Plateau Sigma]]

It's better to know how much you've taken at the start of the trip, rather than guesstimate how much you're on as you keep dosing. The effects will start to come in waves and may not be pleasant. If you feel the need, it's recommended to take a high initial dose and a lower dose 1-2 hours in. As the duration of the trip is extended with dose boosting or redosing, the dysphoric aspects of the experience increase, until eventually most people report feeling like the walking dead. Not to mention by extending the duration of the trip you are increasing the chance for adverse effects and brain damage.

=== Predosing ===

Grapefruit juice effects dxm due to interactions with cytochrome P450-2D6. Essentially, it inhibits the enzyme that converts dxm to dxo, making a higher DXM:DXO ratio, meaning a higher, more psychedelic high, and less of a body high. With 1st and 2nd plateau, it can make it much more "trippy" and less of a physical high.<ref>http://medicine.iupui.edu/clinpharm/ddis/2d6references/#dextromethorphanSub</ref> <ref>https://en.wikipedia.org/wiki/CYP2D6</ref>

In order to properly predose, drink around 16oz (500mL) of grapefruit juice 1-2 hours prior to the point where you dose the dxm itself.

== Effects ==

As previously stated, the effects of this drug vary wildly from plateau to plateau, this list is in general from ALL plateaus.

=== Positive ===

* Euphoria, mood lift

* Increased giggling and laughing

* Dissociation of mind from body (positive when sought)

* Creative dream-like experiences

* Increased tactile sensation

* Some users report empathy and forgiveness towards other people

=== Neutral ===

* Pupil dilation

* Visual stop motion effect (flanging or strobing)

* Visual and aural (auditory) hallucinations

* Decreased sexual functioning (difficulty achieving orgasm)

* Confusion, disorientation

* Skin sensitivity, alters tactile (touch) and skin sensations

* Robotic, zombie-like walking, "robo-walk"

* Dis-coordination, reduced agility

* Loss of appetite

* Involuntary flexing of muscles

* Feelings of merging with adjacent objects like a couch or bed (with higher doses)

* Some users report feeling disconnected, isolated from others, (positive when sought)

=== Negative ===

* Vomiting

* Dizziness

* Body itching

* Rash, red blotchy skin (similar to a niacin rush)

* Diarrhea

* Fever

* Tachycardia (racing, pounding heart)

=== After-Effects ===

The after-effects of DXM are referred to as the afterglow.

The afterglow is almost non-existent on the First Plateau.

For a Second Plateau dose, the afterglow can be quite pleasurable, although some feel depressed/hungover afterwards for up to 14-16 hours after the initial dose. Expect to feel lazy and fairly tired the next day, easily remediable with caffeine and/or nootropics.

For a Third Plateau dose, the afterglow may additionally add a headache, feel more like an alcohol hangover, and almost like a 1st plateau trip for most of the day after. The effects of this may last for up to 16-20 hours, with some people feeling the "brain-dead", tired and lazy effects up to 72 hours! The tired and "brain-dead" effects can be remedied with caffeine and/or nootropics.

For a Fourth Plateau dose, don't plan anything for the day after, because you will be very "out of it" for a good 24-32 hours after dosing, with some people feeling the sedation/"brain-dead"/lazy effects up to 72 hours!. Definitely plan a Fourth Plateau dose at least a good 2 days away from social events, work, school, ect. (IE, do it Friday night/Saturday Morning if you have to work Monday). Eating becomes a difficult task during a Fourth Plateau afterglow. The best things to eat during this period are soft foods like yogurt, mashed potatoes, soups, and nutritional milkshakes like SlimFast or ENU Total Nutrition Meal Replacement Shakes. This afterglow may be fairly painful like an alcohol hangover, but can be slightly remedied with Ibuprofen/Acetaminophen, a multivitamin and the aforementioned supplements/food, caffeine and/or nootropics. . You will also appear to be extremely high from an outward appearance. Expect to feel very tired, lethargic and "brain-dead" for up to 72 hours.

=== Robo-Walk ===

The robo-walk feels like all of the muscles in your body are activated at once and while strange to the observer is not painful to the user. You can still walk but detailed coordination such as running, jumping, or maneuvering around furniture becomes much harder if not impossible. However, when you you start getting the effects of robo-walk, you really wouldn't want to be moving around anyway. The best thing to do is get a good pair of headphones, turn off the lights, close your eyes and let your mind wander.

It's similar to being overly aware that you are walking incorrectly and overcompensating because of it. Not much you can do about it except to minimize your walking by having everything ready before you start (food, water, triptoys, grapefruit juice, dxm in whatever preparation, ect).

== Plateaus ==

There are various 'stages' to DXM trips called ''plateaus''. Traditionally, there are only four plateaus that someone should try to aim for. All of them share general feelings of dissociation, but the strength and effects of these feelings are more pronounced in the later two plateaus.

The first two plateaus are commonly associated with a mix of being high on THC and drunk on alcohol. If you take a First Plateau dose, it's totally possible to socialize. At second, it becomes harder, but not impossible. Lower plateau doses are relatively easy to hide compared to higher plateau doses and talking with others becomes a lot easier while under the influence of DXM. It would also be fun to chill in your room alone and do whatever you normally do for fun, but it's suggested to try something that will take up most of your attention but allow your mind to wander at the same time. Something like playing a casual video game, or drawing whatever comes to mind.

If you take a Third or Fourth plateau dose, it is recommend to trip alone or with a close friend, as it is not a social drug at this dose. The best way to enjoy it is to lay back and listen to music with your eyes closed.

Choosing your destination plateau will depend a lot on what other drugs you've done and how comfortable you are with your own mind. People who have never tried any hallucinogen other than marijuana and/or alcohol should start with a First Plateau dose, while people with mushrooms or [[LSD]] experience could start at a Second Plateau dose. '''It is not advised to start at the Third or Fourth plateau''' unless you have extensive experience with other dissociatives.

=== First Plateau ===

The First Plateau is the lightest in effect. It feels a bit 'off', and is often likened to something of a cross between the effects of [[MDA]] and Alcohol. First plateau is usually slightly stimulating. The First plateau has also been described as "basically like a hit or two of good weed and 2-3 beers with 10 minutes of a 'trip' about 2 hours in."

Effects commonly experienced at the first plateau level

* A shift in thinking perspective; things look and feel 'different'

* Increased tactile sensation

* Increased appreciation of music

* Feeling heavy, sensation of increased body weight

* Enhanced emotional response & sensitivity

* Some dizziness or vertigo

'''First Plateau dose: 1.5-2.5mg/kg.'''

=== Second Plateau ===

This plateau is a bit more intense. You may feel like you are stoned and movement may become difficult. The second plateau can be fun yet disorienting. Music sounds much deeper, clearer, almost like you are there at the concert. Walking/Moving your body becomes slightly difficult at this point. Some may experience some closed eye visuals at this point. You can socialize with ''close'' friends and you could say you're slightly drunk. A slight warning, DXM is almost like a truth serum and you may share embarrassing or "secret" things you wouldn't normally share. You may start to get a bit of disassociation, and the high starts to get somewhat intense in the second plateau.

'''Second Plateau dose: 2.5-7.5mg/kg.'''

'''Transitional'''

Most people stop their DXM journey here, as the higher two plateaus are not really '''fun''' but ''introspective'' and ''enlightening''. We don't recommend crossing this threshold until you're ready to move on from a lighter, happier experience to a sometimes darker and definitely more introspective full blown trip. Enjoy the 2nd plateau as long as you can because it's more of a fun experience and one tends to enjoy second plateau less after visiting the third plateau. "Once you see what's behind the curtain, you can't enjoy the show" so they say.

Additionally, exactly at 7.5mg/kg there is an elusive "Eiffel Tower" dose where you may experience the effects of both the Second and Third plateaus simultaneously.

=== Third Plateau ===

Third Plateau is a full on dissociative experience. You cannot ignore the feeling inside of you and at this point its no longer a social drug and should be done by yourself or with a sitter. The third plateau isn't 'party-mode' or even 'socialize-mode'. Its more like 'alone-and-tripping-mode'. Closed eye visuals are more prominent at this level. You will lose track of time quit easily as it becomes meaningless quite quickly. Large amounts of dissociation happens at this level, and the internal thoughts can be quite interesting. To explain further, you may start to feel like you don't belong in your own body, or that your mind and body are two separate beings. Additionally, thoughts may be similar to "My body is only what everyone else sees but not really me, because I am just my mind, not my body."

'''Third Plateau dose: 7.5-15 mg/kg.'''

=== Fourth Plateau ===

This is the deep meditative state. This is most akin to a "k-hole" that people experience after taking large amounts of ketamine. Few people enjoy going this far, as all one can really do (or really wants to do) is sit, listen to music, close your eyes, and experience a full blown dissociative trip. You can create universes in your mind just by thinking of them. DXM users have been known to have extremely vivid, controllable hallucinations and out of body experiences at this level. Full blown disassociation from everything and full on ego death is very common at this level. Other very common hallucinations at this level are people visiting aliens, meeting god (sometimes the two being the same entity) and becoming god.
One explanation of the fourth plateau "It's kind of like the top of your skull pops off and all the knowledge of the universe is poured into your head, but by the end of the trip it's all seeped out again and you are left with the realization that you really don't much of anything at all."
Another explanation is : "A total detachment from the body. The ego is pulled inside. Everything is very distant. Walking, talking, moving is not possible. Thinking is however. Left free to observe the self from a dark quiet immobility. A strange taste in the mouth. Like the numb of the dentist in every tissue. Loss of emotion, loss of anything earthly. "

It is quite difficult to recall these very powerful hallucinations as post-trip amnesia is very common.

'''Fourth Plateau dose: 15mg/kg-20mg/kg. Higher is possible, but not advised, because risk of death around 25mg/kg, but varies slightly from person to person'''

=== Plateau Sigma ===

There is another level that DXM can take you to, but it is not higher in dosage than 4th plateau, it is more of an extension of 2nd and 3rd plateaus. In order to get to this state, you must binge. For this reason '''WE HIGHLY RECOMMEND AGAINST IT!''' For example, a user has said "I took a 3rd plateau dose, then when it was starting to wear off, I took a 2nd plateau dose, when that was finally coming down, I took a 3rd plateau dose again, and when that came down, I did ANOTHER 2nd plateau dose. When that final dose hit, I was stuck in Plateau Sigma."

Many people refer to this level as "plateau sigma" because when you get to this state, your sigma receptors are hit on, and HARD. This completely changes the trip. This mind state is generally referred to as dysphoric, dark, confusing and "a hellish introspective nightmare". As one user put it "it's a dark and confusing dream-like state where everything you think you know is insanely hard to grasp while all of your wildest, most bizarre fantasies are merely common, boring every day events that feel as normal as waking up and drinking coffee."

As with 4th plateau, it's hard to describe as amnesia is quite common and information about this state is quite rare as it is. That being said, this state has VERY RARELY been reported as being pleasurable '''AT ALL'''. Most people describe it as dark and confusing, like a living nightmare.

For more information, the William White FAQ has a section on Plateau Sigma at [https://www.erowid.org/chemicals/dxm/faq/dxm_experience.shtml#toc.5.9 This Page]

== Harm Reduction ==

There is only three '''MAJOR''' rules about dxm use, and they are as follows :

*'''NEVER''' use any preparation of DXM that has '''ANY''' other active ingredients, as they can make you sick and/or dead. See [[DXM#Adulteration|Adulteration]]
*Keep in mind this general rule of thumb for DXM : 1 plateau/week.
**In other words, If you take a Third Plateau Dose, wait 3 weeks before using again. If you use a Second Plateau dose, wait 2 weeks before using again.
*Watch out what you are mixing DXM with, as mixing with certain drugs can cause serotonin syndrome, or Ataxia, see [[DXM#Interactions|Interactions]]

See [[Dissociatives#Harm_Reduction|Dissociative Harm Reduction]] for general information.

=== Adulteration ===

Many products which contain DXM also contain other medication or otherwise non-medically-active ingredients that can cause serious harm in the doses found in DXM containing products. If a user intends to use an OTC cough medication in order to get high on DXM they almost always will have to consume a dangerous quantity of other dangerous ingredients if they are present in the medication. For this reason it is strongly recommended to find a source which contains '''''DXM''''' as the '''ONLY''' ''active'' ingredient

The following is a summary of other ingredients commonly found in DXM products.

{| class="wikitable"
|+ Adulterant Table
|-
| Name
| Description
| Common Brands
| Danger
|-
| Acetaminophen/Paracetamol/APAP
| a painkiller found in headache/flu medicine
| Tylenol, Vicks (NyQuil), TheraFlu, Triaminic
| is hepatoxic in high doses. This means it will damage your liver if taken in high doses. Your body can only process a certain amount of APAP at once before it the normal pathways become saturated Once the regular pathways used for metabolizing APAP have been saturated the remaining APAP gets broken down in the liver by an enzyme called ''cytochrome P450'' '''When forced to break down APAP this enzyme produces toxic metabolites!'''
|-
| Guaifenesin
| Guaifenesin is an expectorant.
| Robitussin DM, Mucinex, Robefen
| Guaifenesin overdoses cause severe nausea and vomiting in most users.
|-
| Antihistamines
| Found in Allergy/Sleep/Nighttime medications
| Coricidin Cough and Cold, Zicam, Dimetapp, Chloraseptic
| When taken in high doses antihistamines can cause dizzyness, nausea, a strong dysphoria, paranoia, delirium and hallucinations. Many antihistamines can also have a dangerous synergy with DXM
|-
| PPA, pseudoephedrine, and phenyleprine
| Decongestant agents
| Sudafed, Vescadril, Curedex, Watkins, Hardex
| Vasoconstriction (constriction of blood vessels) and decreased nasal secretions , and ''with larger doses'' insomnia, hypertension, heart rhythm abnormalities, hemorrhaging, stroke, or death. Note that these are extreme reactions, and that individual tolerance to sympathomimetics tends to vary considerably. Tolerance can build quickly, and a fatal dose for one person may have only a mild effect on another person.
|}
{| class="wikitable"
|+ Inactive Ingredients Adulterant Table
|-
| Name
| Description
| Common Brands
| Danger
|-
| Food Coloring/Dyes
| Dyes added for color
| Almost ALL brands except Zarbee's Naturals and Chestal Naturals
| Usually these dyes are not harmful in low doses however in doses which may be required for DXM's effects they can become problematic. '''Tartrazine (FD&C Yellow #5)''' is one of the most notable coloring ingredients to cause reactions. Not necessarily dangerous unless you are allergic to certain dyes. Check out the ingredients list if you are.
|-
| Glucose, sucrose, fructose, invert sugar
| Cough syrups usually contain one or more chemicals used to make them taste sweet.
| Pretty much all brands except Prospan, Diabetic Tussin and Scot-Tussin
| These sweeteners pose an obvious risk to people with blood sugar conditions such as diabetes or hypoglycemia. If you have diabetes or hypoglycemia, make sure you get a diabetic brand, gel-caps, or even an extraction instead of syrup. In rare cases, excessive, chronic use of cough syrup '''HAS''' led to people getting diabetes.
|-
| Propylene glycol or Polyethylene glycol
| Thickening agents
| Pretty much all brands of syrup
| These are not toxic nor inherently dangerous but may cause an upset stomach when consumed in large doses.
|}

=== Interactions ===

DXM has several potentially dangerous interactions with pharmaceutical and recreational drugs including analgesics (painkillers), antihistamines, antidepressants and stimulants.

DXM has the potential to cause [[Wikipedia:Serotonin Syndrome|Serotonin Syndrome]] if mixed with other serotonergic drugs such as [[Antidepressants|antidepressants]] that act as SSRIs, MAOIs, empathogens which affect serotonin release such as [[MDMA]], [[MDA]], [[Mephedrone]], [[Tramadol]], 2-c-t-x drugs, [[MXE]], aMT, 5-HTP, ect.
Serotonin Syndrome causes discomfort, excitability, irritability, diarrhea, moodswings, seizures, coma and can be deadly <ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464814/</ref> if not treated.

* See [[Drug_Combinations|Drug combinations]] and [[Dissociatives#Interactions|Dissociative Interactions]] for more information.

== Chemistry and Pharmacology ==

IUPAC:(4bS,8aR,9S)-3-Methoxy-11-methyl-6,7,8,8a,9,10-hexahydro-5H-9,4b-(epiminoethano)phenanthrene.

Dextromethorphan is the dextrorotartory enantiomer of levomethophan, which is the methyl ether of levophanol, both opioid analgesics.

=== Pharmacodynamics ===

{| class="wikitable"

|+ Binding receptors

|-

| NMDA - 7253

|-

| SERT - 2015

|-

| NET - 110606

|-

| Sigma-1 - 23

|-

| Sigma-2 - 240

|}

=== Pharmacokinectics ===

Following oral dosing, DXM is rapidly absorbed from the GI tract. Where it enters the bloodstream, and crosses the blood-brain barrier.

At therapeutic doses, DXM acts centrally (brain) as opposed to locally (Respiratory tract). It's rapidly absorbed from the GI tract into the active metabolite Dextrophan (DXO) in the liver by the cytochrome P450 enzyme CYP2D6.

Around 10 percent of the Caucasian population has little or no CYP2D6 enzyme activity, leading to long-lived high drug levels. ALL Caucasians should take a small test dose (1st plateau or medical levels) to feel for this ahead of time.

== Images ==

<gallery mode="packed-hover">

Image:Dxm1.jpg|''Robitussin brand DXM Gel Caps''

Image:Dxm_gelcap.jpg

</gallery>

== Links ==
* [http://tripsit.me/the-dexterous-world-of-dxm/ The Dexterous World of DXM from TripSit]
* [http://www.erowid.org/chemicals/dxm/faq/dxm_faq.shtml DXM FAQ]
* [https://www.erowid.org/chemicals/dxm/dxm_timeline.php DXM timeline on Erowid]
* [http://en.wikipedia.org/wiki/Dextromethorphan Wikipedia]
* [http://www.dextroverse.org Dextroverse]
== References ==

<references />

[[Category:Dissociative]]

[[Category:Drugs]]

Drug combinations

2017-12-13T20:52:31Z

Borax: */ cocaine & alcohol /*

'''WARNING! For educational purposes: We do not endorse any of these combinations. This page will always be 'work in progress'. It is extremely important to be safe at all times! See below the graphic for important information regarding specific combinations.'''

[[File:Combo_2.png|1000px|center]]

== Overview ==
This chart is meant as a quick reference guide and additional research MUST always be done. If you use this chart or information on your site you must link to the full summaries and display this message.

If you want to give us some feedback/recommendation/comment on the chart, you can contact us:

[http://chat.tripsit.me/?nick=AskContent?#content Join #content channel on IRC]

Email: '''content@tripsit.me'''.

== Categorisations ==

''Low Risk & Synergy'' - These drugs work together to cause an effect greater than the sum of its parts, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before combining drugs.

''Low Risk & No Synergy'' - Effects are just additive. The combination is unlikely to cause any adverse or undesirable reaction beyond those that might ordinarily be expected from these drugs.

''Caution'' - These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.

''Unsafe'' - There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

''Dangerous'' - These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

== Chart versions ==

'''[https://wiki.tripsit.me/images/3/3f/TripSitDrugComboChart-Spanish.png Spanish]'''

'''[https://wiki.tripsit.me/images/d/d4/TripSitDrugComboChart-German.png German]'''

'''[http://wiki.tripsit.me/images/0/0c/Drug-combinations-fr.png French]'''

'''[https://wiki.tripsit.me/images/9/9e/TripSitDrugComboChart-Esperanto.png Esperanto]'''

'''Portuguese''' (Needs Translation)

'''Polish''' (Needs Translation)

== Specific Combinations ==
===cannabis & lsd===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & lsd===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & mushrooms===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & mushrooms===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & dmt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & dmt===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===5-meo-xxt & mescaline===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions

===cannabis & mescaline===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===cocaine & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===caffeine & mescaline===

Status: Low Risk & No Synergy

Note: High doses of caffeine are uncomfortable and this will be magnified by psychedelics

===tramadol & mescaline===

Status: Unsafe

Note: This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

===5-meo-xxt & dox===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

===cannabis & dox===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===ketamine & dox===

Status: Low Risk & Synergy

Note: Ketamine and psychedelics tend to potentiate each other - go slowly.

===mxe & dox===

Status: Caution

Note: As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense

===dxm & dox===

Status: Unsafe

Note: The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

===pcp & dox===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===amphetamines & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

===mdma & dox===

Status: Caution

Note: The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

===cocaine & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic

===caffeine & dox===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

===alcohol & dox===

Status: Low Risk & Decrease

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

===opioids & dox===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===tramadol & dox===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===maois & dox===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & nbomes===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided

===cannabis & nbomes===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===mxe & nbomes===

Status: Caution

Note: As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense

===amphetamines & nbomes===

Status: Unsafe

Note: Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

===cocaine & nbomes===

Status: Unsafe

Note: Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & nbomes===

Status: Caution

Note: Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping

===tramadol & nbomes===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures

===maois & nbomes===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-x===

Status: Caution

Note: The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics

===cannabis & 2c-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===cocaine & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===caffeine & 2c-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===tramadol & 2c-x===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

===maois & 2c-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-t-x===

Status: Caution

Note: Both classes of compounds can be unpredictable alone

===cannabis & 2c-t-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-t-x===

Status: Unsafe

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===cocaine & 2c-t-x===

Status: Unsafe

Note: Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & 2c-t-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & 2c-t-x===

Status: Low Risk & Decrease

Note: Both these classes of compound can interact unpredictably. Caution should be exercised.

===opioids & 2c-t-x===

Status: Low Risk & No Synergy

Note: No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

===maois & 2c-t-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series

===cannabis & amt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.

===caffeine & amt===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & amt===

Status: Caution

Note: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable

===opioids & amt===

Status: Low Risk & No Synergy

Note: No unexpected interactions

===maois & amt===

Status: Dangerous

Note: aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.

===mxe & 5-meo-xxt===

Status: Low Risk & Synergy

Note: Little information exists about this combination.

===dxm & 5-meo-xxt===

Status: Unsafe

Note: Little information exists about this combination.

===cannabis & 5-meo-xxt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===mdma & 5-meo-xxt===

Status: Caution

Note: Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care

===cocaine & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===caffeine & 5-meo-xxt===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===amphetamines & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===mdma & cannabis===

Status: Low Risk & Synergy

Note: Large amounts of either or both may cause strong and somewhat unpredictable experiences, which can be as intense as psychedelics. Consider rather Set and Setting are good, before you combine these. Cannabis should be saved for towards the end of the MDMA experience if possible, where the psychedelic alike effect won't come to play.

