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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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 & 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

N-methyl-D-aspartate receptor. NMDA antagonists are often dissociatives.

A substance that interferes with or inhibits the physiological action of another.

Methoxetamine

Monoamine Oxidase, an enzyme that catalyses the metabolism of many drugs (e.g., DMT, dopamine and serotonin).

N-Benzyl-Ortho-Methoxy derivatives of psychedelic phenethylamines.

A monoamine neurotransmitter, biochemically derived from tryptophan, that is primarily found in the gastrointestinal (GI) tract, platelets, and central nervous system (CNS) of humans and animals. It is a well-known contributor to feelings of well-being.

A monoamine neurotransmitter, biochemically derived from tryptophan, that is primarily found in the gastrointestinal (GI) tract, platelets, and central nervous system (CNS) of humans and animals. It is a well-known contributor to feelings of well-being.

Monoamine oxidase inhibitor are drugs that inhibit the action of monoamine oxidase in the brain and so allow monoamines to accumulate.

Loss of motor coordination

Selective Serotonin Reuptake Inhibitor

Central Nervous System

A neurotransmitter associated with movement, attention, learning, and the brain’s pleasure and reward system.