Metropolol and DXM HBr interactions?

[helvete]

Hi, I was wondering if there were any potential interactions between taking therapeutic doses of Metoprolol Tartrate (25mg) and recreational doses of DXM HBr (450-900mg). I am prescribed Metoprolol for anxiety and take it daily but want to take high doses of DXM recreationally.

Metoprolol is a beta blocker which lowers your heart rate and blood pressure. DXM increases both, and I don't know anything about pharmacodynamics, but from the research I did, DXM does bind to similar receptors in particular 2 andergenic receptors). DXM also causes vasoconstriction and "inhibits serotonin and norepinephrine recapture" so it acts as a heart stimulant.

Metoprolol, on the other hand, "is a cardioselective beta-1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors". This is everything that I found in my online research.

I was wondering if someone experience could tell me if it would be ok to take both drugs together (the beta blocker at normal doses, and DXM at high recreational doses)? I have no underlying heart conditions but ideally the beta blocker would reduce my blood pressure and heart rate and combat some of DXM's heart stimulant properties. Thank you, any advice/suggestions would mean a lot to me.

 

[Skorpio]

It should block the increase in HR due to norepinephrine reuptake inhibition due to the dxm, but will likely not block any bp increase, as this is mediated by alpha 1 receptors.

May cause a fair increase in bp due to unopposed alpha agonism, but i need to check which subtype of beta receptors are responsible for vasodilation. Will update soon. Edit: you should be good, beta2 receptors are responsible for vasodilation. (alpha 1 and beta 2 receptors have reciprocal roles in vasodilation which lets the body handle increases in norepinephrine).

You named after that Nasum album or just the general concept of hell?

 

[helvete]

It should block the increase in HR due to norepinephrine reuptake inhibition due to the dxm, but will likely not block any bp increase, as this is mediated by alpha 1 receptors.

May cause a fair increase in bp due to unopposed alpha agonism, but i need to check which subtype of beta receptors are responsible for vasodilation. Will update soon. Edit: you should be good, beta2 receptors are responsible for vasodilation. (alpha 1 and beta 2 receptors have reciprocal roles in vasodilation which lets the body handle increases in norepinephrine).

You named after that Nasum album or just the general concept of hell?

Thank you for the advice! And yes my alias was named after the general concept of hell.

To clarify, the Metoprolol would help combat the increase in HR but have no effect on BP? Would it at least reduce BP slightly or have no effect? What if my BP was higher due to anxiety rather than the DXM? Would it still not help lower it at all?

I will be honest. Last time I took DXM (about 5 years ago now), I was ballsy enough to combine a high dose of it with a few LSD tabs. I had a terrible panic attack and ended up in the ER due to severe heart palpitations, my entire body shaking, and fear of a cardiac event. My resting heart rate was in the 140s-180s (fluctuating constantly) and my blood pressure was high as fuck, and I was well within the range of a hypertensive crisis, due to freaking out combined w/ the heart stimulant properties of both the substances. The doctors gave me Metoprolol and Diazepam to calm me down and then I went home and never touched either drug again. I had an EKG and spoke with a cardiologist afterwards, and my heart is seemingly perfectly healthy, so maybe nothing would've happened anyway, but the spike in BP and HR was rather scary. I've been taking Metoprolol since as prescribed just for general anxiety and to prevent adrenaline spikes that lead to panic attacks.

I'm not sure if I'm mentally "ready" to take DXM again (this time by itself without LSD of course...), but I really would like to try it again and do whatever I can to get in the right mindset & environment to reduce chances of a bad trip. So lots of water, no sodium, no foods or caffeine or anything that increases HR/BP, etc., and in the off chance that I did have a bad trip and "freak out" again, I want to reduce the risks of a stroke or cardiac event if my HR/BP were to skyrocket. If this were to happen, I'm not sure if I should just take more Metoprolol at this point in the middle of the trip and ride it out, or literally go to the ER again if, which is the last thing I want to do as the amount of stress it would put on my family. I realize the best advice would be to just not risk it at all, but I think I'm in an ok state of mind as long as I play it safe and do not take it with anything else. Thank you.

 

[Skorpio]

Beta 1 selective beta blockers really only affect heart rate. Taking more of it would not really help anything if you are trying to deal with blood pressure. (if it were less selective, taking more of it could even contribute to high bp due to beta 2 blockade).

Honestly, if you are worried about getting a panic type experience, take a lower dose of DXM to become re-acclimated to that experience. Then later try taking a higher dose.

Alternately you could try to source some benzo to treat a drug induced panic attack.

The alpha 2 agonists clonidine, tizanidine and guanfacine all reduce norepinephrine release, they also have the benefit of being upstream of the reuptake inhibition of dxm, so less likely to get weird emergent effects.

I think in most cases though, the best idea is to take fewer drugs, so that the experience is tolerable. Adding more drugs to cope with an experience will always complicate things due to non linear drug-drug interactions. This may be a valid path of action during an emergency, but shouldn't be an immediate approach.

 

[Keif' Richards]

Respectfully, I'd like to send this to pharmacology. I believe they can handle it better than we.

 

[helvete]

Beta 1 selective beta blockers really only affect heart rate. Taking more of it would not really help anything if you are trying to deal with blood pressure. (if it were less selective, taking more of it could even contribute to high bp due to beta 2 blockade).

Honestly, if you are worried about getting a panic type experience, take a lower dose of DXM to become re-acclimated to that experience. Then later try taking a higher dose.

Alternately you could try to source some benzo to treat a drug induced panic attack.

The alpha 2 agonists clonidine, tizanidine and guanfacine all reduce norepinephrine release, they also have the benefit of being upstream of the reuptake inhibition of dxm, so less likely to get weird emergent effects.