===cocaine & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===alcohol & cannabis===

Status: Low Risk & Synergy

Note: In excess, this combination can cause nausea.

===amphetamines & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===mdma & ketamine===

Status: Low Risk & Synergy

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===cocaine & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===caffeine & ketamine===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===alcohol & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===ghb/gbl & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & ketamine===

Status: Dangerous

Note: Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===benzodiazepines & ketamine===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & ketamine===

Status: Caution

Note: MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===pcp & mxe===

Status: Caution

Note: There are no reports available about this combination

===amphetamines & mxe===

Status: Caution

Note: Risk of tachycardia, hypertension, and manic states

===mdma & mxe===

Status: Caution

Note: There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

===cocaine & mxe===

Status: Caution

Note: Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

===caffeine & mxe===

Status: Low Risk & No Synergy

Note: No likely interactions

===alcohol & mxe===

Status: Dangerous

Note: There is a high risk of memory loss, vomiting and severe ataxia from this combination.

===ghb/gbl & mxe===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & mxe===

Status: Dangerous

Note: This combination can potentiate the effects of the opioid

===benzodiazepines & mxe===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

===maois & mxe===

Status: Unsafe

Note: MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===ssris & mxe===

Status: Caution

Note: Depending on the SSRI this combination can be unpredictable

===amphetamines & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

===cocaine & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues

===caffeine & dxm===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & dxm===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

===ghb/gbl & dxm===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict

===opioids & dxm===

Status: Dangerous

Note: CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

===benzodiazepines & dxm===

Status: Caution

Note: Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome

===ssris & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome.

===amphetamines & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===mdma & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===cocaine & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===caffeine & pcp===

Status: Caution

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===ghb/gbl & pcp===

Status: Dangerous

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===opioids & pcp===

Status: Caution

Note: PCP can reduce opioid tolerance, increasing the risk of overdose

===benzodiazepines & pcp===

Status: Unsafe

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely

===maois & pcp===

Status: Dangerous

Note: This combination is very poorly explored

===ssris & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===ghb/gbl & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===opioids & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===tramadol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===mdma & amphetamines===

Status: Low Risk & Synergy

Note: Amphetamines increase the neurotoxic effects of MDMA

===cocaine & amphetamines===

Status: Caution

Note: This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine

===caffeine & amphetamines===

Status: Caution

Note: This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

===alcohol & amphetamines===

Status: Caution

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

===ghb/gbl & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===opioids & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & amphetamines===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===benzodiazepines & amphetamines===

Status: Low Risk & Decrease

Note: Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction

===maois & amphetamines===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.

===cocaine & mdma===

Status: Caution

Note: Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

===caffeine & mdma===

Status: Caution

Note: Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA

===alcohol & mdma===

Status: Caution

Note: Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA

===ghb/gbl & mdma===

Status: Caution

Note: Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.

===tramadol & mdma===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & mdma===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.

===caffeine & cocaine===

Status: Caution

Note: Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

===alcohol & cocaine===

Status: Unsafe

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

===ghb/gbl & cocaine===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind

===opioids & cocaine===

Status: Dangerous

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & cocaine===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & cocaine===

Status: Dangerous

Note: This combination is poorly explored

===ssris & cocaine===

Status: Low Risk & No Synergy

Note: May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.

===ghb/gbl & alcohol===

Status: Dangerous

Note: Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

===opioids & alcohol===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely

===tramadol & alcohol===

Status: Dangerous

Note: Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

===benzodiazepines & alcohol===

Status: Dangerous

Note: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

===maois & alcohol===

Status: Unsafe

Note: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

===ssris & alcohol===

Status: Caution

Note: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

===opioids & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position

===tramadol & ghb/gbl===

Status: Dangerous

Note: The sedative effects of this combination can lead to dangerous respiratory depression.

===benzodiazepines & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===tramadol & opioids===

Status: Dangerous

Note: Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present

===benzodiazepines & opioids===

Status: Dangerous

Note: Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely

===maois & opioids===

Status: Caution

Note: Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

===ssris & opioids===

Status: Low Risk & No Synergy

Note: There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.

===benzodiazepines & tramadol===

Status: Dangerous

Note: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

--

=== LSD & Mushrooms ===
=== LSD & DMT ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Mescaline ===
=== LSD & DOx ===
=== LSD & NBOMes ===
=== LSD & 2C-x ===
=== LSD & 2C-T-x ===
=== LSD & αMT ===
=== LSD & 5-MeO-xxT ===
=== LSD & Cannabis ===
=== LSD & Ketamine ===
=== LSD & MXE ===
=== LSD & DXM ===
=== LSD & Nitrous ===
=== LSD & Amphetamines ===
=== LSD & MDMA ===
=== LSD & Cocaine ===
=== LSD & Caffeine ===
=== LSD & Alcohol ===
=== LSD & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== LSD & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/547279

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* "Low doses antagonized the effects of both hallucinogens, whereas larger doses enhanced their effects."

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== LSD & Benzodiazepines ===
=== LSD & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/8788508

* http://www.ncbi.nlm.nih.gov/pubmed/108709

* https://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=2439&DocPartID=2199

=== LSD & SSRIs ===
* http://www.nature.com/npp/journal/v14/n6/full/1380431a.html

* http://www.ncbi.nlm.nih.gov/pubmed/8726753

=== Mushrooms & DMT ===
=== Mushrooms & Mescaline ===
=== Mushrooms & DOx ===
=== Mushrooms & NBOMes ===
=== Mushrooms & 2C-x ===
=== Mushrooms & 2C-T-x ===
=== Mushrooms & αMT ===
=== Mushrooms & 5-MeO-xxT ===
=== Mushrooms & Cannabis ===
=== Mushrooms & Ketamine ===
=== Mushrooms & MXE ===
=== Mushrooms & DXM ===
=== Mushrooms & Nitrous ===
=== Mushrooms & Amphetamines ===
=== Mushrooms & MDMA ===
=== Mushrooms & Cocaine ===
=== Mushrooms & Caffeine ===
=== Mushrooms & Alcohol ===
=== Mushrooms & GHB\GBL ===
=== Mushrooms & Opioids ===
=== Mushrooms & Tramadol ===
=== Mushrooms & Benzodiazepines ===
=== Mushrooms & MAOIs ===
=== Mushrooms & SSRIs ===
=== DMT & Mescaline ===
=== DMT & DOx ===
=== DMT & NBOMes ===
=== DMT & 2C-x ===
=== DMT & 2C-T-x ===
=== DMT & αMT ===
=== DMT & 5-MeO-xxT ===
=== DMT & Cannabis ===
=== DMT & Ketamine ===
=== DMT & MXE ===
=== DMT & DXM ===
=== DMT & Nitrous ===
=== DMT & Amphetamines ===
=== DMT & MDMA ===
=== DMT & Cocaine ===
=== DMT & Caffeine ===
=== DMT & Alcohol ===
=== DMT & GHB\GBL ===
=== DMT & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Benzodiazepines ===
=== DMT & MAOIs ===
=== DMT & SSRIs ===
=== Mescaline & DOx ===
=== Mescaline & NBOMes ===
=== Mescaline & 2C-x ===
=== Mescaline & 2C-T-x ===
=== Mescaline & αMT ===
=== Mescaline & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions.

=== Mescaline & Cannabis ===
=== Mescaline & Ketamine ===
=== Mescaline & MXE ===
=== Mescaline & DXM ===
=== Mescaline & Nitrous ===
=== Mescaline & Amphetamines ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & MDMA ===
=== Mescaline & Cocaine ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & Caffeine ===
* High doses of caffeine are uncomfortable and this will be magnified by psychedelics.

=== Mescaline & Alcohol ===
=== Mescaline & GHB\GBL ===
=== Mescaline & Opioids ===
=== Mescaline & Tramadol ===
* This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

=== Mescaline & Benzodiazepines ===
=== Mescaline & MAOIs ===
=== Mescaline & SSRIs ===
=== DOx & NBOMes ===
=== DOx & 2C-x ===
=== DOx & 2C-T-x ===
=== DOx & αMT ===
=== DOx & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

=== DOx & Cannabis ===
=== DOx & Ketamine ===
* Ketamine and psychedelics tend to potentiate each other - go slowly.

=== DOx & MXE ===
* As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense.

=== DOx & DXM ===
* The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

=== DOx & Nitrous ===
=== DOx & Amphetamines ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

* http://www.ncbi.nlm.nih.gov/pubmed/1208759

=== DOx & MDMA ===
* The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

=== DOx & Cocaine ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic.

=== DOx & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

=== DOx & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

=== DOx & GHB\GBL ===
=== DOx & Opioids ===
* No unexpected interactions.

=== DOx & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

=== DOx & Benzodiazepines ===
=== DOx & MAOIs ===
=== DOx & SSRIs ===
=== NBOMes & 2C-x ===
=== NBOMes & 2C-T-x ===
=== NBOMes & αMT ===
=== NBOMes & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided.

=== NBOMes & Cannabis ===
=== NBOMes & Ketamine ===
=== NBOMes & MXE ===
=== NBOMes & DXM ===
=== NBOMes & Nitrous ===
=== NBOMes & Amphetamines ===
* Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

=== NBOMes & MDMA ===
=== NBOMes & Cocaine ===
* Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

=== NBOMes & Caffeine ===
* Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping.

=== NBOMes & Alcohol ===
=== NBOMes & GHB\GBL ===
=== NBOMes & Opioids ===
=== NBOMes & Tramadol ===
* Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures.

=== NBOMes & Benzodiazepines ===
=== NBOMes & MAOIs ===
=== NBOMes & SSRIs ===
=== 2C-x & 2C-T-x ===
=== 2C-x & αMT ===
=== 2C-x & 5-MeO-xxT ===
* The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics.

=== 2C-x & Cannabis ===
=== 2C-x & Ketamine ===
=== 2C-x & MXE ===
=== 2C-x & DXM ===
=== 2C-x & Nitrous ===
=== 2C-x & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & MDMA ===
=== 2C-x & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-x & Alcohol ===
=== 2C-x & GHB\GBL ===
=== 2C-x & Opioids ===
=== 2C-x & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

=== 2C-x & Benzodiazepines ===
=== 2C-x & MAOIs ===
=== 2C-x & SSRIs ===
=== 2C-T-x & αMT ===
=== 2C-T-x & 5-MeO-xxT ===
=== 2C-T-x & Cannabis ===
=== 2C-T-x & Ketamine ===
=== 2C-T-x & MXE ===
=== 2C-T-x & DXM ===
=== 2C-T-x & Nitrous ===
=== 2C-T-x & Amphetamines ===
=== 2C-T-x & MDMA ===
=== 2C-T-x & Cocaine ===
=== 2C-T-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-T-x & Alcohol ===
* Both these classes of compound can interact unpredictably. Caution should be exercised.

=== 2C-T-x & GHB\GBL ===
=== 2C-T-x & Opioids ===
* No expected interactions, some Opioids have Serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

=== 2C-T-x & Tramadol ===
=== 2C-T-x & Benzodiazepines ===
=== 2C-T-x & MAOIs ===
=== 2C-T-x & SSRIs ===
=== αMT & 5-MeO-xxT ===
=== αMT & Cannabis ===
=== αMT & Ketamine ===
=== αMT & MXE ===
=== αMT & DXM ===
=== αMT & Nitrous ===
=== αMT & Amphetamines ===
=== αMT & MDMA ===
=== αMT & Cocaine ===
=== αMT & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== αMT & Alcohol ===
* αMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable.

=== αMT & GHB\GBL ===
=== αMT & Opioids ===
* No unexpected interactions

=== αMT & Tramadol ===
=== αMT & Benzodiazepines ===
=== αMT & MAOIs ===
=== αMT & SSRIs ===
=== 5-MeO-xxT & Cannabis ===
=== 5-MeO-xxT & Ketamine ===
=== 5-MeO-xxT & MXE ===
=== 5-MeO-xxT & DXM ===
=== 5-MeO-xxT & Nitrous ===
=== 5-MeO-xxT & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & MDMA ===
* Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care.

=== 5-MeO-xxT & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & Caffeine ===
=== 5-MeO-xxT & Alcohol ===
=== 5-MeO-xxT & GHB\GBL ===
=== 5-MeO-xxT & Opioids ===
=== 5-MeO-xxT & Tramadol ===
=== 5-MeO-xxT & Benzodiazepines ===
=== 5-MeO-xxT & MAOIs ===
=== 5-MeO-xxT & SSRIs ===
=== Cannabis & Ketamine ===
=== Cannabis & MXE ===
=== Cannabis & DXM ===
=== Cannabis & Nitrous ===
=== Cannabis & Amphetamines ===
=== Cannabis & MDMA ===
=== Cannabis & Cocaine ===
=== Cannabis & Caffeine ===
=== Cannabis & Alcohol ===
=== Cannabis & GHB\GBL ===
=== Cannabis & Opioids ===
=== Cannabis & Tramadol ===
=== Cannabis & Benzodiazepines ===
=== Cannabis & MAOIs ===
=== Cannabis & SSRIs ===
=== Ketamine & MXE ===
=== Ketamine & DXM ===
=== Ketamine & Nitrous ===
=== Ketamine & Amphetamines ===
* Amphetamine worsens Ketamines ataxia.

* http://www.ncbi.nlm.nih.gov/pubmed/23660488

=== Ketamine & MDMA ===
=== Ketamine & Cocaine ===
=== Ketamine & Caffeine ===
* No unexpected interactions.

* http://onlinelibrary.wiley.com/doi/10.1111/j.1742-7843.2009.00382.x/full

=== Ketamine & Alcohol ===
* Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://onlinelibrary.wiley.com/doi/10.1002/jemt.22045/abstract

=== Ketamine & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== Ketamine & Opioids ===
* Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/21224020

=== Ketamine & Tramadol ===
* No unexpected interactions.

=== Ketamine & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== Ketamine & MAOIs ===
=== Ketamine & SSRIs ===
=== MXE & DXM ===
* http://i.imgur.com/zmqaw.jpg

* http://www.sciencedirect.com/science/article/pii/S0014488607002543

=== MXE & Nitrous ===
=== MXE & Amphetamines ===
* Risk of tachycardia, hypertension, and manic states.

* http://www.ncbi.nlm.nih.gov/pubmed/25060403

=== MXE & MDMA ===
* There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

=== MXE & Cocaine ===
* Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

=== MXE & Caffeine ===
* No likely interactions.

=== MXE & Alcohol ===
* There is a high risk of memory loss, vomiting and severe ataxia from this combination.

=== MXE & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

=== MXE & Opioids ===
* This combination can potentiate the effects of the opioid.

=== MXE & Tramadol ===
=== MXE & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

=== MXE & MAOIs ===
=== MXE & SSRIs ===
* Depending on the SSRI this combination can be unpredictable.

=== DXM & Nitrous ===
=== DXM & Amphetamines ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & MDMA ===
=== DXM & Cocaine ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== DXM & Alcohol ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

=== DXM & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict.

=== DXM & Opioids ===
* CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally, there is a reverse cross tolerance between opiates/dxm. I.E. if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

=== DXM & Tramadol ===
=== DXM & Benzodiazepines ===
* Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== DXM & MAOIs ===
* High risk of serotonin syndrome.

=== DXM & SSRIs ===
* High risk of serotonin syndrome.

=== Nitrous & Amphetamines ===
=== Nitrous & MDMA ===
=== Nitrous & Cocaine ===
=== Nitrous & Caffeine ===
=== Nitrous & Alcohol ===
* This combination can lead to vomiting.

=== Nitrous & GHB\GBL ===
=== Nitrous & Opioids ===
=== Nitrous & Tramadol ===
=== Nitrous & Benzodiazepines ===
=== Nitrous & MAOIs ===
=== Nitrous & SSRIs ===
=== Amphetamines & MDMA ===
* Amphetamines increase the neurotoxic effects of MDMA.

=== Amphetamines & Cocaine ===
* This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine.

=== Amphetamines & Caffeine ===
* This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

=== Amphetamines & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

=== Amphetamines & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Amphetamines & Benzodiazepines ===
* http://www.ncbi.nlm.nih.gov/pubmed/17320309

=== Amphetamines & MAOIs ===
=== Amphetamines & SSRIs ===
=== MDMA & Cocaine ===
* Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

=== MDMA & Caffeine ===
* Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492978/

* http://link.springer.com/article/10.1007/s00213-010-1864-1

* http://www.sciencedirect.com/science/article/pii/S0028390805003114

* http://www.ncbi.nlm.nih.gov/pubmed/24211539

=== MDMA & Alcohol ===
* Both MDMA and alcohol cause severe dehydration. Approach this combination with caution, moderation and sufficient hydration.

* http://www.ncbi.nlm.nih.gov/pubmed/21040238

* http://www.ncbi.nlm.nih.gov/pubmed/21756931

=== MDMA & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16234132

* http://www.ncbi.nlm.nih.gov/pubmed/22554869

* http://www.ncbi.nlm.nih.gov/pubmed/20730418

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== MDMA & Opioids ===
=== MDMA & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== MDMA & Benzodiazepines ===
=== MDMA & MAOIs ===
=== MDMA & SSRIs ===
=== Cocaine & Caffeine ===
* Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

=== Cocaine & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel he alcohol less. Cocaine is potentiated somewhat by alcohol by reduction of cocaine breakdown which results in increased risk to the heart.

=== Cocaine & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.

=== Cocaine & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Cocaine & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Cocaine & Benzodiazepines ===
=== Cocaine & MAOIs ===
=== Cocaine & SSRIs ===
* Risk of serotonin syndrome, Likely to make the SSRI's innefective with regular cocaine use. The SSRIs may also make the cocaine less effective. Mental stability and cocaine don't go together.

* http://www.ncbi.nlm.nih.gov/pubmed/23761390

* http://www.ncbi.nlm.nih.gov/pubmed/20195220

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377381

=== Caffeine & Alcohol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20001110

=== Caffeine & GHB\GBL ===
=== Caffeine & Opioids ===
=== Caffeine & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20837047

=== Caffeine & Benzodiazepines ===
=== Caffeine & MAOIs ===
=== Caffeine & SSRIs ===
* http://journals.lww.com/jpharmacogenetics/abstract/1996/06000/a_fluvoxamine_caffeine_interaction_study.3.aspx

=== Alcohol & GHB\GBL ===
* Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

* http://www.ncbi.nlm.nih.gov/pubmed/15274975

=== Alcohol & Opioids ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Tramadol ===
* Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Benzodiazepines ===
* Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

=== Alcohol & MAOIs ===
* The chemical tyramine in alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

=== Alcohol & SSRIs ===
* Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

* http://www.ncbi.nlm.nih.gov/pubmed/15739105

=== GHB\GBL & Opioids ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Tramadol ===
* The sedative effects of this combination can lead to dangerous respiratory depression.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Benzodiazepines ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== GHB\GBL & MAOIs ===
* No study, but MAO B inhibitors should enhance the effects, no interaction with MAO A.

=== GHB\GBL & SSRIs ===
=== Opioids & Tramadol ===
* Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.

=== Opioids & Benzodiazepines ===
* Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/

=== Opioids & MAOIs ===
* Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

* http://www.ncbi.nlm.nih.gov/pubmed/17157368 (?)

* http://www.ncbi.nlm.nih.gov/pubmed/2891392

* http://www.if-pan.krakow.pl/pjp/pdf/2013/3_593.pdf

=== Opioids & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/23391344

* http://www.ncbi.nlm.nih.gov/pubmed/20513454

* http://www.ncbi.nlm.nih.gov/pubmed/16005413

* http://www.ncbi.nlm.nih.gov/pubmed/18676387

* http://www.ncbi.nlm.nih.gov/pubmed/17381671

=== Tramadol & Benzodiazepines ===
* Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

* http://www.ncbi.nlm.nih.gov/pubmed/12842359

=== Tramadol & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/16051647

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Tramadol & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Benzodiazepines & MAOIs ===
=== Benzodiazepines & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446479/

* http://www.ncbi.nlm.nih.gov/pubmed/9435993

=== MAOIs & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/24577320

[[Category:Guides]]

Heroin

2017-11-03T12:50:16Z

Borax: paragraphs

==History==

Heroin (diacetylmorphine, morphine diacetate and also diamorphine) was first synthesized in 1874 by English chemist C.R. Wright. But its commercial value was first recognized in 1897 by Heinrich Dreser and Felix Hoffman at the Bayer pharmaceutical laboratory - the same researchers who invented aspirin, which is is made by a similar process. Heroin was intended to be a less-addictive substitute for other common opiates.

In the late nineteenth and early twentieth centuries, heroin was common in over-the-counter medicines, but it was made illegal in the United States in 1924 through the Heroin Act. In the second half of the twentieth century, heroin was widely stigmatized as the quintessential illicit drug, as images of urban heroin addicts were propagated by media reports.

== Types of heroin ==

'''1''': Morphine freebase or another form of morphine.

'''2''': Heroin acetate or Heroin freebase.

'''3''': "Supposedly" 60% Heroin HCl and 40% Caffeine however it is usually found in as Heroin freebase, which needs something like citric acid to be added before it will dissolve in water.

'''4''': Heroin HCl, which is a white or grey-ish substance that can be snorted or injected without treatment to make it soluble, but cannot be easily smoked.

Black tar heroin. In a sense does not fall under the above number, as it uses a completely different method from opium to Heroin. Contains 6-MAM and 3-MAM (which binds relatively weak to the μ-Opioid receptors).

== Dosage ==

Note: Purity varies wildly, and with such the dose does also.

{| class="wikitable"
|+ Intravenous
|-
| Common (no tolerance) || 5-15mg
|-
| Strong (no tolerance) || 10-20mg
|-
| Common (with tolerance) || 20-30mg
|-
| Strong (with tolerance) || 30-50mg
|}

{| class="wikitable"
|+ Smoked
|-
| Common || 10-20mg
|-
| Strong || 20-30mg
|}

== Duration ==

When injected intravenously, smoked, or insufflated, heroin produces a wash of euphoria followed by a period of sedation lasting for 2-4 hours. Intramuscular and subcutaneous injection typically lack the initial wave of intense euphoria, and cause feelings of sedation lasting three to five hours.

