My dxm trip that sent me to the ER

[Second Last]

So let me start out by saying that I did not take a crazy amount of dxm, just a low 3rd plateau dose of 600mg. What I did wrong was take 200mg of MDMA the night before. I didn't even think about how dxm affects serotonin, stupid I know but I usually feel happy the next day so I thought I could use the lift and I had two days off from work to take advantage of. I took the dxm and smoked a gram of weed. My trip started off the usual, I listened to music at night in my room with the lights off. I'm not sure what hour it was but the trip hit me like a bulldozer. I had full blown open eye visuals which isn't new, but they were intense and frequent. My vision will darken until I'm in a blank space and various structures and things will build in neon colors.

I was staring at the ceiling and it turned into two wooden doors, a tall wall endless wall that extends forever, and some windows. What was even more crazy was instead of looking vertical, it appeared horizontal to me like I was looking straight ahead at the wall instead. I saw various creatures, a spider, a giant raven, a rabbit ect. It wasn't until hour 6 or 7 that I got concerned. My head usually clears and I go to sleep. But it wasn't ending, it was still intense. I tried to sleep but couldn't. I could tell my blood pressure was up and my heart rate. So I figured oh great I have serotonin syndrome and I'm going to die.

I looked up the symptoms, restlessness, high bp and heart rate, still had dilated pupils, said it would lead to unconsciousness and death, fun stuff. I thought maybe I killed my liver and it couldn't filter out the drug. I was scared. I took the dxm at 11pm and it was now 7am, still tripping, still having visuals, still had the robo walk and my speech was difficult. I thought it was best to go to the hospital. Explained the situation, the doctor came in and said I heard you took some E and aren't feeling too good, hold your hands up, so I did. He said well it isn't serotonin syndrome. I was confused but OK. They gave me an IV of fluids and said it had ativan but I don't think it did.

I was laying in the bed tired and basically napping, I looked at the ceiling and still had visuals.. My bp was in the 160s and my heart rate was 105, normal temp and blood work was normal. I was discharged, ok, and layed around and did nothing for the day. It was a crazy trip and I don't understand it. But my advice is just wait when taking different things close together.

 

[Kaleida]

The Consequences of 3,4-Methylenedioxymethamphetamine Induced CYP2D6 Inhibition in Humans

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is a widely abused substituted amphetamine. MDMA is predominantly O-demethylenated in humans by cytochrome P450 isoforms 2D6 and 1A2 (CYP2D6 and CYP CYP1A2, respectively). MDMA is also a mechanism-based inhibitor of CYP2D6. A controlled clinical trial was conducted in 15 healthy male subjects whereby a probe drug, dextromethorphan (DEX), was administered after an oral dose of 1.5 mg/kg MDMA. The pharmacokinetics of DEX and its metabolites were used to evaluate changes in CYP2D6 activity. The urinary metabolic ratio of DEX and dextrorphan was used to calculate a recovery half-life of CYP2D6. After MDMA, DEX C_max and area under the curve increased approximately 10-fold with corresponding decreases in dextrorphan pharmacokinetic parameters. The metabolic ratio increased almost 100-fold from 0.0061 ± 0.0056 to 0.4322 ± 0.2848 after MDMA administration, with 67% of the subjects having a value greater than the antimode of 0.3 for assigning the poor metabolizer phenotype. CYP2D6 activity recovered after 10 days with a recovery half-life of 46.6 hours. In addition to the possible long-term serotonergic effects of MDMA, users must be warned of the consequences of such an inhibition.

This is likely what actually happened to you, rather than serotonin syndrome. The side effects you described are consistent with just being on a very strong dose of DXM, so nothing too out of the ordinary there. The reason that this enzyme inhibition stuff matters is because CYP2D6 is what metabolizes DXM into DXO, so when it's inhibited by recent MDMA use you get a higher amount of DXM compared to DXO in your trip. There is a genetic condition present in a small portion of the population which causes insufficient metabolic activity at CYP2D6 as well, and people who have this condition also experience very powerful, more overtly hallucinogenic, and long-lasting effects from smaller amounts of DXM.

I am glad that you made it through okay, and it's good that you didn't dose even higher than that. Definitely something to keep in mind for the future!

 

[Second Last]

Wow I had no idea. That makes a lot of sense since it took forever to metabolize. Definitely not doing that again, this is a good example for everyone to take a look at and stay safe. Thank you for the information

 

[Kaleida]

No problem. It seems like pretty important information to spread around, considering how popular these two substances are.

 

[cannablissss]

What interests me a lot is the part where the OP was told to put their hands up to check for serotonin syndrome. Anyone have any input on that? Maybe I should just look it up myself. I just think that's intriguing how you can physically check for that.

Anyways, an increase in blood pressure and tachycardia are common side effects from DXM, no matter the dose, of course they're more common in higher doses. It looks like you were freaking out a little bit from the side effects, and a benzodiazepine will calm these effects down if needed. The hospital probably did give you Ativan as it calms down the heart and what not, being a benzo.