Drug combinations

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!

Overview

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Specific Combinations

LSD & DMT

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

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

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 & 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

DMT & Opioids

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

DMT & Tramadol

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

Mescaline & 5-MeO-xxT

• The 5-MeO class of tryptamines can be unpredictable in their interactions.

Mescaline & Amphetamines

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

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 & Tramadol

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

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 & 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 & 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 & Opioids

• No unexpected interactions.

DOx & Tramadol

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

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 & 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 & 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 & Tramadol

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

2C-x & 5-MeO-xxT

• The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics.

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 & 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 & Tramadol

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

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 & 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.

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 & Opioids

• No unexpected interactions

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.

Ketamine & Amphetamines

• Amphetamine worsens Ketamines ataxia.

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

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.

MXE & DXM

• http://i.imgur.com/zmqaw.jpg

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

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 & 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 & SSRIs

• Depending on the SSRI this combination can be unpredictable.

DXM & Amphetamines

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

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 & 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 & Alcohol

• This combination can lead to vomiting.

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

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 & Tramadol

• Tramadol and stimulants both increase the risk of seizures.

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 & 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 & Tramadol

• http://www.ncbi.nlm.nih.gov/pubmed/20837047

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.

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 & 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