{| class="wikitable"
|+ Intravenous
|-
| Onset || 3-5 seconds
|-
| Total || 4-5 hours
|}

{| class="wikitable"
|+ Smoked
|-
| Onset || 5-15 seconds
|-
| Peak || 5-10 minutes
|-
| Total || 3-5 hours
|}

== Harm Reduction ==

* Always have Narcan when using heroin, which can save your life if you OD. Be in the presence of other people who can help you if you OD

* Do not drive or use heavy machinery

* Do not mix heroin (or other opiates) with benzos or alcohol. For a full list of interactions view [[Drug combinations]]

=== Potentiators ===

A common misconception is that grapefruit juice potentiates morphine and/or Heroin. It does not.

Any first generation anti-histamines.

=== Conversion from freebase Heroin to a salt ===

Converting the freebase version of Heroin to a salt version impacts the chemical in subjectively positive and negative effects, lets begin with listing those.

Pros:
- Easily water soluble (Easy IVing and snorting, also snorting has an notable increase in potency as the heroin is now able to easily pass the mucous membrane)
- You have 'more' as you add powder to your Heroin but depending on your route of administration (RoA from now on) this can even increase potency

Neutral:
- It changes the color of the Heroin

Cons:
- Not smokeable anymore (freebase Heroin is made for that and thus way better if your RoA is smoking/vaping)

So basically if you got freebase Heroin and wanna smoke/vape it? Stay with your freebase. You wanna IV or snort it though? Definitely get some kind of acid! These are your safe, and most of the time, cheap options:
- ascorbic acid powder (vitamin C) -> turns your Heroin into Heroin Ascorbate
- citric acid powder (DO NOT, I REPEAT DO NOT USE LEMON JUICE TO IV HEROIN. IT CAN MAKE YOU BLIND) -> turns your Heroin into
- vinegar (same as above! it's just listed it for completions sake, I highly recommend to use ascorbic acid ) -> turns your Heroin into Heroin Citrate (same as popular 'ECP')

I could sadly not find any information on difference in strength but I suppose all 3 CAN be slightly different and depending on your body, metabolism and more.

So whats the ratio? You only need very little of one of those 3 options and all the heroin should dissolve in water, but if you snort it you must mix it up pretty good in order for it to work exactly how it's supposed to and with full strength.

=== Some words from a fellow member ===

Hello fellow & former opiate/heroin addicts. I have some very important information that may save your life one day.

There's a good chance you've heard it before, but cannot emphasize how strong its so important to know the following critical information:

*If you relapse after having a week or more clean time, you have very well may die. Why, you ask? Most cases involve an individual who managed to get clean for a fair amount of time and relapse, often using the same dose they normally would use. Sometimes even less. In fact, I'd wager that at least 70% of heroin related deaths are from who make this lethal mistake. I feel obligated to make this post, as one of my closest friends died last month after making this common mistake.

There is more to keep in mind. Many people are not very bright, and don't realize how serious drug interactions can be, ESPECIALLY with little to no tolerance. A lot of other overdoses occur from people mixing heroin/opiates/alcohol with benzos. Without serious tolerance to all/any of these drugs, especially benzos, this is an incredibly potential lethal combination. I have been using opiates/heroin for well over 5 years now, and nearly every time I hear about someone overdosing & dying, it is either a result of benzos+opiates/alcohol, or from relapsing without stopping to think about how low their tolerance has become.

A third killer is easily a result from mixing heroin with cocaine. It is true that many experienced users are able to handle a speedball, but even with a high tolerance, people still have died. And I assure you, cocaine overdose is NOT fun. The majority of users don't speedball, and if you haven't tried coke+heroin IV, do yourself a favor and just don't try it or your addiction will get far worse. I sincerely hope any heroin/opiate/benzo/alcohol users will heed my warning & remember this vital information forever. Share it with your friends, but most of all, be SAFE.

~ soli

[[Category:Drugs]]

[[Category:Opioid]]

[[Category:Depressant]]

Heroin

2017-11-03T12:47:31Z

Borax: grammar and syntax

==History==

Heroin (diacetylmorphine, morphine diacetate and also diamorphine) was first synthesized in 1874 by English chemist C.R. Wright. But its commercial value was first recognized in 1897 by Heinrich Dreser and Felix Hoffman at the Bayer pharmaceutical laboratory - the same researchers who invented aspirin, which is is made by a similar process. Heroin was intended to be a less-addictive substitute for other common opiates.

In the late nineteenth and early twentieth centuries, heroin was common in over-the-counter medicines, but it was made illegal in the United States in 1924 through the Heroin Act. In the second half of the twentieth century, heroin was widely stigmatized as the quintessential illicit drug, as images of urban heroin addicts were propagated by media reports.

== Types of heroin ==

'''1''': Morphine freebase or another form of morphine.

'''2''': Heroin acetate or Heroin freebase.

'''3''': "Supposedly" 60% Heroin HCl and 40% Caffeine however it is usually found in as Heroin freebase, which needs something like citric acid to be added before it will dissolve in water.

'''4''': Heroin HCl, which is a white or grey-ish substance that can be snorted or injected without treatment to make it soluble, but cannot be easily smoked.

Black tar heroin. In a sense does not fall under the above number, as it uses a completely different method from opium to Heroin. Contains 6-MAM and 3-MAM (which binds relatively weak to the μ-Opioid receptors).

== Dosage ==

Note: Purity varies wildly, and with such the dose does also.

{| class="wikitable"
|+ Intravenous
|-
| Common (no tolerance) || 5-15mg
|-
| Strong (no tolerance) || 10-20mg
|-
| Common (with tolerance) || 20-30mg
|-
| Strong (with tolerance) || 30-50mg
|}

{| class="wikitable"
|+ Smoked
|-
| Common || 10-20mg
|-
| Strong || 20-30mg
|}

== Duration ==

When injected intravenously, smoked, or insufflated, heroin produces a wash of euphoria followed by a period of sedation lasting for 2-4 hours. Intramuscular and subcutaneous injection typically lack the initial wave of intense euphoria, and cause feelings of sedation lasting three to five hours.

{| class="wikitable"
|+ Intravenous
|-
| Onset || 3-5 seconds
|-
| Total || 4-5 hours
|}

{| class="wikitable"
|+ Smoked
|-
| Onset || 5-15 seconds
|-
| Peak || 5-10 minutes
|-
| Total || 3-5 hours
|}

== Harm Reduction ==

* Always have Narcan when using heroin, which can save your life if you OD. Be in the presence of other people who can help you if you OD

* Do not drive or use heavy machinery

* Do not mix heroin (or other opiates) with benzos or alcohol. For a full list of interactions view [[Drug combinations]]

=== Potentiators ===

A common misconception is that grapefruit juice potentiates morphine and/or Heroin. It does not.

Any first generation anti-histamines.

=== Conversion from freebase Heroin to a salt ===

Converting the freebase version of Heroin to a salt version impacts the chemical in subjectively positive and negative effects, lets begin with listing those.

Pros:
- Easily water soluble (Easy IVing and snorting, also snorting has an notable increase in potency as the heroin is now able to easily pass the mucous membrane)
- You have 'more' as you add powder to your Heroin but depending on your route of administration (RoA from now on) this can even increase potency

Neutral:
- It changes the color of the Heroin

Cons:
- Not smokeable anymore (freebase Heroin is made for that and thus way better if your RoA is smoking/vaping)

So basically if you got freebase Heroin and wanna smoke/vape it? Stay with your freebase. You wanna IV or snort it though? Definitely get some kind of acid! These are your safe, and most of the time, cheap options:
- ascorbic acid powder (vitamin C) -> turns your Heroin into Heroin Ascorbate
- citric acid powder (DO NOT, I REPEAT DO NOT USE LEMON JUICE TO IV HEROIN. IT CAN MAKE YOU BLIND) -> turns your Heroin into
- vinegar (same as above! it's just listed it for completions sake, I highly recommend to use ascorbic acid ) -> turns your Heroin into Heroin Citrate (same as popular 'ECP')

I could sadly not find any information on difference in strength but I suppose all 3 CAN be slightly different and depending on your body, metabolism and more.

So whats the ratio? You only need very little of one of those 3 options and all the heroin should dissolve in water, but if you snort it you must mix it up pretty good in order for it to work exactly how it's supposed to and with full strength.

=== Some words from a fellow member ===

Hello fellow & former opiate/heroin addicts. I have some very important information that may save your life one day.

There's a good chance you've heard it before, but cannot emphasize how strong its so important to know the following critical information:

*If you relapse after having a week or more clean time, you have very well may die. Why, you ask? Most cases involve an individual who managed to get clean for a fair amount of time and relapse, often using the same dose they normally would use. Sometimes even less. In fact, I'd wager that at least 70% of heroin related deaths are from who make this lethal mistake. I feel obligated to make this post, as one of my closest friends died last month after making this common mistake. There is more to keep in mind. Many people are not very bright, and don't realize how serious drug interactions can be, ESPECIALLY with little to no tolerance. A lot of other overdoses occur from people mixing heroin/opiates/alcohol with benzos. Without serious tolerance to all/any of these drugs, especially benzos, this is an incredibly potential lethal combination. I have been using opiates/heroin for well over 5 years now, and nearly every time I hear about someone overdosing & dying, it is either a result of benzos+opiates/alcohol, or from relapsing without stopping to think about how low their tolerance has become. A third killer is easily a result from mixing heroin with cocaine. It is true that many experienced users are able to handle a speedball, but even with a high tolerance, people still have died. And I assure you, cocaine overdose is NOT fun. The majority of users don't speedball, and if you haven't tried coke+heroin IV, do yourself a favor and just don't try it or your addiction will get far worse. I sincerely hope any heroin/opiate/benzo/alcohol users will heed my warning & remember this vital information forever. Share it with your friends, but most of all, be SAFE.

~ soli

[[Category:Drugs]]

[[Category:Opioid]]

[[Category:Depressant]]

Cold Water Extraction

2017-04-19T20:22:54Z

Borax: /* Preparing the extraction */

=== Why Perform a Cold Water Extraction? ===
Many opioids such as Vicodin and Percocet contain other harmful drugs. A cold water extraction is most commonly used to remove paracetamol, also known as acetaminophen and hereafter referred to as APAP. CWE also works with aspirin and, to a lesser extent, ibuprofen, which are all very toxic in high doses and overdoses may result in permanent damage to your liver. APAP toxicity is one of the most common causes of poisoning worldwide, and in the US and UK, the most common cause of acute liver failure. A cold water extraction, hereafter referred to as a CWE, helps remove APAP from prescription pills. It is generally recommended that healthy adults take no more than 4 grams of APAP in a day, and not more than 1g APAP at once, but even lower doses can harm your liver.

Either way, we are glad you are here and hope these CWE steps are easy to follow. Stay safe and perform a CWE on your drugs!

=== How Extraction Works ===
The main idea is that APAP is hardly soluble in water. Most opioids however are very soluble in water.

APAP is soluble in methanol, ethanol, dimethyl-formamide, ethylene dichloride, acetone, ethyl acetate; slightly soluble in ether; very-slightly soluble in cold water, considerably more soluble in hot water. APAP is insoluble in petroleum ether, pentane, and benzene.

=== Preparing the extraction ===
The best temperature water to extract APAP or aspirin is roughly 10C/50F. Solubility is as follows:

{| class="wikitable" border="1"
|+ Solubility
! Type!! Solubility (31C/88F water)!! Solubility (21C/70F water)
|-
| Aspirin|| 1g/ 100ml|| 1g/300ml
|-
| APAP|| 1g/ 70ml|| 1g/ 159ml
|-
| Codeine|| 1g/2.3ml|| 1g/0.7ml
|}

As you can see, you can dissolve 20 tablets of APAP or aspirin in 50ml of warm water, then cool it to 10C/50F, filter the solution, and end up with roughly the same amount of codeine as the tables contained but only a fraction of the original amount of APAP and aspirin. Opioids are also very soluble in cold water. Extraction works because the the opioids will be dissolved into the cold water and leave the APAP, aspirin, or ibuprofen behind. Also, the aspirin will be able to be caught in your filter.

If you are using capsules, you will not need to crush your pills/tablets. Capsules are also easier to dissolve. If you don't have capsules, do crush your tablets/pills before performing the CWE.

=== Quick Step-By-Step CWE ===
This process is relatively quick aside from cooling the water. A CWE is as simple as crushing your tablets, dissolving them in water, and straining the mixture through a filter.

1. Crush the tablets into a fine powder. Minimize powder loss.
*Tip: Put your tablets in a Ziplock bag so you don't lose any!

2. Dissolve the powder into warm water. Get hot water from the tap (NOT too hot!), as boiling water may destroy the opioid. Put the water in a container/bowl with a wide surface area, which allows the mixture to cool faster. Add the powder you crushed to about 1/2 cup water.
*Tip: Its better to have too much water than not enough.

3. Let the mixture sit and cool to room temperature on the counter for about 10-20 minutes. Stir it every few minutes until it is completely dissolved.
*Tip: Don't rush this! Go watch tv or something if you have nothing else to do but watch the mixture dissolve!

4. Put the container/mixture into the freezer until cold. No need for a lid on the container. Leave it sit until it is extremely cold to the touch. Do not let it freeze or ice up! This process might take 20-25 minutes.

5. Filter your mixture. Use a pre wet coffee filter, cheesecloth, or even an aeropress. A handkerchief might work as well if you don't have any of those. Put the filter over the top of a cup and secure it with a rubber band or tape. SLOWLY pour the mixture into the filtered cup. Do not pour in too much water or touch the filter, as you make break it and have to redo the filtering.

6. When it appears like the filter is done dripping into the cup and there is nothing left to filter, you will then have a dense, marshmallow-like substance. You may choose to squeeze the contents of the old filters through a new filter to save any remaining moisture. Careful not to spill! You may also had more water to the marshmallow mash and re-filter it, but this step isn't necessary.

7. Bottoms up! Drink your mixture and throw away the APAP/ibuprofen/aspirin; most should have been successfully removed. The remaining concoction might be really bitter, so try mixing it with something sweet.

[[Category:Guides]]

Scales

2017-03-06T18:14:37Z

Borax: added alternative balance (original was £200!)

This page includes a list of sources for quality milligram scales worldwide, with a mind for a relatively cheap cost.

===Basic Usage Guide===

To achieve the most accurate measurement from one's scales, one should put it on a surface that is as flat as possible. Other factors that can contribute to an inaccurate measurement are winds or drafts and vibrations, particularly from the bass one's speakers if one is listening to music. If your scale is new, make sure to follow the calibration instructions if there are any and use the calibration weights(if given) to confirm the success of the process. If one is measuring directly onto the scales, it would be wise to sanitise them with something like a wet wipe followed by a dry wipe, as general dirt(from exposure) or powder can contribute to the inaccuracy of one's measurement.

Warning: Do not assume that these scales are accurate for amounts lower than at least 50mg. Measure potent chemicals at your own risk; an entry level scale should never be used to measure any drug with an overdose margin smaller than 100mg from your intended dose. For chemicals active at a lower dose, consult our [[quick guide to volumetric dosing]].

[[File:Gem20Accuracy.png]]

===USA===

* [https://www.amazon.com/American-Weigh-GEMINI-20-Portable-MilliGram/dp/B0012TDNAM Gemini-20]
* [https://www.amazon.com/American-Weigh-GPR-20-Digital-MilliGram/dp/B003STEJD4 GPR-20]
* [https://www.amazon.com/Horizon-PRO-20B-Digital-Jewelry-0-001g/dp/B005XSN63M PRO-20B]

===UK===

* [https://www.amazon.co.uk/American-Weigh-GEMINI-20-Portable-MilliGram/dp/B0012TDNAM Gemini-20]
* [https://www.reagent-tests.uk/product/a03-mg-balance/ Diamond A03]

===Germany===

* [https://www.amazon.de/Kalibriergewicht-Feinwaage-Juwelierwaage-Pr%C3%A4zisonswaage-Goldwaage/dp/B003KMX9FS G&G]

[[Category:Guides]]

Test Kits

2016-10-27T22:46:51Z

Borax: RTUK now have mecke

The vast majority of synthetic drugs are white powders. A reagent test kit is the only way you can safely attempt to verify the identity of a substance without expensive and complicated lab equipment. This article is an introduction to the various kinds of common test kits including a variety of worldwide sources. It should be noted that these test kits cannot measure the purity of a drug, only its presence. If you've got more than one drug in a powder, it's possible that a reagent test may show the presence of only one of the drugs.

A color change reference chart for the four main reagents can be found at [http://www.dancesafe.org/wp-content/uploads/2014/02/kit-instructions-back.jpg Dancesafe] ([http://i.imgur.com/0a9jBcd.jpg Imgur mirror]). Erowid.org also has a great [https://www.erowid.org/chemicals/mdma/mdma_faq_testing_kits.shtml Ecstasy Testing Kit FAQ.] United Nations Office on Drugs and Crime [http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1975-01-01_1_page008.html Field and laboratory tests results for raw and prepared opium.]

==Marquis Reagent==

Marquis' reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of formaldehyde and concentrated sulfuric acid, which is dripped onto the substance being tested. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95–98%) sulfuric acid to 5 mL of 40% formaldehyde.

===Canada===

* [http://testkitplus.ca/product/mdma-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/marquis-reagent/ QKTest]

===Europe===

* [http://www.eztestkits.com/en/ez-testing-kits/marquis10pack-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]
* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* [http://www.dancesafe.org/product/marquis-reagent-testing-kit/ Dancesafe]

==Mandelin Reagent==

The Mandelin reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of ammonium metavanadate and concentrated sulfuric acid. Its primary use is for the detection of ketamine and PMA. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95–98%) sulfuric acid to 1 g of ammonium vanadate.

====Canada====

* [http://testkitplus.ca/product/ketamine-pma-mandelin-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/mandelin-reagent/ QKTest]

===Europe===

* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!
* [http://www.eztestkits.com/en/ez-testing-kits/mandelin10-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]

===USA===

* [http://www.dancesafe.org/product/mandelin-reagent-testing-kit/ Dancesafe]

==Mecke Reagent==

The Mecke reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of selenious acid and concentrated sulfuric acid, which is dripped onto the substance being tested. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95-98%) sulfuric acid to 1 g of selenious acid.

====Canada====

* [http://testkitplus.ca/product/mecke-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/mecke-reagent/ QKTest]

===Europe===

* [http://www.eztestkits.com/en/ez-testing-kits/mecke10-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]
* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* [http://www.dancesafe.org/product/mecke-reagent-testing-kit/ Dancesafe]

==Ehrlich's Reagent==

The Ehrlich's reagent is used as a simple spot-test to presumptively identify alkaloids. It is prepared by dissolving 0.5-2.0 g of p–dimethylaminobenzaldehyde (DMAB) in 50 mL of 95% ethanol and 50 mL of concentrated hydrochloric acid. It is best prepared fresh.

===Europe===

* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===Canada===

* [http://testkitplus.ca/product/lsd-test-kit/ TestKitPlus]

==Other==

===Australia===

* Marquis, Mandelin, Mecke, Simon 4-in-1 [http://ecstasypilltest.com/product/basic-ecstasy-test-kit/ Ecstasy Pill Test] (Also shipped worldwide)

===Canada===

* Marquis, Mandelin, Mecke 3-in-1: [http://testkitplus.ca/product/complete-screening-kit-marquis-mecke-mandelin/ TestKitPlus]
* Froehde, Simon's Reagent A & B, Ferric Chloride: [https://qktest.com/products-page/ QKTest]

===Europe===

* [http://www.eztest.com/ eztestkits]
* UK [http://www.safetest4.co.uk/ SafeTest4]
* [http://www.reagent-tests.uk/ Liebermann and Froehde - Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* Marquis, Mandelin, Mecke, Simon 4-in-1: [http://www.dancesafe.org/product/coomplete-adulterant-screening-kit/ Dancesafe]
* Simon's reagent - [http://www.dancesafe.org/product/simons-reagent-testing-kit/ Dancesafe]
* [http://www.copquest.com/43-2100_nik-narcotic-test-kits.htm CopQuest NIK Narcotic Test Kits]

[[Category:Guides]]

Drug combinations

2016-10-12T16:30:23Z

Borax: /* Overview */ This chart is meant as a quick reference guide and additional research MUST always be done. If you use this chart or information on your site you must link to the full summaries and dis

'''WARNING! For educational purposes: We do not endorse any of these combinations. This page will always be 'work in progress'. It is extremely important to be safe at all times! See below the graphic for important information regarding specific combinations.'''

[[File:Combo_2.png|1000px|center]]

== Overview ==
This chart is meant as a quick reference guide and additional research MUST always be done. If you use this chart or information on your site you must link to the full summaries and display this message.

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== Categorisations ==

''Low Risk & Synergy'' - These drugs work together to cause an effect greater than the sum of its parts, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before combining drugs.

''Low Risk & No Synergy'' - Effects are just additive. The combination is unlikely to cause any adverse or undesirable reaction beyond those that might ordinarily be expected from these drugs.

''Caution'' - These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.

''Unsafe'' - There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

''Dangerous'' - These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

== Chart versions ==

'''[https://wiki.tripsit.me/images/3/3f/TripSitDrugComboChart-Spanish.png Spanish]'''

'''[https://wiki.tripsit.me/images/d/d4/TripSitDrugComboChart-German.png German]'''

'''[http://wiki.tripsit.me/images/0/0c/Drug-combinations-fr.png French]'''

'''[https://wiki.tripsit.me/images/9/9e/TripSitDrugComboChart-Esperanto.png Esperanto]'''

'''Portuguese''' (Needs Translation)

'''Polish''' (Needs Translation)

== Specific Combinations ==
===cannabis & lsd===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & lsd===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & mushrooms===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & mushrooms===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & dmt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & dmt===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===5-meo-xxt & mescaline===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions

===cannabis & mescaline===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===cocaine & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===caffeine & mescaline===

Status: Low Risk & No Synergy

Note: High doses of caffeine are uncomfortable and this will be magnified by psychedelics

===tramadol & mescaline===

Status: Unsafe

Note: This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

===5-meo-xxt & dox===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

===cannabis & dox===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===ketamine & dox===

Status: Low Risk & Synergy

Note: Ketamine and psychedelics tend to potentiate each other - go slowly.