I think in most cases though, the best idea is to take fewer drugs, so that the experience is tolerable. Adding more drugs to cope with an experience will always complicate things due to non linear drug-drug interactions. This may be a valid path of action during an emergency, but shouldn't be an immediate approach.

Thank you for the advice. I think I will just take a normal therapeutic dose of Metoprolol several hours before taking DXM (say 25mg) and now I realize that taking more could actually raise my BP. But at least it would lower my HR and presumably help against the adrenaline spikes that lead to panic attacks.

I was thinking of gradually dosing DXM every 45 minutes or so to see how it affects me as the effects kick in. I would take around 600mg, which is enough to reach into 3rd plateau for my weight. So maybe 200mg over the course of 2.5 hours on a half-empty stomach after eating like a salad or something. No sodium or sugar or anything that might contribute to a higher BP.

I wish I could get benzos or BP reducing medications, but I can't get any prescription medications since my physician definitely wouldn't be willing to prescribe them as I don't suffer from hypertension or anything. If there are any OTC alternatives or other things I can try, I'd love to hear them.

I suppose I'm mostly worried that if I do get a panic-type experience again, and my BP is 180/120 or higher, or my resting HR 140-170 and fluctuating constantly even on Metoprolol, I'm not sure how long to "wait" to try and calm down before I decide it's time to go to the ER. The last time, my panic attack lasted for hours. Do you think it would be an ok strategy to just lay down in bed for a couple of hours and ride it out? I'd take deep breaths and try my best to relax, and if my BP/HR are still high, I'll go to the ER if the chances of stroke are actually high.

For now, I will likely follow your advice and just experiment with lower doses and work my way up if I am actually risking my life. Thank you!

 

[RDP89]

I would dose DXM on a totally empty stomach. The nausea on the comeup is manageable on an empty stomack but food can make it impossible not to vomit before all the DXM absorbs, ruining your trip. Also, as stated above benzos can be great to have on hand if you are prone to anxiety/panic attacks when tripping. That said, I think your ill effects were mostly or exclusively due to the combo of LSD and DXM.

 

[helvete]

I would dose DXM on a totally empty stomach. The nausea on the comeup is manageable on an empty stomack but food can make it impossible not to vomit before all the DXM absorbs, ruining your trip. Also, as stated above benzos can be great to have on hand if you are prone to anxiety/panic attacks when tripping. That said, I think your ill effects were mostly or exclusively due to the combo of LSD and DXM.

Thank you, I didn't know that. I thought most of the nausea was from all of the gunk they put in your average Robitussin cough syrup, and the bottles I bought recently are the RoboCough ones which are essentially concentrate DXM from what I've seen. The bottles look tiny and seem to be much easier to swallow compared to the typical thick disgusting cough syrup I remember purchasing years ago.

Would you say that LSD contributed more than DXM to the elevated BP/HR levels? Like which one would be a stronger contributor out of the two? If LSD is a large contributor, that would make sense. If my heart rate was like 170 and my BP 180/110, then I imagine both would be moderately lower if I hadn't taken those 3 LSD tabs as well at the same time. Not to mention LSD on its own amplifies your emotions / panic attacks by quite a bit being the drug it is.

I think the biggest thing that scared me was the severe heart palpitations that just showed up out of nowhere, and they would almost make me drop to my knees each time and wouldn't stop, and then I started to freak out and my panic attack gradually started to spiral out of control.

 

[RDP89]

DXM itself will cause nausea, especially on the comeup. For me it comes in waves on the comeup, but once you are fully high it goes away. The syrup will be worse than for instance, Robitussin cough gels. As I said for me it was manageable as long as I had an empty stomach.

Honestly both LSD and DXM are vasoconstrictive and raise heart rate and blood pressure, but just from my own anecdotal experience, DXM is worse than LSD, but still not as bad in that area as most strong stimulants. Combining the two likely made for exponential effects as often happens when mixing things, which is why combinations can be so dangerous.

 

[The Holy Quadruplty]

I want to try a beta blocker so bad like that one, or even like propanolol. Wish I knew where to get them, but I don't. Lol

 

[The Holy Quadruplty]

Someone said DXM doesn't potentiate it at all (which I know isn't true cuz I've done it a good bit of times actually not that long ago like last week ish) just helps with opioid tolerance, but I'm sure it actually potentiates it while you're on it with bupe at the same time. I actually felt pretty good with the

Dextromethorphan
Chlorpheniramine
Promethazine
Subutex
Xanax
Marijuana

combination, and it was quite euphoric. I Wana do it again it's just sometimes it makes me feel too overwhelmed. If I had access to more benzos I'd probably do it everyday though. Lol what do y'all think about DXM and Subutex together? Someone said it felt like Dilaudid, or another strong opioid.

 

[plumbus-nine]

I want to try a beta blocker so bad like that one, or even like propanolol. Wish I knew where to get them, but I don't. Lol

Online pharmacies, or a doc of your choice. Tell them you have performance anxiety, propranolol is used for this. It is an anxiolytic, blocking the physical part of anxiety but makes also tired. I have tachycardia (90-110bpm resting pulse) and took various betablockers, currently I'm on propranolol but take the whole dose of 200mg before sleep, and when I wake up early I take another 120mg. It's more effective in inducing natural tiredness than antihistamines, this is definitely to consider. Before I tried bisoprolol and metoprolol, they don't influence the psyche and are only something for real circulation related problems. Might take the edge off panic too though.

DXM does potentiate other drugs, specially opioids, for sure and it takes the anxiety off psychedelics - like all the dissociatuves do. Maybe the person telling you that it wouldn't potentiate took too less or is a poor metabolizer - you want the DXO metabolite, not DXM itself I guess.