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[edit | edit source]

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Chart versions[edit | edit source]

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Specific Combinations[edit | edit source]

Amphetamine & Mescaline[edit | edit source]

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

Cocaine & Mescaline[edit | edit source]

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

Caffeine & Mescaline[edit | edit source]

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

5-meo-xxt & Mescaline[edit | edit source]

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

Tramadol & Mescaline[edit | edit source]

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[edit | edit source]

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

Ketamine & Dox[edit | edit source]

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

MXE & Dox[edit | edit source]

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

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[edit | edit source]

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

Amphetamine & Dox[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

No unexpected interactions.

Tramadol & Dox[edit | edit source]

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

5-meo-xxt & Nbomes[edit | edit source]

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

Amphetamine & Nbomes[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

5-meo-xxt & 2c-x[edit | edit source]

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

Amphetamine & 2c-x[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

Caffeine & 2c-t-x[edit | edit source]

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[edit | edit source]

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

Opioids & 2c-t-x[edit | edit source]

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.

Caffeine & αMT[edit | edit source]

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 & αMT[edit | edit source]

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

Opioids & αMT[edit | edit source]

No unexpected interactions

Amphetamine & 5-meo-xxt[edit | edit source]

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[edit | edit source]

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

Cocaine & 5-meo-xxt[edit | edit source]

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.

Amphetamine & Ketamine[edit | edit source]

No unexpected interactions. Likely to increase blood pressure but not an issue with sensible doses

Caffeine & Ketamine[edit | edit source]

No unexpected interactions.

Alcohol & Ketamine[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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.

Tramadol & Ketamine[edit | edit source]

No unexpected interactions

Benzodiazepines & Ketamine[edit | edit source]

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.

Amphetamine & MXE[edit | edit source]

Risk of tachycardia, hypertension, and manic states

MDMA & MXE[edit | edit source]

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[edit | edit source]

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

Caffeine & MXE[edit | edit source]

No likely interactions

Alcohol & MXE[edit | edit source]

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

Ghb/gbl & MXE[edit | edit source]

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[edit | edit source]

This combination can potentiate the effects of the opioid

Benzodiazepines & MXE[edit | edit source]

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.

Ssris & MXE[edit | edit source]

Depending on the SSRI this combination can be unpredictable

Amphetamine & DXM[edit | edit source]

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

Maois & DXM[edit | edit source]

High risk of serotonin syndrome

Cocaine & DXM[edit | edit source]

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

Ssris & DXM[edit | edit source]

High risk of serotonin syndrome.

Caffeine & DXM[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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.

Benzodiazepines & DXM[edit | edit source]

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.

Amphetamine & PCP[edit | edit source]

This combination can easily lead to hypermanic states

MDMA & PCP[edit | edit source]

This combination can easily lead to hypermanic states

Cocaine & PCP[edit | edit source]

This combination can easily lead to hypermanic states

Caffeine & PCP[edit | edit source]

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

Alcohol & PCP[edit | edit source]

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

Ghb/gbl & PCP[edit | edit source]

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

Opioids & PCP[edit | edit source]

PCP can reduce opioid tolerance, increasing the risk of overdose

Benzodiazepines & PCP[edit | edit source]

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

Ssris & PCP[edit | edit source]

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

Alcohol & N2O[edit | edit source]

This combination can lead to vomiting

Ghb/gbl & N2O[edit | edit source]

MDMA & Amphetamine[edit | edit source]

Amphetamines increase the neurotoxic effects of MDMA

Cocaine & Amphetamine[edit | edit source]

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 & Amphetamine[edit | edit source]

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 & Amphetamine[edit | edit source]

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 & Amphetamine[edit | edit source]

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 & Amphetamine[edit | edit source]

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 & Amphetamine[edit | edit source]

Tramadol and stimulants both increase the risk of seizures.

Cocaine & MDMA[edit | edit source]

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

Caffeine & MDMA[edit | edit source]

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

Alcohol & MDMA[edit | edit source]

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

Tramadol & MDMA[edit | edit source]

Tramadol and stimulants both increase the risk of seizures.

Caffeine & Cocaine[edit | edit source]

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

Alcohol & Cocaine[edit | edit source]

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.

Ghb/gbl & Cocaine[edit | edit source]

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[edit | edit source]

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[edit | edit source]

Tramadol and stimulants both increase the risk of seizures.

Ssris & Cocaine[edit | edit source]

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

Ghb/gbl & Alcohol[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

Ssris & Alcohol[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

Benzodiazepines & Ghb/gbl[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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.

Benzodiazepines & Tramadol[edit | edit source]

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.