===mxe & dox===

Status: Caution

Note: As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense

===dxm & dox===

Status: Unsafe

Note: The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

===pcp & dox===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===amphetamines & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

===mdma & dox===

Status: Caution

Note: The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

===cocaine & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic

===caffeine & dox===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

===alcohol & dox===

Status: Low Risk & Decrease

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

===opioids & dox===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===tramadol & dox===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===maois & dox===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & nbomes===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided

===cannabis & nbomes===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===mxe & nbomes===

Status: Caution

Note: As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense

===amphetamines & nbomes===

Status: Unsafe

Note: Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

===cocaine & nbomes===

Status: Unsafe

Note: Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & nbomes===

Status: Caution

Note: Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping

===tramadol & nbomes===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures

===maois & nbomes===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-x===

Status: Caution

Note: The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics

===cannabis & 2c-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===cocaine & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===caffeine & 2c-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===tramadol & 2c-x===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

===maois & 2c-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-t-x===

Status: Caution

Note: Both classes of compounds can be unpredictable alone

===cannabis & 2c-t-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-t-x===

Status: Unsafe

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===cocaine & 2c-t-x===

Status: Unsafe

Note: Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & 2c-t-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & 2c-t-x===

Status: Low Risk & Decrease

Note: Both these classes of compound can interact unpredictably. Caution should be exercised.

===opioids & 2c-t-x===

Status: Low Risk & No Synergy

Note: No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

===maois & 2c-t-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series

===cannabis & amt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.

===caffeine & amt===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & amt===

Status: Caution

Note: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable

===opioids & amt===

Status: Low Risk & No Synergy

Note: No unexpected interactions

===maois & amt===

Status: Dangerous

Note: aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.

===mxe & 5-meo-xxt===

Status: Low Risk & Synergy

Note: Little information exists about this combination.

===dxm & 5-meo-xxt===

Status: Unsafe

Note: Little information exists about this combination.

===cannabis & 5-meo-xxt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===mdma & 5-meo-xxt===

Status: Caution

Note: Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care

===cocaine & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===caffeine & 5-meo-xxt===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===amphetamines & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===mdma & cannabis===

Status: Low Risk & Synergy

Note: Large amounts of cannabis may cause strong and somewhat unpredictable experiences in combination with MDMA. Cannabis should be saved for towards the end of the experience if possible.

===cocaine & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===alcohol & cannabis===

Status: Low Risk & Synergy

Note: In excess, this combination can cause nausea.

===amphetamines & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===mdma & ketamine===

Status: Low Risk & Synergy

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===cocaine & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===caffeine & ketamine===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===alcohol & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===ghb/gbl & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & ketamine===

Status: Dangerous

Note: Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===benzodiazepines & ketamine===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & ketamine===

Status: Caution

Note: MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===pcp & mxe===

Status: Caution

Note: There are no reports available about this combination

===amphetamines & mxe===

Status: Caution

Note: Risk of tachycardia, hypertension, and manic states

===mdma & mxe===

Status: Caution

Note: There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

===cocaine & mxe===

Status: Caution

Note: Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

===caffeine & mxe===

Status: Low Risk & No Synergy

Note: No likely interactions

===alcohol & mxe===

Status: Dangerous

Note: There is a high risk of memory loss, vomiting and severe ataxia from this combination.

===ghb/gbl & mxe===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & mxe===

Status: Dangerous

Note: This combination can potentiate the effects of the opioid

===benzodiazepines & mxe===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

===maois & mxe===

Status: Unsafe

Note: MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===ssris & mxe===

Status: Caution

Note: Depending on the SSRI this combination can be unpredictable

===amphetamines & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

===cocaine & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues

===caffeine & dxm===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & dxm===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

===ghb/gbl & dxm===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict

===opioids & dxm===

Status: Dangerous

Note: CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

===benzodiazepines & dxm===

Status: Caution

Note: Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome

===ssris & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome.

===amphetamines & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===mdma & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===cocaine & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===caffeine & pcp===

Status: Caution

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===ghb/gbl & pcp===

Status: Dangerous

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===opioids & pcp===

Status: Caution

Note: PCP can reduce opioid tolerance, increasing the risk of overdose

===benzodiazepines & pcp===

Status: Unsafe

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely

===maois & pcp===

Status: Dangerous

Note: This combination is very poorly explored

===ssris & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===ghb/gbl & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===opioids & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===tramadol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===mdma & amphetamines===

Status: Low Risk & Synergy

Note: Amphetamines increase the neurotoxic effects of MDMA

===cocaine & amphetamines===

Status: Caution

Note: This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine

===caffeine & amphetamines===

Status: Caution

Note: This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

===alcohol & amphetamines===

Status: Caution

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

===ghb/gbl & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===opioids & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & amphetamines===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===benzodiazepines & amphetamines===

Status: Low Risk & Decrease

Note: Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction

===maois & amphetamines===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.

===cocaine & mdma===

Status: Caution

Note: Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

===caffeine & mdma===

Status: Caution

Note: Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA

===alcohol & mdma===

Status: Caution

Note: Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA

===ghb/gbl & mdma===

Status: Caution

Note: Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.

===tramadol & mdma===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & mdma===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.

===caffeine & cocaine===

Status: Caution

Note: Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

===alcohol & cocaine===

Status: Unsafe

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

===ghb/gbl & cocaine===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind

===opioids & cocaine===

Status: Dangerous

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & cocaine===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & cocaine===

Status: Dangerous

Note: This combination is poorly explored

===ssris & cocaine===

Status: Low Risk & No Synergy

Note: May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.

===ghb/gbl & alcohol===

Status: Dangerous

Note: Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

===opioids & alcohol===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely

===tramadol & alcohol===

Status: Dangerous

Note: Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

===benzodiazepines & alcohol===

Status: Dangerous

Note: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

===maois & alcohol===

Status: Unsafe

Note: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

===ssris & alcohol===

Status: Caution

Note: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

===opioids & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position

===tramadol & ghb/gbl===

Status: Dangerous

Note: The sedative effects of this combination can lead to dangerous respiratory depression.

===benzodiazepines & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===tramadol & opioids===

Status: Dangerous

Note: Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present

===benzodiazepines & opioids===

Status: Dangerous

Note: Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely

===maois & opioids===

Status: Caution

Note: Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

===ssris & opioids===

Status: Low Risk & No Synergy

Note: There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.

===benzodiazepines & tramadol===

Status: Dangerous

Note: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

--

=== LSD & Mushrooms ===
=== LSD & DMT ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Mescaline ===
=== LSD & DOx ===
=== LSD & NBOMes ===
=== LSD & 2C-x ===
=== LSD & 2C-T-x ===
=== LSD & αMT ===
=== LSD & 5-MeO-xxT ===
=== LSD & Cannabis ===
=== LSD & Ketamine ===
=== LSD & MXE ===
=== LSD & DXM ===
=== LSD & Nitrous ===
=== LSD & Amphetamines ===
=== LSD & MDMA ===
=== LSD & Cocaine ===
=== LSD & Caffeine ===
=== LSD & Alcohol ===
=== LSD & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== LSD & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/547279

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* "Low doses antagonized the effects of both hallucinogens, whereas larger doses enhanced their effects."

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== LSD & Benzodiazepines ===
=== LSD & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/8788508

* http://www.ncbi.nlm.nih.gov/pubmed/108709

* https://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=2439&DocPartID=2199

=== LSD & SSRIs ===
* http://www.nature.com/npp/journal/v14/n6/full/1380431a.html

* http://www.ncbi.nlm.nih.gov/pubmed/8726753

=== Mushrooms & DMT ===
=== Mushrooms & Mescaline ===
=== Mushrooms & DOx ===
=== Mushrooms & NBOMes ===
=== Mushrooms & 2C-x ===
=== Mushrooms & 2C-T-x ===
=== Mushrooms & αMT ===
=== Mushrooms & 5-MeO-xxT ===
=== Mushrooms & Cannabis ===
=== Mushrooms & Ketamine ===
=== Mushrooms & MXE ===
=== Mushrooms & DXM ===
=== Mushrooms & Nitrous ===
=== Mushrooms & Amphetamines ===
=== Mushrooms & MDMA ===
=== Mushrooms & Cocaine ===
=== Mushrooms & Caffeine ===
=== Mushrooms & Alcohol ===
=== Mushrooms & GHB\GBL ===
=== Mushrooms & Opioids ===
=== Mushrooms & Tramadol ===
=== Mushrooms & Benzodiazepines ===
=== Mushrooms & MAOIs ===
=== Mushrooms & SSRIs ===
=== DMT & Mescaline ===
=== DMT & DOx ===
=== DMT & NBOMes ===
=== DMT & 2C-x ===
=== DMT & 2C-T-x ===
=== DMT & αMT ===
=== DMT & 5-MeO-xxT ===
=== DMT & Cannabis ===
=== DMT & Ketamine ===
=== DMT & MXE ===
=== DMT & DXM ===
=== DMT & Nitrous ===
=== DMT & Amphetamines ===
=== DMT & MDMA ===
=== DMT & Cocaine ===
=== DMT & Caffeine ===
=== DMT & Alcohol ===
=== DMT & GHB\GBL ===
=== DMT & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Benzodiazepines ===
=== DMT & MAOIs ===
=== DMT & SSRIs ===
=== Mescaline & DOx ===
=== Mescaline & NBOMes ===
=== Mescaline & 2C-x ===
=== Mescaline & 2C-T-x ===
=== Mescaline & αMT ===
=== Mescaline & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions.

=== Mescaline & Cannabis ===
=== Mescaline & Ketamine ===
=== Mescaline & MXE ===
=== Mescaline & DXM ===
=== Mescaline & Nitrous ===
=== Mescaline & Amphetamines ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & MDMA ===
=== Mescaline & Cocaine ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & Caffeine ===
* High doses of caffeine are uncomfortable and this will be magnified by psychedelics.

=== Mescaline & Alcohol ===
=== Mescaline & GHB\GBL ===
=== Mescaline & Opioids ===
=== Mescaline & Tramadol ===
* This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

=== Mescaline & Benzodiazepines ===
=== Mescaline & MAOIs ===
=== Mescaline & SSRIs ===
=== DOx & NBOMes ===
=== DOx & 2C-x ===
=== DOx & 2C-T-x ===
=== DOx & αMT ===
=== DOx & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

=== DOx & Cannabis ===
=== DOx & Ketamine ===
* Ketamine and psychedelics tend to potentiate each other - go slowly.

=== DOx & MXE ===
* As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense.

=== DOx & DXM ===
* The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

=== DOx & Nitrous ===
=== DOx & Amphetamines ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

* http://www.ncbi.nlm.nih.gov/pubmed/1208759

=== DOx & MDMA ===
* The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

=== DOx & Cocaine ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic.

=== DOx & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

=== DOx & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

=== DOx & GHB\GBL ===
=== DOx & Opioids ===
* No unexpected interactions.

=== DOx & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

=== DOx & Benzodiazepines ===
=== DOx & MAOIs ===
=== DOx & SSRIs ===
=== NBOMes & 2C-x ===
=== NBOMes & 2C-T-x ===
=== NBOMes & αMT ===
=== NBOMes & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided.

=== NBOMes & Cannabis ===
=== NBOMes & Ketamine ===
=== NBOMes & MXE ===
=== NBOMes & DXM ===
=== NBOMes & Nitrous ===
=== NBOMes & Amphetamines ===
* Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

=== NBOMes & MDMA ===
=== NBOMes & Cocaine ===
* Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

=== NBOMes & Caffeine ===
* Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping.

=== NBOMes & Alcohol ===
=== NBOMes & GHB\GBL ===
=== NBOMes & Opioids ===
=== NBOMes & Tramadol ===
* Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures.

=== NBOMes & Benzodiazepines ===
=== NBOMes & MAOIs ===
=== NBOMes & SSRIs ===
=== 2C-x & 2C-T-x ===
=== 2C-x & αMT ===
=== 2C-x & 5-MeO-xxT ===
* The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics.

=== 2C-x & Cannabis ===
=== 2C-x & Ketamine ===
=== 2C-x & MXE ===
=== 2C-x & DXM ===
=== 2C-x & Nitrous ===
=== 2C-x & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & MDMA ===
=== 2C-x & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-x & Alcohol ===
=== 2C-x & GHB\GBL ===
=== 2C-x & Opioids ===
=== 2C-x & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

=== 2C-x & Benzodiazepines ===
=== 2C-x & MAOIs ===
=== 2C-x & SSRIs ===
=== 2C-T-x & αMT ===
=== 2C-T-x & 5-MeO-xxT ===
=== 2C-T-x & Cannabis ===
=== 2C-T-x & Ketamine ===
=== 2C-T-x & MXE ===
=== 2C-T-x & DXM ===
=== 2C-T-x & Nitrous ===
=== 2C-T-x & Amphetamines ===
=== 2C-T-x & MDMA ===
=== 2C-T-x & Cocaine ===
=== 2C-T-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-T-x & Alcohol ===
* Both these classes of compound can interact unpredictably. Caution should be exercised.

=== 2C-T-x & GHB\GBL ===
=== 2C-T-x & Opioids ===
* No expected interactions, some Opioids have Serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

=== 2C-T-x & Tramadol ===
=== 2C-T-x & Benzodiazepines ===
=== 2C-T-x & MAOIs ===
=== 2C-T-x & SSRIs ===
=== αMT & 5-MeO-xxT ===
=== αMT & Cannabis ===
=== αMT & Ketamine ===
=== αMT & MXE ===
=== αMT & DXM ===
=== αMT & Nitrous ===
=== αMT & Amphetamines ===
=== αMT & MDMA ===
=== αMT & Cocaine ===
=== αMT & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== αMT & Alcohol ===
* αMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable.

=== αMT & GHB\GBL ===
=== αMT & Opioids ===
* No unexpected interactions

=== αMT & Tramadol ===
=== αMT & Benzodiazepines ===
=== αMT & MAOIs ===
=== αMT & SSRIs ===
=== 5-MeO-xxT & Cannabis ===
=== 5-MeO-xxT & Ketamine ===
=== 5-MeO-xxT & MXE ===
=== 5-MeO-xxT & DXM ===
=== 5-MeO-xxT & Nitrous ===
=== 5-MeO-xxT & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & MDMA ===
* Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care.

=== 5-MeO-xxT & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & Caffeine ===
=== 5-MeO-xxT & Alcohol ===
=== 5-MeO-xxT & GHB\GBL ===
=== 5-MeO-xxT & Opioids ===
=== 5-MeO-xxT & Tramadol ===
=== 5-MeO-xxT & Benzodiazepines ===
=== 5-MeO-xxT & MAOIs ===
=== 5-MeO-xxT & SSRIs ===
=== Cannabis & Ketamine ===
=== Cannabis & MXE ===
=== Cannabis & DXM ===
=== Cannabis & Nitrous ===
=== Cannabis & Amphetamines ===
=== Cannabis & MDMA ===
=== Cannabis & Cocaine ===
=== Cannabis & Caffeine ===
=== Cannabis & Alcohol ===
=== Cannabis & GHB\GBL ===
=== Cannabis & Opioids ===
=== Cannabis & Tramadol ===
=== Cannabis & Benzodiazepines ===
=== Cannabis & MAOIs ===
=== Cannabis & SSRIs ===
=== Ketamine & MXE ===
=== Ketamine & DXM ===
=== Ketamine & Nitrous ===
=== Ketamine & Amphetamines ===
* Amphetamine worsens Ketamines ataxia.

* http://www.ncbi.nlm.nih.gov/pubmed/23660488

=== Ketamine & MDMA ===
=== Ketamine & Cocaine ===
=== Ketamine & Caffeine ===
* No unexpected interactions.

* http://onlinelibrary.wiley.com/doi/10.1111/j.1742-7843.2009.00382.x/full

=== Ketamine & Alcohol ===
* Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://onlinelibrary.wiley.com/doi/10.1002/jemt.22045/abstract

=== Ketamine & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== Ketamine & Opioids ===
* Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/21224020

=== Ketamine & Tramadol ===
* No unexpected interactions.

=== Ketamine & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== Ketamine & MAOIs ===
=== Ketamine & SSRIs ===
=== MXE & DXM ===
* http://i.imgur.com/zmqaw.jpg

* http://www.sciencedirect.com/science/article/pii/S0014488607002543

=== MXE & Nitrous ===
=== MXE & Amphetamines ===
* Risk of tachycardia, hypertension, and manic states.

* http://www.ncbi.nlm.nih.gov/pubmed/25060403

=== MXE & MDMA ===
* There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

=== MXE & Cocaine ===
* Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

=== MXE & Caffeine ===
* No likely interactions.

=== MXE & Alcohol ===
* There is a high risk of memory loss, vomiting and severe ataxia from this combination.

=== MXE & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

=== MXE & Opioids ===
* This combination can potentiate the effects of the opioid.

=== MXE & Tramadol ===
=== MXE & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

=== MXE & MAOIs ===
=== MXE & SSRIs ===
* Depending on the SSRI this combination can be unpredictable.

=== DXM & Nitrous ===
=== DXM & Amphetamines ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & MDMA ===
=== DXM & Cocaine ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== DXM & Alcohol ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

=== DXM & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict.

=== DXM & Opioids ===
* CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally, there is a reverse cross tolerance between opiates/dxm. I.E. if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

=== DXM & Tramadol ===
=== DXM & Benzodiazepines ===
* Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== DXM & MAOIs ===
* High risk of serotonin syndrome.

=== DXM & SSRIs ===
* High risk of serotonin syndrome.

=== Nitrous & Amphetamines ===
=== Nitrous & MDMA ===
=== Nitrous & Cocaine ===
=== Nitrous & Caffeine ===
=== Nitrous & Alcohol ===
* This combination can lead to vomiting.

=== Nitrous & GHB\GBL ===
=== Nitrous & Opioids ===
=== Nitrous & Tramadol ===
=== Nitrous & Benzodiazepines ===
=== Nitrous & MAOIs ===
=== Nitrous & SSRIs ===
=== Amphetamines & MDMA ===
* Amphetamines increase the neurotoxic effects of MDMA.

=== Amphetamines & Cocaine ===
* This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine.

=== Amphetamines & Caffeine ===
* This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

=== Amphetamines & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

=== Amphetamines & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Amphetamines & Benzodiazepines ===
* http://www.ncbi.nlm.nih.gov/pubmed/17320309

=== Amphetamines & MAOIs ===
=== Amphetamines & SSRIs ===
=== MDMA & Cocaine ===
* Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

=== MDMA & Caffeine ===
* Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492978/

* http://link.springer.com/article/10.1007/s00213-010-1864-1

* http://www.sciencedirect.com/science/article/pii/S0028390805003114

* http://www.ncbi.nlm.nih.gov/pubmed/24211539

=== MDMA & Alcohol ===
* Both MDMA and alcohol cause severe dehydration. Approach this combination with caution, moderation and sufficient hydration.

* http://www.ncbi.nlm.nih.gov/pubmed/21040238

* http://www.ncbi.nlm.nih.gov/pubmed/21756931

=== MDMA & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16234132

* http://www.ncbi.nlm.nih.gov/pubmed/22554869

* http://www.ncbi.nlm.nih.gov/pubmed/20730418

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== MDMA & Opioids ===
=== MDMA & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== MDMA & Benzodiazepines ===
=== MDMA & MAOIs ===
=== MDMA & SSRIs ===
=== Cocaine & Caffeine ===
* Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

=== Cocaine & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel he alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

=== Cocaine & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.

=== Cocaine & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Cocaine & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Cocaine & Benzodiazepines ===
=== Cocaine & MAOIs ===
=== Cocaine & SSRIs ===
* Risk of serotonin syndrome, Likely to make the SSRI's innefective with regular cocaine use. The SSRIs may also make the cocaine less effective. Mental stability and cocaine don't go together.

* http://www.ncbi.nlm.nih.gov/pubmed/23761390

* http://www.ncbi.nlm.nih.gov/pubmed/20195220

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377381

=== Caffeine & Alcohol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20001110

=== Caffeine & GHB\GBL ===
=== Caffeine & Opioids ===
=== Caffeine & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20837047

=== Caffeine & Benzodiazepines ===
=== Caffeine & MAOIs ===
=== Caffeine & SSRIs ===
* http://journals.lww.com/jpharmacogenetics/abstract/1996/06000/a_fluvoxamine_caffeine_interaction_study.3.aspx

=== Alcohol & GHB\GBL ===
* Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

* http://www.ncbi.nlm.nih.gov/pubmed/15274975

=== Alcohol & Opioids ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Tramadol ===
* Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Benzodiazepines ===
* Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

=== Alcohol & MAOIs ===
* The chemical tyramine in alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

=== Alcohol & SSRIs ===
* Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

* http://www.ncbi.nlm.nih.gov/pubmed/15739105

=== GHB\GBL & Opioids ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Tramadol ===
* The sedative effects of this combination can lead to dangerous respiratory depression.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Benzodiazepines ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== GHB\GBL & MAOIs ===
* No study, but MAO B inhibitors should enhance the effects, no interaction with MAO A.

=== GHB\GBL & SSRIs ===
=== Opioids & Tramadol ===
* Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.

=== Opioids & Benzodiazepines ===
* Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/

=== Opioids & MAOIs ===
* Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

* http://www.ncbi.nlm.nih.gov/pubmed/17157368 (?)

* http://www.ncbi.nlm.nih.gov/pubmed/2891392

* http://www.if-pan.krakow.pl/pjp/pdf/2013/3_593.pdf

=== Opioids & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/23391344

* http://www.ncbi.nlm.nih.gov/pubmed/20513454

* http://www.ncbi.nlm.nih.gov/pubmed/16005413

* http://www.ncbi.nlm.nih.gov/pubmed/18676387

* http://www.ncbi.nlm.nih.gov/pubmed/17381671

=== Tramadol & Benzodiazepines ===
* Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

* http://www.ncbi.nlm.nih.gov/pubmed/12842359

=== Tramadol & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/16051647

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Tramadol & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Benzodiazepines & MAOIs ===
=== Benzodiazepines & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446479/

* http://www.ncbi.nlm.nih.gov/pubmed/9435993

=== MAOIs & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/24577320

[[Category:Guides]]

Drug combinations

2016-08-18T16:52:42Z

Borax: removed old versions

'''WARNING! For educational purposes: We do not endorse any of these combinations. This page will always be 'work in progress'. It is extremely important to be safe at all times! See below the graphic for important information regarding specific combinations.'''

[[File:Combo_2.png|1000px|center]]

== Overview ==
If you want to give us some feedback/recommendation/comment on the chart, you can contact us:

[http://chat.tripsit.me/?nick=AskContent?#content Join #content channel on IRC]

Email: '''content@tripsit.me'''.

== Categorisations ==

''Low Risk & Synergy'' - These drugs work together to cause an effect greater than the sum of its parts, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before combining drugs.

''Low Risk & No Synergy'' - Effects are just additive. The combination is unlikely to cause any adverse or undesirable reaction beyond those that might ordinarily be expected from these drugs.

''Caution'' - These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.

''Unsafe'' - There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

''Dangerous'' - These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

== Chart versions ==

'''[https://wiki.tripsit.me/images/3/3f/TripSitDrugComboChart-Spanish.png Spanish]'''

'''[https://wiki.tripsit.me/images/d/d4/TripSitDrugComboChart-German.png German]'''

'''[http://wiki.tripsit.me/images/0/0c/Drug-combinations-fr.png French]'''

'''[https://wiki.tripsit.me/images/9/9e/TripSitDrugComboChart-Esperanto.png Esperanto]'''

'''Portuguese''' (Needs Translation)

'''Polish''' (Needs Translation)

== Specific Combinations ==
===cannabis & lsd===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & lsd===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & mushrooms===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & mushrooms===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & dmt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & dmt===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===5-meo-xxt & mescaline===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions

===cannabis & mescaline===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===cocaine & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===caffeine & mescaline===

Status: Low Risk & No Synergy

Note: High doses of caffeine are uncomfortable and this will be magnified by psychedelics

===tramadol & mescaline===

Status: Unsafe

Note: This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

===5-meo-xxt & dox===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

===cannabis & dox===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===ketamine & dox===

Status: Low Risk & Synergy

Note: Ketamine and psychedelics tend to potentiate each other - go slowly.

===mxe & dox===

Status: Caution

Note: As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense

===dxm & dox===

Status: Unsafe

Note: The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

===pcp & dox===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===amphetamines & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

===mdma & dox===

Status: Caution

Note: The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

===cocaine & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic

===caffeine & dox===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

===alcohol & dox===

Status: Low Risk & Decrease

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

===opioids & dox===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===tramadol & dox===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===maois & dox===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & nbomes===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided

===cannabis & nbomes===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===mxe & nbomes===

Status: Caution

Note: As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense

===amphetamines & nbomes===

Status: Unsafe

Note: Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

===cocaine & nbomes===

Status: Unsafe

Note: Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & nbomes===

Status: Caution

Note: Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping

===tramadol & nbomes===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures

===maois & nbomes===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-x===

Status: Caution

Note: The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics

===cannabis & 2c-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===cocaine & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===caffeine & 2c-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===tramadol & 2c-x===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

===maois & 2c-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-t-x===

Status: Caution

Note: Both classes of compounds can be unpredictable alone

===cannabis & 2c-t-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-t-x===

Status: Unsafe

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===cocaine & 2c-t-x===

Status: Unsafe

Note: Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & 2c-t-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & 2c-t-x===

Status: Low Risk & Decrease

Note: Both these classes of compound can interact unpredictably. Caution should be exercised.

===opioids & 2c-t-x===

Status: Low Risk & No Synergy

Note: No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

===maois & 2c-t-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series

===cannabis & amt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.

===caffeine & amt===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & amt===

Status: Caution

Note: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable

===opioids & amt===

Status: Low Risk & No Synergy

Note: No unexpected interactions

===maois & amt===

Status: Dangerous

Note: aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.

===mxe & 5-meo-xxt===

Status: Low Risk & Synergy

Note: Little information exists about this combination.

===dxm & 5-meo-xxt===

Status: Unsafe

Note: Little information exists about this combination.

===cannabis & 5-meo-xxt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===mdma & 5-meo-xxt===

Status: Caution

Note: Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care

===cocaine & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===caffeine & 5-meo-xxt===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===amphetamines & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===mdma & cannabis===

Status: Low Risk & Synergy

Note: Large amounts of cannabis may cause strong and somewhat unpredictable experiences in combination with MDMA. Cannabis should be saved for towards the end of the experience if possible.

===cocaine & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===alcohol & cannabis===

Status: Low Risk & Synergy

Note: In excess, this combination can cause nausea.

===amphetamines & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===mdma & ketamine===

Status: Low Risk & Synergy

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===cocaine & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===caffeine & ketamine===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===alcohol & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===ghb/gbl & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & ketamine===

Status: Dangerous

Note: Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===benzodiazepines & ketamine===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & ketamine===

Status: Caution

Note: MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===pcp & mxe===

Status: Caution

Note: There are no reports available about this combination

===amphetamines & mxe===

Status: Caution

Note: Risk of tachycardia, hypertension, and manic states

===mdma & mxe===

Status: Caution

Note: There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

===cocaine & mxe===

Status: Caution

Note: Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

===caffeine & mxe===

Status: Low Risk & No Synergy

Note: No likely interactions

===alcohol & mxe===

Status: Dangerous

Note: There is a high risk of memory loss, vomiting and severe ataxia from this combination.

===ghb/gbl & mxe===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & mxe===

Status: Dangerous

Note: This combination can potentiate the effects of the opioid

===benzodiazepines & mxe===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

===maois & mxe===

Status: Unsafe

Note: MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===ssris & mxe===

Status: Caution

Note: Depending on the SSRI this combination can be unpredictable

===amphetamines & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

===cocaine & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues

===caffeine & dxm===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & dxm===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

===ghb/gbl & dxm===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict

===opioids & dxm===

Status: Dangerous

Note: CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

===benzodiazepines & dxm===

Status: Caution

Note: Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome

===ssris & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome.

===amphetamines & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===mdma & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===cocaine & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===caffeine & pcp===

Status: Caution

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===ghb/gbl & pcp===

Status: Dangerous

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===opioids & pcp===

Status: Caution

Note: PCP can reduce opioid tolerance, increasing the risk of overdose

===benzodiazepines & pcp===

Status: Unsafe

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely

===maois & pcp===

Status: Dangerous

Note: This combination is very poorly explored

===ssris & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===ghb/gbl & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===opioids & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===tramadol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===mdma & amphetamines===

Status: Low Risk & Synergy

Note: Amphetamines increase the neurotoxic effects of MDMA

===cocaine & amphetamines===

Status: Caution

Note: This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine

===caffeine & amphetamines===

Status: Caution

Note: This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

===alcohol & amphetamines===

Status: Caution

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

===ghb/gbl & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===opioids & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & amphetamines===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===benzodiazepines & amphetamines===

Status: Low Risk & Decrease

Note: Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction

===maois & amphetamines===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.

===cocaine & mdma===

Status: Caution

Note: Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

===caffeine & mdma===

Status: Caution

Note: Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA

===alcohol & mdma===

Status: Caution

Note: Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA

===ghb/gbl & mdma===

Status: Caution

Note: Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.

===tramadol & mdma===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & mdma===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.

===caffeine & cocaine===

Status: Caution

Note: Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

===alcohol & cocaine===

Status: Unsafe

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

===ghb/gbl & cocaine===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind

===opioids & cocaine===

Status: Dangerous

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & cocaine===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & cocaine===

Status: Dangerous

Note: This combination is poorly explored

===ssris & cocaine===

Status: Low Risk & No Synergy

Note: May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.

===ghb/gbl & alcohol===

Status: Dangerous

Note: Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

===opioids & alcohol===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely

===tramadol & alcohol===

Status: Dangerous

Note: Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

===benzodiazepines & alcohol===

Status: Dangerous

Note: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

===maois & alcohol===

Status: Unsafe

Note: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

===ssris & alcohol===

Status: Caution

Note: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

===opioids & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position

===tramadol & ghb/gbl===

Status: Dangerous

Note: The sedative effects of this combination can lead to dangerous respiratory depression.

===benzodiazepines & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===tramadol & opioids===

Status: Dangerous

Note: Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present

===benzodiazepines & opioids===

Status: Dangerous

Note: Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely

===maois & opioids===

Status: Caution

Note: Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

===ssris & opioids===

Status: Low Risk & No Synergy

Note: There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.

===benzodiazepines & tramadol===

Status: Dangerous

Note: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

--

=== LSD & Mushrooms ===
=== LSD & DMT ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Mescaline ===
=== LSD & DOx ===
=== LSD & NBOMes ===
=== LSD & 2C-x ===
=== LSD & 2C-T-x ===
=== LSD & αMT ===
=== LSD & 5-MeO-xxT ===
=== LSD & Cannabis ===
=== LSD & Ketamine ===
=== LSD & MXE ===
=== LSD & DXM ===
=== LSD & Nitrous ===
=== LSD & Amphetamines ===
=== LSD & MDMA ===
=== LSD & Cocaine ===
=== LSD & Caffeine ===
=== LSD & Alcohol ===
=== LSD & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== LSD & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/547279

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* "Low doses antagonized the effects of both hallucinogens, whereas larger doses enhanced their effects."

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== LSD & Benzodiazepines ===
=== LSD & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/8788508

* http://www.ncbi.nlm.nih.gov/pubmed/108709

* https://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=2439&DocPartID=2199

=== LSD & SSRIs ===
* http://www.nature.com/npp/journal/v14/n6/full/1380431a.html

* http://www.ncbi.nlm.nih.gov/pubmed/8726753

=== Mushrooms & DMT ===
=== Mushrooms & Mescaline ===
=== Mushrooms & DOx ===
=== Mushrooms & NBOMes ===
=== Mushrooms & 2C-x ===
=== Mushrooms & 2C-T-x ===
=== Mushrooms & αMT ===
=== Mushrooms & 5-MeO-xxT ===
=== Mushrooms & Cannabis ===
=== Mushrooms & Ketamine ===
=== Mushrooms & MXE ===
=== Mushrooms & DXM ===
=== Mushrooms & Nitrous ===
=== Mushrooms & Amphetamines ===
=== Mushrooms & MDMA ===
=== Mushrooms & Cocaine ===
=== Mushrooms & Caffeine ===
=== Mushrooms & Alcohol ===
=== Mushrooms & GHB\GBL ===
=== Mushrooms & Opioids ===
=== Mushrooms & Tramadol ===
=== Mushrooms & Benzodiazepines ===
=== Mushrooms & MAOIs ===
=== Mushrooms & SSRIs ===
=== DMT & Mescaline ===
=== DMT & DOx ===
=== DMT & NBOMes ===
=== DMT & 2C-x ===
=== DMT & 2C-T-x ===
=== DMT & αMT ===
=== DMT & 5-MeO-xxT ===
=== DMT & Cannabis ===
=== DMT & Ketamine ===
=== DMT & MXE ===
=== DMT & DXM ===
=== DMT & Nitrous ===
=== DMT & Amphetamines ===
=== DMT & MDMA ===
=== DMT & Cocaine ===
=== DMT & Caffeine ===
=== DMT & Alcohol ===
=== DMT & GHB\GBL ===
=== DMT & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Benzodiazepines ===
=== DMT & MAOIs ===
=== DMT & SSRIs ===
=== Mescaline & DOx ===
=== Mescaline & NBOMes ===
=== Mescaline & 2C-x ===
=== Mescaline & 2C-T-x ===
=== Mescaline & αMT ===
=== Mescaline & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions.

=== Mescaline & Cannabis ===
=== Mescaline & Ketamine ===
=== Mescaline & MXE ===
=== Mescaline & DXM ===
=== Mescaline & Nitrous ===
=== Mescaline & Amphetamines ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & MDMA ===
=== Mescaline & Cocaine ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & Caffeine ===
* High doses of caffeine are uncomfortable and this will be magnified by psychedelics.

=== Mescaline & Alcohol ===
=== Mescaline & GHB\GBL ===
=== Mescaline & Opioids ===
=== Mescaline & Tramadol ===
* This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

=== Mescaline & Benzodiazepines ===
=== Mescaline & MAOIs ===
=== Mescaline & SSRIs ===
=== DOx & NBOMes ===
=== DOx & 2C-x ===
=== DOx & 2C-T-x ===
=== DOx & αMT ===
=== DOx & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

=== DOx & Cannabis ===
=== DOx & Ketamine ===
* Ketamine and psychedelics tend to potentiate each other - go slowly.

=== DOx & MXE ===
* As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense.

=== DOx & DXM ===
* The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

=== DOx & Nitrous ===
=== DOx & Amphetamines ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

* http://www.ncbi.nlm.nih.gov/pubmed/1208759

=== DOx & MDMA ===
* The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

=== DOx & Cocaine ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic.

=== DOx & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

=== DOx & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

=== DOx & GHB\GBL ===
=== DOx & Opioids ===
* No unexpected interactions.

=== DOx & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

=== DOx & Benzodiazepines ===
=== DOx & MAOIs ===
=== DOx & SSRIs ===
=== NBOMes & 2C-x ===
=== NBOMes & 2C-T-x ===
=== NBOMes & αMT ===
=== NBOMes & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided.

=== NBOMes & Cannabis ===
=== NBOMes & Ketamine ===
=== NBOMes & MXE ===
=== NBOMes & DXM ===
=== NBOMes & Nitrous ===
=== NBOMes & Amphetamines ===
* Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

=== NBOMes & MDMA ===
=== NBOMes & Cocaine ===
* Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

=== NBOMes & Caffeine ===
* Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping.

=== NBOMes & Alcohol ===
=== NBOMes & GHB\GBL ===
=== NBOMes & Opioids ===
=== NBOMes & Tramadol ===
* Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures.

=== NBOMes & Benzodiazepines ===
=== NBOMes & MAOIs ===
=== NBOMes & SSRIs ===
=== 2C-x & 2C-T-x ===
=== 2C-x & αMT ===
=== 2C-x & 5-MeO-xxT ===
* The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics.

=== 2C-x & Cannabis ===
=== 2C-x & Ketamine ===
=== 2C-x & MXE ===
=== 2C-x & DXM ===
=== 2C-x & Nitrous ===
=== 2C-x & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & MDMA ===
=== 2C-x & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-x & Alcohol ===
=== 2C-x & GHB\GBL ===
=== 2C-x & Opioids ===
=== 2C-x & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

=== 2C-x & Benzodiazepines ===
=== 2C-x & MAOIs ===
=== 2C-x & SSRIs ===
=== 2C-T-x & αMT ===
=== 2C-T-x & 5-MeO-xxT ===
=== 2C-T-x & Cannabis ===
=== 2C-T-x & Ketamine ===
=== 2C-T-x & MXE ===
=== 2C-T-x & DXM ===
=== 2C-T-x & Nitrous ===
=== 2C-T-x & Amphetamines ===
=== 2C-T-x & MDMA ===
=== 2C-T-x & Cocaine ===
=== 2C-T-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-T-x & Alcohol ===
* Both these classes of compound can interact unpredictably. Caution should be exercised.

=== 2C-T-x & GHB\GBL ===
=== 2C-T-x & Opioids ===
* No expected interactions, some Opioids have Serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

=== 2C-T-x & Tramadol ===
=== 2C-T-x & Benzodiazepines ===
=== 2C-T-x & MAOIs ===
=== 2C-T-x & SSRIs ===
=== αMT & 5-MeO-xxT ===
=== αMT & Cannabis ===
=== αMT & Ketamine ===
=== αMT & MXE ===
=== αMT & DXM ===
=== αMT & Nitrous ===
=== αMT & Amphetamines ===
=== αMT & MDMA ===
=== αMT & Cocaine ===
=== αMT & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== αMT & Alcohol ===
* αMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable.

=== αMT & GHB\GBL ===
=== αMT & Opioids ===
* No unexpected interactions

=== αMT & Tramadol ===
=== αMT & Benzodiazepines ===
=== αMT & MAOIs ===
=== αMT & SSRIs ===
=== 5-MeO-xxT & Cannabis ===
=== 5-MeO-xxT & Ketamine ===
=== 5-MeO-xxT & MXE ===
=== 5-MeO-xxT & DXM ===
=== 5-MeO-xxT & Nitrous ===
=== 5-MeO-xxT & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & MDMA ===
* Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care.

=== 5-MeO-xxT & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & Caffeine ===
=== 5-MeO-xxT & Alcohol ===
=== 5-MeO-xxT & GHB\GBL ===
=== 5-MeO-xxT & Opioids ===
=== 5-MeO-xxT & Tramadol ===
=== 5-MeO-xxT & Benzodiazepines ===
=== 5-MeO-xxT & MAOIs ===
=== 5-MeO-xxT & SSRIs ===
=== Cannabis & Ketamine ===
=== Cannabis & MXE ===
=== Cannabis & DXM ===
=== Cannabis & Nitrous ===
=== Cannabis & Amphetamines ===
=== Cannabis & MDMA ===
=== Cannabis & Cocaine ===
=== Cannabis & Caffeine ===
=== Cannabis & Alcohol ===
=== Cannabis & GHB\GBL ===
=== Cannabis & Opioids ===
=== Cannabis & Tramadol ===
=== Cannabis & Benzodiazepines ===
=== Cannabis & MAOIs ===
=== Cannabis & SSRIs ===
=== Ketamine & MXE ===
=== Ketamine & DXM ===
=== Ketamine & Nitrous ===
=== Ketamine & Amphetamines ===
* Amphetamine worsens Ketamines ataxia.

* http://www.ncbi.nlm.nih.gov/pubmed/23660488

=== Ketamine & MDMA ===
=== Ketamine & Cocaine ===
=== Ketamine & Caffeine ===
* No unexpected interactions.

* http://onlinelibrary.wiley.com/doi/10.1111/j.1742-7843.2009.00382.x/full

=== Ketamine & Alcohol ===
* Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://onlinelibrary.wiley.com/doi/10.1002/jemt.22045/abstract

=== Ketamine & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== Ketamine & Opioids ===
* Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/21224020

=== Ketamine & Tramadol ===
* No unexpected interactions.

=== Ketamine & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== Ketamine & MAOIs ===
=== Ketamine & SSRIs ===
=== MXE & DXM ===
* http://i.imgur.com/zmqaw.jpg

* http://www.sciencedirect.com/science/article/pii/S0014488607002543

=== MXE & Nitrous ===
=== MXE & Amphetamines ===
* Risk of tachycardia, hypertension, and manic states.

* http://www.ncbi.nlm.nih.gov/pubmed/25060403

=== MXE & MDMA ===
* There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

=== MXE & Cocaine ===
* Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

=== MXE & Caffeine ===
* No likely interactions.

=== MXE & Alcohol ===
* There is a high risk of memory loss, vomiting and severe ataxia from this combination.

=== MXE & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

=== MXE & Opioids ===
* This combination can potentiate the effects of the opioid.

=== MXE & Tramadol ===
=== MXE & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

=== MXE & MAOIs ===
=== MXE & SSRIs ===
* Depending on the SSRI this combination can be unpredictable.

=== DXM & Nitrous ===
=== DXM & Amphetamines ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & MDMA ===
=== DXM & Cocaine ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== DXM & Alcohol ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

=== DXM & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict.

=== DXM & Opioids ===
* CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally, there is a reverse cross tolerance between opiates/dxm. I.E. if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

=== DXM & Tramadol ===
=== DXM & Benzodiazepines ===
* Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== DXM & MAOIs ===
* High risk of serotonin syndrome.

=== DXM & SSRIs ===
* High risk of serotonin syndrome.

=== Nitrous & Amphetamines ===
=== Nitrous & MDMA ===
=== Nitrous & Cocaine ===
=== Nitrous & Caffeine ===
=== Nitrous & Alcohol ===
* This combination can lead to vomiting.

=== Nitrous & GHB\GBL ===
=== Nitrous & Opioids ===
=== Nitrous & Tramadol ===
=== Nitrous & Benzodiazepines ===
=== Nitrous & MAOIs ===
=== Nitrous & SSRIs ===
=== Amphetamines & MDMA ===
* Amphetamines increase the neurotoxic effects of MDMA.

=== Amphetamines & Cocaine ===
* This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine.

=== Amphetamines & Caffeine ===
* This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

=== Amphetamines & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

=== Amphetamines & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Amphetamines & Benzodiazepines ===
* http://www.ncbi.nlm.nih.gov/pubmed/17320309

=== Amphetamines & MAOIs ===
=== Amphetamines & SSRIs ===
=== MDMA & Cocaine ===
* Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

=== MDMA & Caffeine ===
* Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492978/

* http://link.springer.com/article/10.1007/s00213-010-1864-1

* http://www.sciencedirect.com/science/article/pii/S0028390805003114

* http://www.ncbi.nlm.nih.gov/pubmed/24211539

=== MDMA & Alcohol ===
* Both MDMA and alcohol cause severe dehydration. Approach this combination with caution, moderation and sufficient hydration.

* http://www.ncbi.nlm.nih.gov/pubmed/21040238

* http://www.ncbi.nlm.nih.gov/pubmed/21756931

=== MDMA & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16234132

* http://www.ncbi.nlm.nih.gov/pubmed/22554869

* http://www.ncbi.nlm.nih.gov/pubmed/20730418

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== MDMA & Opioids ===
=== MDMA & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== MDMA & Benzodiazepines ===
=== MDMA & MAOIs ===
=== MDMA & SSRIs ===
=== Cocaine & Caffeine ===
* Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

=== Cocaine & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel he alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

=== Cocaine & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.

=== Cocaine & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Cocaine & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Cocaine & Benzodiazepines ===
=== Cocaine & MAOIs ===
=== Cocaine & SSRIs ===
* Risk of serotonin syndrome, Likely to make the SSRI's innefective with regular cocaine use. The SSRIs may also make the cocaine less effective. Mental stability and cocaine don't go together.

* http://www.ncbi.nlm.nih.gov/pubmed/23761390

* http://www.ncbi.nlm.nih.gov/pubmed/20195220

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377381

=== Caffeine & Alcohol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20001110

=== Caffeine & GHB\GBL ===
=== Caffeine & Opioids ===
=== Caffeine & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20837047

=== Caffeine & Benzodiazepines ===
=== Caffeine & MAOIs ===
=== Caffeine & SSRIs ===
* http://journals.lww.com/jpharmacogenetics/abstract/1996/06000/a_fluvoxamine_caffeine_interaction_study.3.aspx

=== Alcohol & GHB\GBL ===
* Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

* http://www.ncbi.nlm.nih.gov/pubmed/15274975

=== Alcohol & Opioids ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Tramadol ===
* Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Benzodiazepines ===
* Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

=== Alcohol & MAOIs ===
* The chemical tyramine in alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

=== Alcohol & SSRIs ===
* Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

* http://www.ncbi.nlm.nih.gov/pubmed/15739105

=== GHB\GBL & Opioids ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Tramadol ===
* The sedative effects of this combination can lead to dangerous respiratory depression.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Benzodiazepines ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== GHB\GBL & MAOIs ===
* No study, but MAO B inhibitors should enhance the effects, no interaction with MAO A.

=== GHB\GBL & SSRIs ===
=== Opioids & Tramadol ===
* Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.

=== Opioids & Benzodiazepines ===
* Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/

=== Opioids & MAOIs ===
* Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

* http://www.ncbi.nlm.nih.gov/pubmed/17157368 (?)

* http://www.ncbi.nlm.nih.gov/pubmed/2891392

* http://www.if-pan.krakow.pl/pjp/pdf/2013/3_593.pdf

=== Opioids & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/23391344

* http://www.ncbi.nlm.nih.gov/pubmed/20513454

* http://www.ncbi.nlm.nih.gov/pubmed/16005413

* http://www.ncbi.nlm.nih.gov/pubmed/18676387

* http://www.ncbi.nlm.nih.gov/pubmed/17381671

=== Tramadol & Benzodiazepines ===
* Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

* http://www.ncbi.nlm.nih.gov/pubmed/12842359

=== Tramadol & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/16051647

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Tramadol & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Benzodiazepines & MAOIs ===
=== Benzodiazepines & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446479/

* http://www.ncbi.nlm.nih.gov/pubmed/9435993

=== MAOIs & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/24577320

[[Category:Guides]]

Drug combinations

2016-08-11T23:38:20Z

Borax: undid SS warning for amp & SSRI

'''WARNING! For educational purposes: We do not endorse any of these combinations. This page will always be 'work in progress'. It is extremely important to be safe at all times! See below the graphic for important information regarding specific combinations.'''

[[File:Combo_2.png|1000px|center]]

== Overview ==
If you want to give us some feedback/recommendation/comment on the chart, you can contact us:

[http://chat.tripsit.me/?nick=AskContent?#content Join #content channel on IRC]

Email: '''content@tripsit.me'''.

== Categorisations ==

''Low Risk & Synergy'' - These drugs work together to cause an effect greater than the sum of its parts, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before combining drugs.

''Low Risk & No Synergy'' - Effects are just additive. The combination is unlikely to cause any adverse or undesirable reaction beyond those that might ordinarily be expected from these drugs.

''Caution'' - These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.

''Unsafe'' - There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

''Dangerous'' - These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

== Chart versions ==

'''[https://wiki.tripsit.me/images/3/3f/TripSitDrugComboChart-Spanish.png Spanish]'''

'''[https://wiki.tripsit.me/images/d/d4/TripSitDrugComboChart-German.png German]'''

'''[http://wiki.tripsit.me/images/0/0c/Drug-combinations-fr.png French]'''

'''[https://wiki.tripsit.me/images/9/9e/TripSitDrugComboChart-Esperanto.png Esperanto]'''

Note: These below versions are *out of date*

'''[https://wiki.tripsit.me/images/5/5b/TripSitDrugComboChart-Portuguese.png Portuguese]'''

'''[https://wiki.tripsit.me/wiki/File:TripSitDrugComboChart-Polish.gif Polish]'''

== Specific Combinations ==
===cannabis & lsd===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & lsd===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & mushrooms===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & mushrooms===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & dmt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & dmt===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===5-meo-xxt & mescaline===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions

===cannabis & mescaline===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===cocaine & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===caffeine & mescaline===

Status: Low Risk & No Synergy

Note: High doses of caffeine are uncomfortable and this will be magnified by psychedelics

===tramadol & mescaline===

Status: Unsafe

Note: This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

===5-meo-xxt & dox===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

===cannabis & dox===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===ketamine & dox===

Status: Low Risk & Synergy

Note: Ketamine and psychedelics tend to potentiate each other - go slowly.

===mxe & dox===

Status: Caution

Note: As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense

===dxm & dox===

Status: Unsafe

Note: The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

===pcp & dox===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===amphetamines & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

===mdma & dox===

Status: Caution

Note: The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

===cocaine & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic

===caffeine & dox===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

===alcohol & dox===

Status: Low Risk & Decrease

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

===opioids & dox===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===tramadol & dox===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===maois & dox===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & nbomes===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided

===cannabis & nbomes===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===mxe & nbomes===

Status: Caution

Note: As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense

===amphetamines & nbomes===

Status: Unsafe

Note: Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

===cocaine & nbomes===

Status: Unsafe

Note: Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & nbomes===

Status: Caution

Note: Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping

===tramadol & nbomes===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures

===maois & nbomes===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-x===

Status: Caution

Note: The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics

===cannabis & 2c-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===cocaine & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===caffeine & 2c-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===tramadol & 2c-x===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

===maois & 2c-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-t-x===

Status: Caution

Note: Both classes of compounds can be unpredictable alone

===cannabis & 2c-t-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-t-x===

Status: Unsafe

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===cocaine & 2c-t-x===

Status: Unsafe

Note: Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & 2c-t-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & 2c-t-x===

Status: Low Risk & Decrease

Note: Both these classes of compound can interact unpredictably. Caution should be exercised.

===opioids & 2c-t-x===

Status: Low Risk & No Synergy

Note: No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

===maois & 2c-t-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series

===cannabis & amt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.

===caffeine & amt===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & amt===

Status: Caution

Note: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable

===opioids & amt===

Status: Low Risk & No Synergy

Note: No unexpected interactions

===maois & amt===

Status: Dangerous

Note: aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.

===mxe & 5-meo-xxt===

Status: Low Risk & Synergy

Note: Little information exists about this combination.

===dxm & 5-meo-xxt===

Status: Unsafe

Note: Little information exists about this combination.

===cannabis & 5-meo-xxt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===mdma & 5-meo-xxt===

Status: Caution

Note: Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care

===cocaine & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===caffeine & 5-meo-xxt===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===amphetamines & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===mdma & cannabis===

Status: Low Risk & Synergy

Note: Large amounts of cannabis may cause strong and somewhat unpredictable experiences in combination with MDMA. Cannabis should be saved for towards the end of the experience if possible.

===cocaine & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===alcohol & cannabis===

Status: Low Risk & Synergy

Note: In excess, this combination can cause nausea.

===amphetamines & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===mdma & ketamine===

Status: Low Risk & Synergy

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===cocaine & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===caffeine & ketamine===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===alcohol & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===ghb/gbl & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & ketamine===

Status: Dangerous

Note: Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===benzodiazepines & ketamine===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & ketamine===

Status: Caution

Note: MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===pcp & mxe===

Status: Caution

Note: There are no reports available about this combination

===amphetamines & mxe===

Status: Caution

Note: Risk of tachycardia, hypertension, and manic states

===mdma & mxe===

Status: Caution

Note: There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

===cocaine & mxe===

Status: Caution

Note: Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

===caffeine & mxe===

Status: Low Risk & No Synergy

Note: No likely interactions

===alcohol & mxe===

Status: Dangerous

Note: There is a high risk of memory loss, vomiting and severe ataxia from this combination.

===ghb/gbl & mxe===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & mxe===

Status: Dangerous

Note: This combination can potentiate the effects of the opioid

===benzodiazepines & mxe===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

===maois & mxe===

Status: Unsafe

Note: MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===ssris & mxe===

Status: Caution

Note: Depending on the SSRI this combination can be unpredictable

===amphetamines & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

===cocaine & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues

===caffeine & dxm===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & dxm===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

===ghb/gbl & dxm===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict

===opioids & dxm===

Status: Dangerous

Note: CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

===benzodiazepines & dxm===

Status: Caution

Note: Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome

===ssris & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome.

===amphetamines & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===mdma & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===cocaine & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===caffeine & pcp===

Status: Caution

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===ghb/gbl & pcp===

Status: Dangerous

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===opioids & pcp===

Status: Caution

Note: PCP can reduce opioid tolerance, increasing the risk of overdose

===benzodiazepines & pcp===

Status: Unsafe

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely

===maois & pcp===

Status: Dangerous

Note: This combination is very poorly explored

===ssris & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===ghb/gbl & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===opioids & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===tramadol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===mdma & amphetamines===

Status: Low Risk & Synergy

Note: Amphetamines increase the neurotoxic effects of MDMA

===cocaine & amphetamines===

Status: Caution

Note: This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine

===caffeine & amphetamines===

Status: Caution

Note: This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

===alcohol & amphetamines===

Status: Caution

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

===ghb/gbl & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===opioids & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & amphetamines===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===benzodiazepines & amphetamines===

Status: Low Risk & Decrease

Note: Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction

===maois & amphetamines===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.

===cocaine & mdma===

Status: Caution

Note: Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

===caffeine & mdma===

Status: Caution

Note: Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA

===alcohol & mdma===

Status: Caution

Note: Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA

===ghb/gbl & mdma===

Status: Caution

Note: Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.

===tramadol & mdma===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & mdma===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.

===caffeine & cocaine===

Status: Caution

Note: Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

===alcohol & cocaine===

Status: Unsafe

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

===ghb/gbl & cocaine===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind

===opioids & cocaine===

Status: Dangerous

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & cocaine===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & cocaine===

Status: Dangerous

Note: This combination is poorly explored

===ssris & cocaine===

Status: Low Risk & No Synergy

Note: May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.

===ghb/gbl & alcohol===

Status: Dangerous

Note: Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

===opioids & alcohol===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely

===tramadol & alcohol===

Status: Dangerous

Note: Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

===benzodiazepines & alcohol===

Status: Dangerous

Note: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

===maois & alcohol===

Status: Unsafe

Note: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

===ssris & alcohol===

Status: Caution

Note: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

===opioids & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position

===tramadol & ghb/gbl===

Status: Dangerous

Note: The sedative effects of this combination can lead to dangerous respiratory depression.

===benzodiazepines & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===tramadol & opioids===

Status: Dangerous

Note: Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present

===benzodiazepines & opioids===

Status: Dangerous

Note: Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely

===maois & opioids===

Status: Caution

Note: Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

===ssris & opioids===

Status: Low Risk & No Synergy

Note: There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.

===benzodiazepines & tramadol===

Status: Dangerous

Note: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

--

=== LSD & Mushrooms ===
=== LSD & DMT ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Mescaline ===
=== LSD & DOx ===
=== LSD & NBOMes ===
=== LSD & 2C-x ===
=== LSD & 2C-T-x ===
=== LSD & αMT ===
=== LSD & 5-MeO-xxT ===
=== LSD & Cannabis ===
=== LSD & Ketamine ===
=== LSD & MXE ===
=== LSD & DXM ===
=== LSD & Nitrous ===
=== LSD & Amphetamines ===
=== LSD & MDMA ===
=== LSD & Cocaine ===
=== LSD & Caffeine ===
=== LSD & Alcohol ===
=== LSD & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== LSD & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/547279

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* "Low doses antagonized the effects of both hallucinogens, whereas larger doses enhanced their effects."

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== LSD & Benzodiazepines ===
=== LSD & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/8788508

* http://www.ncbi.nlm.nih.gov/pubmed/108709

* https://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=2439&DocPartID=2199

=== LSD & SSRIs ===
* http://www.nature.com/npp/journal/v14/n6/full/1380431a.html

* http://www.ncbi.nlm.nih.gov/pubmed/8726753

=== Mushrooms & DMT ===
=== Mushrooms & Mescaline ===
=== Mushrooms & DOx ===
=== Mushrooms & NBOMes ===
=== Mushrooms & 2C-x ===
=== Mushrooms & 2C-T-x ===
=== Mushrooms & αMT ===
=== Mushrooms & 5-MeO-xxT ===
=== Mushrooms & Cannabis ===
=== Mushrooms & Ketamine ===
=== Mushrooms & MXE ===
=== Mushrooms & DXM ===
=== Mushrooms & Nitrous ===
=== Mushrooms & Amphetamines ===
=== Mushrooms & MDMA ===
=== Mushrooms & Cocaine ===
=== Mushrooms & Caffeine ===
=== Mushrooms & Alcohol ===
=== Mushrooms & GHB\GBL ===
=== Mushrooms & Opioids ===
=== Mushrooms & Tramadol ===
=== Mushrooms & Benzodiazepines ===
=== Mushrooms & MAOIs ===
=== Mushrooms & SSRIs ===
=== DMT & Mescaline ===
=== DMT & DOx ===
=== DMT & NBOMes ===
=== DMT & 2C-x ===
=== DMT & 2C-T-x ===
=== DMT & αMT ===
=== DMT & 5-MeO-xxT ===
=== DMT & Cannabis ===
=== DMT & Ketamine ===
=== DMT & MXE ===
=== DMT & DXM ===
=== DMT & Nitrous ===
=== DMT & Amphetamines ===
=== DMT & MDMA ===
=== DMT & Cocaine ===
=== DMT & Caffeine ===
=== DMT & Alcohol ===
=== DMT & GHB\GBL ===
=== DMT & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Benzodiazepines ===
=== DMT & MAOIs ===
=== DMT & SSRIs ===
=== Mescaline & DOx ===
=== Mescaline & NBOMes ===
=== Mescaline & 2C-x ===
=== Mescaline & 2C-T-x ===
=== Mescaline & αMT ===
=== Mescaline & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions.

=== Mescaline & Cannabis ===
=== Mescaline & Ketamine ===
=== Mescaline & MXE ===
=== Mescaline & DXM ===
=== Mescaline & Nitrous ===
=== Mescaline & Amphetamines ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & MDMA ===
=== Mescaline & Cocaine ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & Caffeine ===
* High doses of caffeine are uncomfortable and this will be magnified by psychedelics.

=== Mescaline & Alcohol ===
=== Mescaline & GHB\GBL ===
=== Mescaline & Opioids ===
=== Mescaline & Tramadol ===
* This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

=== Mescaline & Benzodiazepines ===
=== Mescaline & MAOIs ===
=== Mescaline & SSRIs ===
=== DOx & NBOMes ===
=== DOx & 2C-x ===
=== DOx & 2C-T-x ===
=== DOx & αMT ===
=== DOx & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

=== DOx & Cannabis ===
=== DOx & Ketamine ===
* Ketamine and psychedelics tend to potentiate each other - go slowly.

=== DOx & MXE ===
* As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense.

=== DOx & DXM ===
* The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

=== DOx & Nitrous ===
=== DOx & Amphetamines ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

* http://www.ncbi.nlm.nih.gov/pubmed/1208759

=== DOx & MDMA ===
* The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

=== DOx & Cocaine ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic.

=== DOx & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

=== DOx & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

=== DOx & GHB\GBL ===
=== DOx & Opioids ===
* No unexpected interactions.

=== DOx & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

=== DOx & Benzodiazepines ===
=== DOx & MAOIs ===
=== DOx & SSRIs ===
=== NBOMes & 2C-x ===
=== NBOMes & 2C-T-x ===
=== NBOMes & αMT ===
=== NBOMes & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided.

=== NBOMes & Cannabis ===
=== NBOMes & Ketamine ===
=== NBOMes & MXE ===
=== NBOMes & DXM ===
=== NBOMes & Nitrous ===
=== NBOMes & Amphetamines ===
* Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

=== NBOMes & MDMA ===
=== NBOMes & Cocaine ===
* Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

=== NBOMes & Caffeine ===
* Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping.

=== NBOMes & Alcohol ===
=== NBOMes & GHB\GBL ===
=== NBOMes & Opioids ===
=== NBOMes & Tramadol ===
* Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures.

=== NBOMes & Benzodiazepines ===
=== NBOMes & MAOIs ===
=== NBOMes & SSRIs ===
=== 2C-x & 2C-T-x ===
=== 2C-x & αMT ===
=== 2C-x & 5-MeO-xxT ===
* The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics.

=== 2C-x & Cannabis ===
=== 2C-x & Ketamine ===
=== 2C-x & MXE ===
=== 2C-x & DXM ===
=== 2C-x & Nitrous ===
=== 2C-x & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & MDMA ===
=== 2C-x & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-x & Alcohol ===
=== 2C-x & GHB\GBL ===
=== 2C-x & Opioids ===
=== 2C-x & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

=== 2C-x & Benzodiazepines ===
=== 2C-x & MAOIs ===
=== 2C-x & SSRIs ===
=== 2C-T-x & αMT ===
=== 2C-T-x & 5-MeO-xxT ===
=== 2C-T-x & Cannabis ===
=== 2C-T-x & Ketamine ===
=== 2C-T-x & MXE ===
=== 2C-T-x & DXM ===
=== 2C-T-x & Nitrous ===
=== 2C-T-x & Amphetamines ===
=== 2C-T-x & MDMA ===
=== 2C-T-x & Cocaine ===
=== 2C-T-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-T-x & Alcohol ===
* Both these classes of compound can interact unpredictably. Caution should be exercised.

=== 2C-T-x & GHB\GBL ===
=== 2C-T-x & Opioids ===
* No expected interactions, some Opioids have Serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

=== 2C-T-x & Tramadol ===
=== 2C-T-x & Benzodiazepines ===
=== 2C-T-x & MAOIs ===
=== 2C-T-x & SSRIs ===
=== αMT & 5-MeO-xxT ===
=== αMT & Cannabis ===
=== αMT & Ketamine ===
=== αMT & MXE ===
=== αMT & DXM ===
=== αMT & Nitrous ===
=== αMT & Amphetamines ===
=== αMT & MDMA ===
=== αMT & Cocaine ===
=== αMT & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== αMT & Alcohol ===
* αMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable.

=== αMT & GHB\GBL ===
=== αMT & Opioids ===
* No unexpected interactions

=== αMT & Tramadol ===
=== αMT & Benzodiazepines ===
=== αMT & MAOIs ===
=== αMT & SSRIs ===
=== 5-MeO-xxT & Cannabis ===
=== 5-MeO-xxT & Ketamine ===
=== 5-MeO-xxT & MXE ===
=== 5-MeO-xxT & DXM ===
=== 5-MeO-xxT & Nitrous ===
=== 5-MeO-xxT & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & MDMA ===
* Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care.

=== 5-MeO-xxT & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & Caffeine ===
=== 5-MeO-xxT & Alcohol ===
=== 5-MeO-xxT & GHB\GBL ===
=== 5-MeO-xxT & Opioids ===
=== 5-MeO-xxT & Tramadol ===
=== 5-MeO-xxT & Benzodiazepines ===
=== 5-MeO-xxT & MAOIs ===
=== 5-MeO-xxT & SSRIs ===
=== Cannabis & Ketamine ===
=== Cannabis & MXE ===
=== Cannabis & DXM ===
=== Cannabis & Nitrous ===
=== Cannabis & Amphetamines ===
=== Cannabis & MDMA ===
=== Cannabis & Cocaine ===
=== Cannabis & Caffeine ===
=== Cannabis & Alcohol ===
=== Cannabis & GHB\GBL ===
=== Cannabis & Opioids ===
=== Cannabis & Tramadol ===
=== Cannabis & Benzodiazepines ===
=== Cannabis & MAOIs ===
=== Cannabis & SSRIs ===
=== Ketamine & MXE ===
=== Ketamine & DXM ===
=== Ketamine & Nitrous ===
=== Ketamine & Amphetamines ===
* Amphetamine worsens Ketamines ataxia.

* http://www.ncbi.nlm.nih.gov/pubmed/23660488

=== Ketamine & MDMA ===
=== Ketamine & Cocaine ===
=== Ketamine & Caffeine ===
* No unexpected interactions.

* http://onlinelibrary.wiley.com/doi/10.1111/j.1742-7843.2009.00382.x/full

=== Ketamine & Alcohol ===
* Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://onlinelibrary.wiley.com/doi/10.1002/jemt.22045/abstract

=== Ketamine & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== Ketamine & Opioids ===
* Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/21224020

=== Ketamine & Tramadol ===
* No unexpected interactions.

=== Ketamine & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== Ketamine & MAOIs ===
=== Ketamine & SSRIs ===
=== MXE & DXM ===
* http://i.imgur.com/zmqaw.jpg

* http://www.sciencedirect.com/science/article/pii/S0014488607002543

=== MXE & Nitrous ===
=== MXE & Amphetamines ===
* Risk of tachycardia, hypertension, and manic states.

* http://www.ncbi.nlm.nih.gov/pubmed/25060403

=== MXE & MDMA ===
* There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

=== MXE & Cocaine ===
* Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

=== MXE & Caffeine ===
* No likely interactions.

=== MXE & Alcohol ===
* There is a high risk of memory loss, vomiting and severe ataxia from this combination.

=== MXE & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

=== MXE & Opioids ===
* This combination can potentiate the effects of the opioid.

=== MXE & Tramadol ===
=== MXE & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

=== MXE & MAOIs ===
=== MXE & SSRIs ===
* Depending on the SSRI this combination can be unpredictable.

=== DXM & Nitrous ===
=== DXM & Amphetamines ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & MDMA ===
=== DXM & Cocaine ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== DXM & Alcohol ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

=== DXM & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict.

=== DXM & Opioids ===
* CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally, there is a reverse cross tolerance between opiates/dxm. I.E. if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

=== DXM & Tramadol ===
=== DXM & Benzodiazepines ===
* Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== DXM & MAOIs ===
* High risk of serotonin syndrome.

=== DXM & SSRIs ===
* High risk of serotonin syndrome.

=== Nitrous & Amphetamines ===
=== Nitrous & MDMA ===
=== Nitrous & Cocaine ===
=== Nitrous & Caffeine ===
=== Nitrous & Alcohol ===
* This combination can lead to vomiting.

=== Nitrous & GHB\GBL ===
=== Nitrous & Opioids ===
=== Nitrous & Tramadol ===
=== Nitrous & Benzodiazepines ===
=== Nitrous & MAOIs ===
=== Nitrous & SSRIs ===
=== Amphetamines & MDMA ===
* Amphetamines increase the neurotoxic effects of MDMA.

=== Amphetamines & Cocaine ===
* This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine.

=== Amphetamines & Caffeine ===
* This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

=== Amphetamines & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

=== Amphetamines & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Amphetamines & Benzodiazepines ===
* http://www.ncbi.nlm.nih.gov/pubmed/17320309

=== Amphetamines & MAOIs ===
=== Amphetamines & SSRIs ===
=== MDMA & Cocaine ===
* Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

=== MDMA & Caffeine ===
* Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492978/

* http://link.springer.com/article/10.1007/s00213-010-1864-1

* http://www.sciencedirect.com/science/article/pii/S0028390805003114

* http://www.ncbi.nlm.nih.gov/pubmed/24211539

=== MDMA & Alcohol ===
* Both MDMA and alcohol cause severe dehydration. Approach this combination with caution, moderation and sufficient hydration.

* http://www.ncbi.nlm.nih.gov/pubmed/21040238

* http://www.ncbi.nlm.nih.gov/pubmed/21756931

=== MDMA & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16234132

* http://www.ncbi.nlm.nih.gov/pubmed/22554869

* http://www.ncbi.nlm.nih.gov/pubmed/20730418

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== MDMA & Opioids ===
=== MDMA & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== MDMA & Benzodiazepines ===
=== MDMA & MAOIs ===
=== MDMA & SSRIs ===
=== Cocaine & Caffeine ===
* Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

=== Cocaine & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel he alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

=== Cocaine & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.

=== Cocaine & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Cocaine & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Cocaine & Benzodiazepines ===
=== Cocaine & MAOIs ===
=== Cocaine & SSRIs ===
* Risk of serotonin syndrome, Likely to make the SSRI's innefective with regular cocaine use. The SSRIs may also make the cocaine less effective. Mental stability and cocaine don't go together.

* http://www.ncbi.nlm.nih.gov/pubmed/23761390

* http://www.ncbi.nlm.nih.gov/pubmed/20195220

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377381

=== Caffeine & Alcohol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20001110

=== Caffeine & GHB\GBL ===
=== Caffeine & Opioids ===
=== Caffeine & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20837047

=== Caffeine & Benzodiazepines ===
=== Caffeine & MAOIs ===
=== Caffeine & SSRIs ===
* http://journals.lww.com/jpharmacogenetics/abstract/1996/06000/a_fluvoxamine_caffeine_interaction_study.3.aspx

=== Alcohol & GHB\GBL ===
* Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

* http://www.ncbi.nlm.nih.gov/pubmed/15274975

=== Alcohol & Opioids ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Tramadol ===
* Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Benzodiazepines ===
* Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

=== Alcohol & MAOIs ===
* The chemical tyramine in alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

=== Alcohol & SSRIs ===
* Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

* http://www.ncbi.nlm.nih.gov/pubmed/15739105

=== GHB\GBL & Opioids ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Tramadol ===
* The sedative effects of this combination can lead to dangerous respiratory depression.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Benzodiazepines ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== GHB\GBL & MAOIs ===
* No study, but MAO B inhibitors should enhance the effects, no interaction with MAO A.

=== GHB\GBL & SSRIs ===
=== Opioids & Tramadol ===
* Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.

=== Opioids & Benzodiazepines ===
* Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/

=== Opioids & MAOIs ===
* Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

* http://www.ncbi.nlm.nih.gov/pubmed/17157368 (?)

* http://www.ncbi.nlm.nih.gov/pubmed/2891392

* http://www.if-pan.krakow.pl/pjp/pdf/2013/3_593.pdf

=== Opioids & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/23391344

* http://www.ncbi.nlm.nih.gov/pubmed/20513454

* http://www.ncbi.nlm.nih.gov/pubmed/16005413

* http://www.ncbi.nlm.nih.gov/pubmed/18676387

* http://www.ncbi.nlm.nih.gov/pubmed/17381671

=== Tramadol & Benzodiazepines ===
* Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

* http://www.ncbi.nlm.nih.gov/pubmed/12842359

=== Tramadol & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/16051647

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Tramadol & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Benzodiazepines & MAOIs ===
=== Benzodiazepines & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446479/

* http://www.ncbi.nlm.nih.gov/pubmed/9435993

=== MAOIs & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/24577320

[[Category:Guides]]

Drug combinations

2016-08-11T23:27:51Z

Borax: /* Amphetamines & SSRIs */

'''WARNING! For educational purposes: We do not endorse any of these combinations. This page will always be 'work in progress'. It is extremely important to be safe at all times! See below the graphic for important information regarding specific combinations.'''

[[File:Combo_2.png|1000px|center]]

== Overview ==
If you want to give us some feedback/recommendation/comment on the chart, you can contact us:

[http://chat.tripsit.me/?nick=AskContent?#content Join #content channel on IRC]

Email: '''content@tripsit.me'''.

== Categorisations ==

''Low Risk & Synergy'' - These drugs work together to cause an effect greater than the sum of its parts, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before combining drugs.

''Low Risk & No Synergy'' - Effects are just additive. The combination is unlikely to cause any adverse or undesirable reaction beyond those that might ordinarily be expected from these drugs.

''Caution'' - These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.

''Unsafe'' - There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

''Dangerous'' - These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

== Chart versions ==

'''[https://wiki.tripsit.me/images/3/3f/TripSitDrugComboChart-Spanish.png Spanish]'''

'''[https://wiki.tripsit.me/images/d/d4/TripSitDrugComboChart-German.png German]'''

'''[http://wiki.tripsit.me/images/0/0c/Drug-combinations-fr.png French]'''

'''[https://wiki.tripsit.me/images/9/9e/TripSitDrugComboChart-Esperanto.png Esperanto]'''

Note: These below versions are *out of date*

'''[https://wiki.tripsit.me/images/5/5b/TripSitDrugComboChart-Portuguese.png Portuguese]'''

'''[https://wiki.tripsit.me/wiki/File:TripSitDrugComboChart-Polish.gif Polish]'''

== Specific Combinations ==
===cannabis & lsd===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & lsd===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & lsd===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & mushrooms===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & mushrooms===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & mushrooms===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===cannabis & dmt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===cocaine & dmt===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===tramadol & dmt===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===5-meo-xxt & mescaline===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions

===cannabis & mescaline===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===cocaine & mescaline===

Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

===caffeine & mescaline===

Status: Low Risk & No Synergy

Note: High doses of caffeine are uncomfortable and this will be magnified by psychedelics

===tramadol & mescaline===

Status: Unsafe

Note: This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

===5-meo-xxt & dox===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

===cannabis & dox===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===ketamine & dox===

Status: Low Risk & Synergy

Note: Ketamine and psychedelics tend to potentiate each other - go slowly.

===mxe & dox===

Status: Caution

Note: As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense

===dxm & dox===

Status: Unsafe

Note: The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

===pcp & dox===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===amphetamines & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

===mdma & dox===

Status: Caution

Note: The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

===cocaine & dox===

Status: Unsafe

Note: The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic

===caffeine & dox===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

===alcohol & dox===

Status: Low Risk & Decrease

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

===opioids & dox===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===tramadol & dox===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

===maois & dox===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & nbomes===

Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided

===cannabis & nbomes===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===mxe & nbomes===

Status: Caution

Note: As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense

===amphetamines & nbomes===

Status: Unsafe

Note: Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

===cocaine & nbomes===

Status: Unsafe

Note: Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & nbomes===

Status: Caution

Note: Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping

===tramadol & nbomes===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures

===maois & nbomes===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-x===

Status: Caution

Note: The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics

===cannabis & 2c-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===cocaine & 2c-x===

Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

===caffeine & 2c-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===tramadol & 2c-x===

Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

===maois & 2c-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

===5-meo-xxt & 2c-t-x===

Status: Caution

Note: Both classes of compounds can be unpredictable alone

===cannabis & 2c-t-x===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 2c-t-x===

Status: Unsafe

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===cocaine & 2c-t-x===

Status: Unsafe

Note: Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

===caffeine & 2c-t-x===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & 2c-t-x===

Status: Low Risk & Decrease

Note: Both these classes of compound can interact unpredictably. Caution should be exercised.

===opioids & 2c-t-x===

Status: Low Risk & No Synergy

Note: No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

===maois & 2c-t-x===

Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series

===cannabis & amt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.

===caffeine & amt===

Status: Caution

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & amt===

Status: Caution

Note: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable

===opioids & amt===

Status: Low Risk & No Synergy

Note: No unexpected interactions

===maois & amt===

Status: Dangerous

Note: aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.

===mxe & 5-meo-xxt===

Status: Low Risk & Synergy

Note: Little information exists about this combination.

===dxm & 5-meo-xxt===

Status: Unsafe

Note: Little information exists about this combination.

===cannabis & 5-meo-xxt===

Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

===amphetamines & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===mdma & 5-meo-xxt===

Status: Caution

Note: Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care

===cocaine & 5-meo-xxt===

Status: Unsafe

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

===caffeine & 5-meo-xxt===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===amphetamines & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===mdma & cannabis===

Status: Low Risk & Synergy

Note: Large amounts of cannabis may cause strong and somewhat unpredictable experiences in combination with MDMA. Cannabis should be saved for towards the end of the experience if possible.

===cocaine & cannabis===

Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

===alcohol & cannabis===

Status: Low Risk & Synergy

Note: In excess, this combination can cause nausea.

===amphetamines & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===mdma & ketamine===

Status: Low Risk & Synergy

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===cocaine & ketamine===

Status: Caution

Note: No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.

===caffeine & ketamine===

Status: Low Risk & No Synergy

Note: No unexpected interactions.

===alcohol & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===ghb/gbl & ketamine===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & ketamine===

Status: Dangerous

Note: Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===benzodiazepines & ketamine===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & ketamine===

Status: Caution

Note: MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===pcp & mxe===

Status: Caution

Note: There are no reports available about this combination

===amphetamines & mxe===

Status: Caution

Note: Risk of tachycardia, hypertension, and manic states

===mdma & mxe===

Status: Caution

Note: There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

===cocaine & mxe===

Status: Caution

Note: Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

===caffeine & mxe===

Status: Low Risk & No Synergy

Note: No likely interactions

===alcohol & mxe===

Status: Dangerous

Note: There is a high risk of memory loss, vomiting and severe ataxia from this combination.

===ghb/gbl & mxe===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

===opioids & mxe===

Status: Dangerous

Note: This combination can potentiate the effects of the opioid

===benzodiazepines & mxe===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

===maois & mxe===

Status: Unsafe

Note: MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available

===ssris & mxe===

Status: Caution

Note: Depending on the SSRI this combination can be unpredictable

===amphetamines & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

===cocaine & dxm===

Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues

===caffeine & dxm===

Status: Low Risk & No Synergy

Note: High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

===alcohol & dxm===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

===ghb/gbl & dxm===

Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict

===opioids & dxm===

Status: Dangerous

Note: CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

===benzodiazepines & dxm===

Status: Caution

Note: Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===maois & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome

===ssris & dxm===

Status: Dangerous

Note: High risk of serotonin syndrome.

===amphetamines & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===mdma & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===cocaine & pcp===

Status: Unsafe

Note: This combination can easily lead to hypermanic states

===caffeine & pcp===

Status: Caution

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===ghb/gbl & pcp===

Status: Dangerous

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===opioids & pcp===

Status: Caution

Note: PCP can reduce opioid tolerance, increasing the risk of overdose

===benzodiazepines & pcp===

Status: Unsafe

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely

===maois & pcp===

Status: Dangerous

Note: This combination is very poorly explored

===ssris & pcp===

Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

===alcohol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===ghb/gbl & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===opioids & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===tramadol & nitrous===

Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.

===mdma & amphetamines===

Status: Low Risk & Synergy

Note: Amphetamines increase the neurotoxic effects of MDMA

===cocaine & amphetamines===

Status: Caution

Note: This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine

===caffeine & amphetamines===

Status: Caution

Note: This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

===alcohol & amphetamines===

Status: Caution

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

===ghb/gbl & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===opioids & amphetamines===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & amphetamines===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===benzodiazepines & amphetamines===

Status: Low Risk & Decrease

Note: Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction

===maois & amphetamines===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.

===cocaine & mdma===

Status: Caution

Note: Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

===caffeine & mdma===

Status: Caution

Note: Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA

===alcohol & mdma===

Status: Caution

Note: Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA

===ghb/gbl & mdma===

Status: Caution

Note: Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.

===tramadol & mdma===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & mdma===

Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.

===caffeine & cocaine===

Status: Caution

Note: Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

===alcohol & cocaine===

Status: Unsafe

Note: Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

===ghb/gbl & cocaine===

Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind

===opioids & cocaine===

Status: Dangerous

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

===tramadol & cocaine===

Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

===maois & cocaine===

Status: Dangerous

Note: This combination is poorly explored

===ssris & cocaine===

Status: Low Risk & No Synergy

Note: May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.

===ghb/gbl & alcohol===

Status: Dangerous

Note: Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

===opioids & alcohol===

Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely

===tramadol & alcohol===

Status: Dangerous

Note: Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

===benzodiazepines & alcohol===

Status: Dangerous

Note: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

===maois & alcohol===

Status: Unsafe

Note: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

===ssris & alcohol===

Status: Caution

Note: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

===opioids & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position

===tramadol & ghb/gbl===

Status: Dangerous

Note: The sedative effects of this combination can lead to dangerous respiratory depression.

===benzodiazepines & ghb/gbl===

Status: Dangerous

Note: The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

===tramadol & opioids===

Status: Dangerous

Note: Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present

===benzodiazepines & opioids===

Status: Dangerous

Note: Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely

===maois & opioids===

Status: Caution

Note: Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

===ssris & opioids===

Status: Low Risk & No Synergy

Note: There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.

===benzodiazepines & tramadol===

Status: Dangerous

Note: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

--

=== LSD & Mushrooms ===
=== LSD & DMT ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Mescaline ===
=== LSD & DOx ===
=== LSD & NBOMes ===
=== LSD & 2C-x ===
=== LSD & 2C-T-x ===
=== LSD & αMT ===
=== LSD & 5-MeO-xxT ===
=== LSD & Cannabis ===
=== LSD & Ketamine ===
=== LSD & MXE ===
=== LSD & DXM ===
=== LSD & Nitrous ===
=== LSD & Amphetamines ===
=== LSD & MDMA ===
=== LSD & Cocaine ===
=== LSD & Caffeine ===
=== LSD & Alcohol ===
=== LSD & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== LSD & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/547279

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* "Low doses antagonized the effects of both hallucinogens, whereas larger doses enhanced their effects."

* http://www.ncbi.nlm.nih.gov/pubmed/3006089

* http://deepblue.lib.umich.edu/bitstream/handle/2027.42/26285/0000370.pdf

=== LSD & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== LSD & Benzodiazepines ===
=== LSD & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/8788508

* http://www.ncbi.nlm.nih.gov/pubmed/108709

* https://www.erowid.org/references/refs_view.php?A=ShowDocPartFrame&ID=2439&DocPartID=2199

=== LSD & SSRIs ===
* http://www.nature.com/npp/journal/v14/n6/full/1380431a.html

* http://www.ncbi.nlm.nih.gov/pubmed/8726753

=== Mushrooms & DMT ===
=== Mushrooms & Mescaline ===
=== Mushrooms & DOx ===
=== Mushrooms & NBOMes ===
=== Mushrooms & 2C-x ===
=== Mushrooms & 2C-T-x ===
=== Mushrooms & αMT ===
=== Mushrooms & 5-MeO-xxT ===
=== Mushrooms & Cannabis ===
=== Mushrooms & Ketamine ===
=== Mushrooms & MXE ===
=== Mushrooms & DXM ===
=== Mushrooms & Nitrous ===
=== Mushrooms & Amphetamines ===
=== Mushrooms & MDMA ===
=== Mushrooms & Cocaine ===
=== Mushrooms & Caffeine ===
=== Mushrooms & Alcohol ===
=== Mushrooms & GHB\GBL ===
=== Mushrooms & Opioids ===
=== Mushrooms & Tramadol ===
=== Mushrooms & Benzodiazepines ===
=== Mushrooms & MAOIs ===
=== Mushrooms & SSRIs ===
=== DMT & Mescaline ===
=== DMT & DOx ===
=== DMT & NBOMes ===
=== DMT & 2C-x ===
=== DMT & 2C-T-x ===
=== DMT & αMT ===
=== DMT & 5-MeO-xxT ===
=== DMT & Cannabis ===
=== DMT & Ketamine ===
=== DMT & MXE ===
=== DMT & DXM ===
=== DMT & Nitrous ===
=== DMT & Amphetamines ===
=== DMT & MDMA ===
=== DMT & Cocaine ===
=== DMT & Caffeine ===
=== DMT & Alcohol ===
=== DMT & GHB\GBL ===
=== DMT & Opioids ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/3006089

=== DMT & Benzodiazepines ===
=== DMT & MAOIs ===
=== DMT & SSRIs ===
=== Mescaline & DOx ===
=== Mescaline & NBOMes ===
=== Mescaline & 2C-x ===
=== Mescaline & 2C-T-x ===
=== Mescaline & αMT ===
=== Mescaline & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions.

=== Mescaline & Cannabis ===
=== Mescaline & Ketamine ===
=== Mescaline & MXE ===
=== Mescaline & DXM ===
=== Mescaline & Nitrous ===
=== Mescaline & Amphetamines ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & MDMA ===
=== Mescaline & Cocaine ===
* The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops.

=== Mescaline & Caffeine ===
* High doses of caffeine are uncomfortable and this will be magnified by psychedelics.

=== Mescaline & Alcohol ===
=== Mescaline & GHB\GBL ===
=== Mescaline & Opioids ===
=== Mescaline & Tramadol ===
* This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

=== Mescaline & Benzodiazepines ===
=== Mescaline & MAOIs ===
=== Mescaline & SSRIs ===
=== DOx & NBOMes ===
=== DOx & 2C-x ===
=== DOx & 2C-T-x ===
=== DOx & αMT ===
=== DOx & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

=== DOx & Cannabis ===
=== DOx & Ketamine ===
* Ketamine and psychedelics tend to potentiate each other - go slowly.

=== DOx & MXE ===
* As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense.

=== DOx & DXM ===
* The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.

=== DOx & Nitrous ===
=== DOx & Amphetamines ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic.

* http://www.ncbi.nlm.nih.gov/pubmed/1208759

=== DOx & MDMA ===
* The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic.

=== DOx & Cocaine ===
* The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic.

=== DOx & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.

=== DOx & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk.

=== DOx & GHB\GBL ===
=== DOx & Opioids ===
* No unexpected interactions.

=== DOx & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

=== DOx & Benzodiazepines ===
=== DOx & MAOIs ===
=== DOx & SSRIs ===
=== NBOMes & 2C-x ===
=== NBOMes & 2C-T-x ===
=== NBOMes & αMT ===
=== NBOMes & 5-MeO-xxT ===
* The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided.

=== NBOMes & Cannabis ===
=== NBOMes & Ketamine ===
=== NBOMes & MXE ===
=== NBOMes & DXM ===
=== NBOMes & Nitrous ===
=== NBOMes & Amphetamines ===
* Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.

=== NBOMes & MDMA ===
=== NBOMes & Cocaine ===
* Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

=== NBOMes & Caffeine ===
* Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping.

=== NBOMes & Alcohol ===
=== NBOMes & GHB\GBL ===
=== NBOMes & Opioids ===
=== NBOMes & Tramadol ===
* Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures.

=== NBOMes & Benzodiazepines ===
=== NBOMes & MAOIs ===
=== NBOMes & SSRIs ===
=== 2C-x & 2C-T-x ===
=== 2C-x & αMT ===
=== 2C-x & 5-MeO-xxT ===
* The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics.

=== 2C-x & Cannabis ===
=== 2C-x & Ketamine ===
=== 2C-x & MXE ===
=== 2C-x & DXM ===
=== 2C-x & Nitrous ===
=== 2C-x & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & MDMA ===
=== 2C-x & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

=== 2C-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-x & Alcohol ===
=== 2C-x & GHB\GBL ===
=== 2C-x & Opioids ===
=== 2C-x & Tramadol ===
* Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

=== 2C-x & Benzodiazepines ===
=== 2C-x & MAOIs ===
=== 2C-x & SSRIs ===
=== 2C-T-x & αMT ===
=== 2C-T-x & 5-MeO-xxT ===
=== 2C-T-x & Cannabis ===
=== 2C-T-x & Ketamine ===
=== 2C-T-x & MXE ===
=== 2C-T-x & DXM ===
=== 2C-T-x & Nitrous ===
=== 2C-T-x & Amphetamines ===
=== 2C-T-x & MDMA ===
=== 2C-T-x & Cocaine ===
=== 2C-T-x & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== 2C-T-x & Alcohol ===
* Both these classes of compound can interact unpredictably. Caution should be exercised.

=== 2C-T-x & GHB\GBL ===
=== 2C-T-x & Opioids ===
* No expected interactions, some Opioids have Serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.

=== 2C-T-x & Tramadol ===
=== 2C-T-x & Benzodiazepines ===
=== 2C-T-x & MAOIs ===
=== 2C-T-x & SSRIs ===
=== αMT & 5-MeO-xxT ===
=== αMT & Cannabis ===
=== αMT & Ketamine ===
=== αMT & MXE ===
=== αMT & DXM ===
=== αMT & Nitrous ===
=== αMT & Amphetamines ===
=== αMT & MDMA ===
=== αMT & Cocaine ===
=== αMT & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== αMT & Alcohol ===
* αMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable.

=== αMT & GHB\GBL ===
=== αMT & Opioids ===
* No unexpected interactions

=== αMT & Tramadol ===
=== αMT & Benzodiazepines ===
=== αMT & MAOIs ===
=== αMT & SSRIs ===
=== 5-MeO-xxT & Cannabis ===
=== 5-MeO-xxT & Ketamine ===
=== 5-MeO-xxT & MXE ===
=== 5-MeO-xxT & DXM ===
=== 5-MeO-xxT & Nitrous ===
=== 5-MeO-xxT & Amphetamines ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & MDMA ===
* Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care.

=== 5-MeO-xxT & Cocaine ===
* The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics.

=== 5-MeO-xxT & Caffeine ===
=== 5-MeO-xxT & Alcohol ===
=== 5-MeO-xxT & GHB\GBL ===
=== 5-MeO-xxT & Opioids ===
=== 5-MeO-xxT & Tramadol ===
=== 5-MeO-xxT & Benzodiazepines ===
=== 5-MeO-xxT & MAOIs ===
=== 5-MeO-xxT & SSRIs ===
=== Cannabis & Ketamine ===
=== Cannabis & MXE ===
=== Cannabis & DXM ===
=== Cannabis & Nitrous ===
=== Cannabis & Amphetamines ===
=== Cannabis & MDMA ===
=== Cannabis & Cocaine ===
=== Cannabis & Caffeine ===
=== Cannabis & Alcohol ===
=== Cannabis & GHB\GBL ===
=== Cannabis & Opioids ===
=== Cannabis & Tramadol ===
=== Cannabis & Benzodiazepines ===
=== Cannabis & MAOIs ===
=== Cannabis & SSRIs ===
=== Ketamine & MXE ===
=== Ketamine & DXM ===
=== Ketamine & Nitrous ===
=== Ketamine & Amphetamines ===
* Amphetamine worsens Ketamines ataxia.

* http://www.ncbi.nlm.nih.gov/pubmed/23660488

=== Ketamine & MDMA ===
=== Ketamine & Cocaine ===
=== Ketamine & Caffeine ===
* No unexpected interactions.

* http://onlinelibrary.wiley.com/doi/10.1111/j.1742-7843.2009.00382.x/full

=== Ketamine & Alcohol ===
* Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://onlinelibrary.wiley.com/doi/10.1002/jemt.22045/abstract

=== Ketamine & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== Ketamine & Opioids ===
* Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/21224020

=== Ketamine & Tramadol ===
* No unexpected interactions.

=== Ketamine & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== Ketamine & MAOIs ===
=== Ketamine & SSRIs ===
=== MXE & DXM ===
* http://i.imgur.com/zmqaw.jpg

* http://www.sciencedirect.com/science/article/pii/S0014488607002543

=== MXE & Nitrous ===
=== MXE & Amphetamines ===
* Risk of tachycardia, hypertension, and manic states.

* http://www.ncbi.nlm.nih.gov/pubmed/25060403

=== MXE & MDMA ===
* There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.

=== MXE & Cocaine ===
* Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

=== MXE & Caffeine ===
* No likely interactions.

=== MXE & Alcohol ===
* There is a high risk of memory loss, vomiting and severe ataxia from this combination.

=== MXE & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

=== MXE & Opioids ===
* This combination can potentiate the effects of the opioid.

=== MXE & Tramadol ===
=== MXE & Benzodiazepines ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

=== MXE & MAOIs ===
=== MXE & SSRIs ===
* Depending on the SSRI this combination can be unpredictable.

=== DXM & Nitrous ===
=== DXM & Amphetamines ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & MDMA ===
=== DXM & Cocaine ===
* Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

=== DXM & Caffeine ===
* High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.

=== DXM & Alcohol ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

=== DXM & GHB\GBL ===
* Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict.

=== DXM & Opioids ===
* CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally, there is a reverse cross tolerance between opiates/dxm. I.E. if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

=== DXM & Tramadol ===
=== DXM & Benzodiazepines ===
* Small doses of benzos can end a bad trip, but both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

=== DXM & MAOIs ===
* High risk of serotonin syndrome.

=== DXM & SSRIs ===
* High risk of serotonin syndrome.

=== Nitrous & Amphetamines ===
=== Nitrous & MDMA ===
=== Nitrous & Cocaine ===
=== Nitrous & Caffeine ===
=== Nitrous & Alcohol ===
* This combination can lead to vomiting.

=== Nitrous & GHB\GBL ===
=== Nitrous & Opioids ===
=== Nitrous & Tramadol ===
=== Nitrous & Benzodiazepines ===
=== Nitrous & MAOIs ===
=== Nitrous & SSRIs ===
=== Amphetamines & MDMA ===
* Amphetamines increase the neurotoxic effects of MDMA.

=== Amphetamines & Cocaine ===
* This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine.

=== Amphetamines & Caffeine ===
* This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.

=== Amphetamines & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.

=== Amphetamines & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Amphetamines & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Amphetamines & Benzodiazepines ===
* http://www.ncbi.nlm.nih.gov/pubmed/17320309

=== Amphetamines & MAOIs ===
=== Amphetamines & SSRIs ===

* Some literature reports indicate that this combination carries a risk of serotonin syndrome. In practice this appears to be incredibly rare but caution should be exercised as with all drug combinations as everyone is different.

=== MDMA & Cocaine ===
* Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

=== MDMA & Caffeine ===
* Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492978/

* http://link.springer.com/article/10.1007/s00213-010-1864-1

* http://www.sciencedirect.com/science/article/pii/S0028390805003114

* http://www.ncbi.nlm.nih.gov/pubmed/24211539

=== MDMA & Alcohol ===
* Both MDMA and alcohol cause severe dehydration. Approach this combination with caution, moderation and sufficient hydration.

* http://www.ncbi.nlm.nih.gov/pubmed/21040238

* http://www.ncbi.nlm.nih.gov/pubmed/21756931

=== MDMA & GHB\GBL ===
* http://www.ncbi.nlm.nih.gov/pubmed/16234132

* http://www.ncbi.nlm.nih.gov/pubmed/22554869

* http://www.ncbi.nlm.nih.gov/pubmed/20730418

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== MDMA & Opioids ===
=== MDMA & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== MDMA & Benzodiazepines ===
=== MDMA & MAOIs ===
=== MDMA & SSRIs ===
=== Cocaine & Caffeine ===
* Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

=== Cocaine & Alcohol ===
* Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel he alcohol less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

=== Cocaine & GHB\GBL ===
* Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind.

=== Cocaine & Opioids ===
* Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

=== Cocaine & Tramadol ===
* Tramadol and stimulants both increase the risk of seizures.

=== Cocaine & Benzodiazepines ===
=== Cocaine & MAOIs ===
=== Cocaine & SSRIs ===
* Risk of serotonin syndrome, Likely to make the SSRI's innefective with regular cocaine use. The SSRIs may also make the cocaine less effective. Mental stability and cocaine don't go together.

* http://www.ncbi.nlm.nih.gov/pubmed/23761390

* http://www.ncbi.nlm.nih.gov/pubmed/20195220

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377381

=== Caffeine & Alcohol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20001110

=== Caffeine & GHB\GBL ===
=== Caffeine & Opioids ===
=== Caffeine & Tramadol ===
* http://www.ncbi.nlm.nih.gov/pubmed/20837047

=== Caffeine & Benzodiazepines ===
=== Caffeine & MAOIs ===
=== Caffeine & SSRIs ===
* http://journals.lww.com/jpharmacogenetics/abstract/1996/06000/a_fluvoxamine_caffeine_interaction_study.3.aspx

=== Alcohol & GHB\GBL ===
* Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

* http://www.ncbi.nlm.nih.gov/pubmed/15274975

=== Alcohol & Opioids ===
* Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Tramadol ===
* Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

=== Alcohol & Benzodiazepines ===
* Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blacking out and memory loss is almost certain.

=== Alcohol & MAOIs ===
* The chemical tyramine in alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

=== Alcohol & SSRIs ===
* Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

* http://www.ncbi.nlm.nih.gov/pubmed/15739105

=== GHB\GBL & Opioids ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Tramadol ===
* The sedative effects of this combination can lead to dangerous respiratory depression.

* http://www.ncbi.nlm.nih.gov/pubmed/7782758

=== GHB\GBL & Benzodiazepines ===
* The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.

* http://www.ncbi.nlm.nih.gov/pubmed/16483730

=== GHB\GBL & MAOIs ===
* No study, but MAO B inhibitors should enhance the effects, no interaction with MAO A.

=== GHB\GBL & SSRIs ===
=== Opioids & Tramadol ===
* Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.

=== Opioids & Benzodiazepines ===
* Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position Blackouts/memory loss likely.

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/

=== Opioids & MAOIs ===
* Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

* http://www.ncbi.nlm.nih.gov/pubmed/17157368 (?)

* http://www.ncbi.nlm.nih.gov/pubmed/2891392

* http://www.if-pan.krakow.pl/pjp/pdf/2013/3_593.pdf

=== Opioids & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/23391344

* http://www.ncbi.nlm.nih.gov/pubmed/20513454

* http://www.ncbi.nlm.nih.gov/pubmed/16005413

* http://www.ncbi.nlm.nih.gov/pubmed/18676387

* http://www.ncbi.nlm.nih.gov/pubmed/17381671

=== Tramadol & Benzodiazepines ===
* Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.

* http://www.ncbi.nlm.nih.gov/pubmed/12842359

=== Tramadol & MAOIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/16051647

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Tramadol & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750095/

=== Benzodiazepines & MAOIs ===
=== Benzodiazepines & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446479/

* http://www.ncbi.nlm.nih.gov/pubmed/9435993

=== MAOIs & SSRIs ===
* http://www.ncbi.nlm.nih.gov/pubmed/24577320

[[Category:Guides]]

Test Kits

2016-02-02T17:25:30Z

Borax: /* Europe */ fixed typo

The vast majority of synthetic drugs are white powders. A reagent test kit is the only way you can safely attempt to verify the identity of a substance without expensive and complicated lab equipment. This article is an introduction to the various kinds of common test kits including a variety of worldwide sources. It should be noted that these test kits cannot measure the purity of a drug, only its presence. If you've got more than one drug in a powder, it's possible that a reagent test may show the presence of only one of the drugs.

A color change reference chart for the four main reagents can be found at [http://www.dancesafe.org/wp-content/uploads/2014/02/kit-instructions-back.jpg Dancesafe] ([http://i.imgur.com/0a9jBcd.jpg Imgur mirror]). Erowid.org also has a great [https://www.erowid.org/chemicals/mdma/mdma_faq_testing_kits.shtml Ecstasy Testing Kit FAQ.] United Nations Office on Drugs and Crime [http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1975-01-01_1_page008.html Field and laboratory tests results for raw and prepared opium.]

==Marquis Reagent==

Marquis' reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of formaldehyde and concentrated sulfuric acid, which is dripped onto the substance being tested. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95–98%) sulfuric acid to 5 mL of 40% formaldehyde.

===Canada===

* [http://testkitplus.ca/product/mdma-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/marquis-reagent/ QKTest]

===Europe===

* [http://www.eztestkits.com/en/ez-testing-kits/marquis10pack-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]
* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* [http://www.dancesafe.org/product/marquis-reagent-testing-kit/ Dancesafe]

==Mandelin Reagent==

The Mandelin reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of ammonium metavanadate and concentrated sulfuric acid. Its primary use is for the detection of ketamine and PMA. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95–98%) sulfuric acid to 1 g of ammonium vanadate.

====Canada====

* [http://testkitplus.ca/product/ketamine-pma-mandelin-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/mandelin-reagent/ QKTest]

===Europe===

* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!
* [http://www.eztestkits.com/en/ez-testing-kits/mandelin10-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]

===USA===

* [http://www.dancesafe.org/product/mandelin-reagent-testing-kit/ Dancesafe]

==Mecke Reagent==

The Mecke reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of selenious acid and concentrated sulfuric acid, which is dripped onto the substance being tested. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95-98%) sulfuric acid to 1 g of selenious acid.

====Canada====

* [http://testkitplus.ca/product/mecke-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/mecke-reagent/ QKTest]

===Europe===

* [http://www.eztestkits.com/en/ez-testing-kits/mecke10-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]

===USA===

* [http://www.dancesafe.org/product/mecke-reagent-testing-kit/ Dancesafe]

==Ehrlich's Reagent==

The Ehrlich's reagent is used as a simple spot-test to presumptively identify alkaloids. It is prepared by dissolving 0.5-2.0 g of p–dimethylaminobenzaldehyde (DMAB) in 50 mL of 95% ethanol and 50 mL of concentrated hydrochloric acid. It is best prepared fresh.

===Europe===

* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===Canada===

* [http://testkitplus.ca/product/lsd-test-kit/ TestKitPlus]

==Other==

===Australia===

* Marquis, Mandelin, Mecke, Simon 4-in-1 [http://ecstasypilltest.com/product/basic-ecstasy-test-kit/ Ecstasy Pill Test] (Also shipped worldwide)

===Canada===

* Marquis, Mandelin, Mecke 3-in-1: [http://testkitplus.ca/product/complete-screening-kit-marquis-mecke-mandelin/ TestKitPlus]
* Froehde, Simon's Reagent A & B, Ferric Chloride: [https://qktest.com/products-page/ QKTest]

===Europe===

* [http://www.eztest.com/ eztestkits]
* UK [http://www.safetest4.co.uk/ SafeTest4]
* [http://www.reagent-tests.uk/ Liebermann and Froehde - Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* Marquis, Mandelin, Mecke, Simon 4-in-1: [http://www.dancesafe.org/product/coomplete-adulterant-screening-kit/ Dancesafe]
* Simon's reagent - [http://www.dancesafe.org/product/simons-reagent-testing-kit/ Dancesafe]
* [http://www.copquest.com/43-2100_nik-narcotic-test-kits.htm CopQuest NIK Narcotic Test Kits]

[[Category:Guides]]

Test Kits

2016-02-02T17:24:16Z

Borax: added mandelin and changed wording for discount codes

The vast majority of synthetic drugs are white powders. A reagent test kit is the only way you can safely attempt to verify the identity of a substance without expensive and complicated lab equipment. This article is an introduction to the various kinds of common test kits including a variety of worldwide sources. It should be noted that these test kits cannot measure the purity of a drug, only its presence. If you've got more than one drug in a powder, it's possible that a reagent test may show the presence of only one of the drugs.

A color change reference chart for the four main reagents can be found at [http://www.dancesafe.org/wp-content/uploads/2014/02/kit-instructions-back.jpg Dancesafe] ([http://i.imgur.com/0a9jBcd.jpg Imgur mirror]). Erowid.org also has a great [https://www.erowid.org/chemicals/mdma/mdma_faq_testing_kits.shtml Ecstasy Testing Kit FAQ.] United Nations Office on Drugs and Crime [http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1975-01-01_1_page008.html Field and laboratory tests results for raw and prepared opium.]

==Marquis Reagent==

Marquis' reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of formaldehyde and concentrated sulfuric acid, which is dripped onto the substance being tested. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95–98%) sulfuric acid to 5 mL of 40% formaldehyde.

===Canada===

* [http://testkitplus.ca/product/mdma-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/marquis-reagent/ QKTest]

===Europe===

* [http://www.eztestkits.com/en/ez-testing-kits/marquis10pack-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]
* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* [http://www.dancesafe.org/product/marquis-reagent-testing-kit/ Dancesafe]

==Mandelin Reagent==

The Mandelin reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of ammonium metavanadate and concentrated sulfuric acid. Its primary use is for the detection of ketamine and PMA. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95–98%) sulfuric acid to 1 g of ammonium vanadate.

====Canada====

* [http://testkitplus.ca/product/ketamine-pma-mandelin-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/mandelin-reagent/ QKTest]

===Europe===

* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!
* [http://www.eztestkits.com/en/ez-testing-kits/mandelin10-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]

===USA===

* [http://www.dancesafe.org/product/mandelin-reagent-testing-kit/ Dancesafe]

==Mecke Reagent==

The Mecke reagent is used as a simple spot-test to presumptively identify alkaloids as well as other compounds. It is composed of a mixture of selenious acid and concentrated sulfuric acid, which is dripped onto the substance being tested. The United States Department of Justice method for producing the reagent is the addition of 100 mL of concentrated (95-98%) sulfuric acid to 1 g of selenious acid.

====Canada====

* [http://testkitplus.ca/product/mecke-test-kit/ TestKitPlus]
* [https://qktest.com/products-page/product-category/mecke-reagent/ QKTest]

===Europe===

* [http://www.eztestkits.com/en/ez-testing-kits/mecke10-ez-testing-kit eztestkits]
* [http://www.safetest4.co.uk/ SafeTest4]

===USA===

* [http://www.dancesafe.org/product/mecke-reagent-testing-kit/ Dancesafe]

==Ehrlich's Reagent==

The Ehrlich's reagent is used as a simple spot-test to presumptively identify alkaloids. It is prepared by dissolving 0.5-2.0 g of p–dimethylaminobenzaldehyde (DMAB) in 50 mL of 95% ethanol and 50 mL of concentrated hydrochloric acid. It is best prepared fresh.

===Europe===

* [http://www.reagent-tests.uk/ Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===Canada===

* [http://testkitplus.ca/product/lsd-test-kit/ TestKitPlus]

==Other==

===Australia===

* Marquis, Mandelin, Mecke, Simon 4-in-1 [http://ecstasypilltest.com/product/basic-ecstasy-test-kit/ Ecstasy Pill Test] (Also shipped worldwide)

===Canada===

* Marquis, Mandelin, Mecke 3-in-1: [http://testkitplus.ca/product/complete-screening-kit-marquis-mecke-mandelin/ TestKitPlus]
* Froehde, Simon's Reagent A & B, Ferric Chloride: [https://qktest.com/products-page/ QKTest]

===Europe===

* [http://www.eztest.com/ eztestkits]
* UK [http://www.safetest4.co.uk/ SafeTest4]
* Liebermann [http://www.reagent-tests.uk/ Liebermann and Froehde - Reagent Tests UK]
** Use 'tripsitwiki' for 10% off reagent test kits!

===USA===

* Marquis, Mandelin, Mecke, Simon 4-in-1: [http://www.dancesafe.org/product/coomplete-adulterant-screening-kit/ Dancesafe]
* Simon's reagent - [http://www.dancesafe.org/product/simons-reagent-testing-kit/ Dancesafe]
* [http://www.copquest.com/43-2100_nik-narcotic-test-kits.htm CopQuest NIK Narcotic Test Kits]

[[Category:Guides]]

Adderall

2015-05-15T16:15:06Z

Borax: GB != UK

[[File:Adderall.jpg|thumb|400px|Several 10mg Adderall IR pills]]
Adderall is a commonly prescribed stimulant to treat ADHD and ADD. Adderall is a 3:1 mixture of dextroamphetamine and levoamphetamine. Adderall is commonly found in two forms, IR and XR. IR is instant release, while XR is extended release. Adderall XR releases half of the dosage immediately, and the other half 4 hours later. Adderall, containing [[Amphetamine|amphetamine]], is exceedingly similar to other forms of the substance, though with Adderall the constitution and doses are known.

== History ==

Adderall was originally developed from an amphetamine blend drug called Obetrol, prescribed for obesity and weight loss. This drug was a mix of racemic amphetamine (dl-amphetamine), d-amphetamine, and racemic methamphetamine. This made sense, as it was for weight loss, so the peripheral effects of l-amphetamine were actually useful as an anorexic and as a thermogenic. It was later reformulated without the methamphetamine, but also without FDA approval. When Richwood Pharmaceuticals bought Rexar, the company making Obetrol, they rebranded the reformulated Obetrol (without the methamphetamine) as Adderall, and began marketing it for ADD/ADHD.

== Dosage ==

Adderall XR is extended release Around 50% of the dose is released instantly, the other half over the next four hours. Effects take a while to begin, and last much longer.

{| class="wikitable"
|+ Oral
|-
| Light || 5-15mg
|-
| Common || 15-40mg
|-
| Strong || 40-75mg
|-
| Heavy || 75-125+mg
|}

{| class="wikitable"
|+ Insufflated
|-
| Light || 5-10mg
|-
| Common || 10-30mg
|-
| Strong || 30-50mg
|-
| Heavy || 50-80+mg
|}

== Duration ==

{| class="wikitable"
|+ Oral
|-
| Onset || 15-30 minutes
|-
| Total (IR) || 2-4 hours
|-
| Total (XR) || 6-10 hours
|}

{| class="wikitable"
|+ Insufflated
|-
| Onset || 1-5 minutes
|-
| Total (IR) || 2-4 hours
|-
| Total (XR) || 6-10 hours
|}

== Effects ==

=== Positive ===

* Increased focus

* Abundance of energy

* Increased motivation

=== Negative ===

* Racing thoughts

* Reduced appetite

* Flushing of the face

* Increased body temperature

* Tachycardia (Elevated heart rate)

* Paranoia

* Insomnia

=== After effects ===

* Hangover

* Afterglow

* Restlessness

* Persisting stimulation (5-15 hours after last dose)

== Harm Reduction ==

* Avoid driving and operating heavy machinery

* Recommended time (pauses) between using the substance

* Adderall can be extremely addictive, and abuse can lead to stimulant psychosis, a very dangerous disorder.

=== Detection Times ===

* Blood: 12 hours

* Hair: 90 days

* Saliva: 3 days

* Urine: 1-4 days

=== Interactions ===

Adderall can interact negatively with many drugs mainly tramadol, APAP, buproprion, and many anti-depressants.

Adderall mixed with downers like Benzodiazepines can also cause adverse reactions.

== Legal status ==

* Canada: Schedule I

* UK: Class B

* Thailand: Category 1

* United States: Schedule II

== Links ==

* [[Amphetamine|Amphetamine]]

[[Category:Drugs]]
[[Category:Stimulant]]

Amphetamine

2015-05-15T16:14:44Z

Borax: GB > UK (not the same)

[[File:Spaste.png|thumb|500px|Dried speed paste]]

Amphetamine is a CNS stimulant, producing mild euphoria and an abundance of energy. Amphetamines include both the specific chemical 'amphetamine' and the general class of chemicals which share structural similaries. Amphetamines generally cause strong physical and mental stimulation, keeping users awake and alert for many hours, and some amphetamines cause mood lift / euphoria. Because they increase wakefulness, various amphetamines have been used by the military, by pilots, truck drivers, and other workers to keep functioning past their normal limits.

Amphetamine was discovered in 1887 and exists as two enantiomers: levoamphetamine and dextroamphetamine. Amphetamine properly refers to the racemic free base, or equal parts of the enantiomers levoamphetamine and dextroamphetamine in their pure amine forms. Nonetheless, the term is frequently used informally to refer to any combination of the enantiomers, or to either of them alone.

== Dosage ==

Depending on purity, amphetamine doses '''will''' vary. Branded amphetamine, like [[Adderall]], knows similar yet better documented and thus more predictable doses.

{| class="wikitable"
|+ Oral
|-
| Light || 25-40mg
|-
| Common || 40-75mg
|-
| Strong || 75-125mg
|-
| Heavy || 125-175mg+
|}

{| class="wikitable"
|+ Insufflated
|-
| Light || 15-25mg
|-
| Common || 25-40mg
|-
| Strong || 40-75mg
|-
| Heavy || 75-100mg+
|}

== Duration ==

Some branded forms of amphetamine like [[Adderall]], generally purposed to be prescribed to treat ADD and ADHD, are extended release (XR), which increases the duration of a single administration.

{| class="wikitable"
|+ Oral
|-
| Onset || 15-30 minutes
|-
| Total || 2-4 hours
|}

{| class="wikitable"
|+ Insufflated
|-
| Onset || 1-5 minutes
|-
| Total || 1-3 hours
|}

== Effects ==

=== Positive ===

* Increased focus

* Abundance of energy

* Increased motivation

=== Negative ===

* Racing thoughts

* Reduced appetite

* Flushing of the face

* Increased body temperature

* Tachycardia (Elevated heart rate)

* Paranoia

* Insomnia

=== After effects ===

* Hangover

* Afterglow

* Restlessness

* Persisting stimulation (5-15 hours after last dose.)

== Harm Reduction ==

* Avoid driving and operating heavy machinery

* Recommended time (pauses) between using the substance

See [[Stimulants#Harm_Reduction|Stimulant Harm Reduction]] for general information.

=== Detection Times ===

* Blood: 12 hours

* Hair: 90 days

* Saliva: 3 days

* Urine: 1-4 days

== Images ==

<gallery mode="packed-hover">
Image:Spaste.png|''Drying amphetamine paste''
Image:Amphetamine.jpg|''Amphetamine with vial''
Image:Amphetamines.JPG|''~50mg of amphetamine''
Image:Adderall.jpg|''Several 10mg [[Adderall]] IR pills''
</gallery>

== Legal status ==

* Canada: Schedule I

* UK: Class B

* Thailand: Category 1

* United States: [http://www.justice.gov/dea/druginfo/ds.shtml Schedule II]

[[Category:Drugs]]
[[Category:Stimulant]]