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Regarding neurotoxicity and enzyme inhibitors for ultra-rapid metabolizers of CYP2D6

evasolo

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Sep 23, 2017
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Hello there!


I have spent a few hours researching this subject (which have lead to the background information below). I have however not been able to find answers to the things that I was looking for so I’ll try my luck here (I have read the mega-thread about why MDMA does not work for me).


Anyways, I believe that I am one of the 1 % of the caucasians that are ultra-rapid metabolizer of the enzyme CYP2D6, which means that I experience less effect of MDMA compared to the general. I have taken it four times (with more than one month apart) and on all occasions I have experienced minor effects (a bit more sharp/awake, a bit happier but far from experiencing the euphoria that most people describe). This was also the case my first time (when my remaining friends were tripping quite hard).


I do not take any SSRIs, I’m in "full health”, both physically and mentally, BMI around 22, at least 4 weeks have passed since each intake. Nor I have ever experienced any negative side effects from it (I feel better the day after MDMA compared with a night of four beers)


Last weekend I took the same E batch as some of my friends, starting with the same dose as the others (2/3 of the tablet that showed ecstasy data 160mg MDMA), so around 100mg. After about 1h it had hit for all my friends but I felt no noticeable change, after another 45 minutes, I took another 1/3 but did not notice any difference then either. 3h after the first intake I took another full tablet (so a total of 320mg) but did not notice any difference. 3h after the second intake, I felt no effect at all. While all my friends were clearly very effected of it.


I do not know if it makes a difference to the case, but I ate about 4h before taking the first tablet and was sure to add water (~ 40cl / h), sodium every two hours and multivitamins/magnesium supplement every 3 hours to minimize the risk of hyperthermia, salt-imbalance and neurotoxicity. Did not drink alcohol, did not smoke nor took any other drugs during the night. Afterwards I could conclude that I did have a little effect since I experienced increased energy, a little more love for people around me, and that the music was a bit better - and that I had minimal jaw tension the following day (otherwise no AT at all)


I have promised myself that I should not take any drugs other than MDMA, so it feels like I am being a bit ”left out” when hearing all the stories of how amazing it should be, compared to what I have felt so far. So I have some questions based on my hypothesis that I am an ultra-rapid metabolizer of CYP2D6, I have very poor knowledge of chemistry and biology so I hope there are more experienced people here that can help me (and I am sorry if the questions are super basic for the average Joe chemist):


[COLOR=#212121 !important]1. A "simple" solution to my problem is to try to take more at the same time. But I do not really understand how it works with AT / neurotoxicity when it comes to being a ultra-rapid metabolizer. Assuming that I do have the enzyme defect; will the body ”take care” of all the MDMA immediately? Or is it like I am not experiencing that much positive effects but I am still getting all the negative stuff from taking more? Let’s say hypothetically that I take a 200mg dose, will I then ”experience” positive effects of lets say 80mg but my body still has to cope with the negative effects of taking 200mg? Or would it even out that I ”only” get the negative things from the amount that actually seems to be taken up by the body (~80mg).


2. There are so-called enzyme inhibitors that I understand will suppress the activity of CYP2D6 so that you go from ultra-rapid to normal. From an article:

"The administration of inhibitors of CYP2D6 activity can affect the metabolism of MDMA, and in turn MDMA can inhibit drugs metabolized by CYP2D6. Previous administration of antidepressants with CYP2D6 inhibitory actions, such as paroxetine, reboxetine, or duloxetine, produce 15 -30% or MDMA concentrations, but decrease concentrations of its metabolite HMMA at 40-50% (Segura et al., 2005; Farré et al., 2007; Hysek et al., 2011, 2012). Moreover, the pharmacological effects of MDMA is reduced, probably due to competition for the uptake transporter decreasing MDMA entry into neurons ".


But when I look at CYP2D6 inhibitors, it's mostly antidepressant drugs that I have understood that you should not mix with MDMA. Have also read other "immunity threads" where people always ask if the person in question take SSRIs and then have the hypothesis that this is why they don’t feel an effect. Which I think sounds very contradictory (it is an inhibitor but at the same time they are saying that it might be the reason to why one does not get an effect, which to me sounds like like an inducer). Or are there some antidepressants that are inhibitors and some that are inducers?


Assuming I would find a reasonable inhibitor (is there one?), how dangerous is it to combine those? Can you be fucked up even if you were going to experiment with a small dose, say 75 mg?


3. More in general terms: what would you have done if you were like me: 1) wants to get an effect but would like to stay away from extreme neurotoxicity and dangerous drug cocktails. Would not eating as much + grapefruit juice be reasonable for me for instance? Or any other suggestions? Would be greatly appreciated.


I think that was all, thank you very much in advance.


Best regards.
[/COLOR]
 
This one is likely going to be a lot of speculation on anyone's part but definitely a valid question IMO given your experiences.

Have you ever taken MDMA on a completely empty stomach with no supps? I have noticed that stuff like vitamin C and magnesium can significantly damper the effects if taken close together.

Off the top of my head I would speculate about bioperine but will let some others chime in
 
Have also read other "immunity threads" where people always ask if the person in question take SSRIs and then have the hypothesis that this is why they don’t feel an effect. Which I think sounds very contradictory (it is an inhibitor but at the same time they are saying that it might be the reason to why one does not get an effect, which to me sounds like like an inducer).

MDMA enters serotonin neurons using the serotonin transporter protein SERT. SSRIs inhibit the action of SERT, and hence they block MDMA from entering neurons. This doesn't really have anything to do with liver enzymes.

https://dancesafe.org/drug-information/ecstasy-slideshow/

Before you try combining MDMA with enzyme inhibitors (I think you are wise to be wary about this), have you tried any similar drugs, like bk-MDMA / methylone for example?
 
This one is likely going to be a lot of speculation on anyone's part but definitely a valid question IMO given your experiences.

Have you ever taken MDMA on a completely empty stomach with no supps? I have noticed that stuff like vitamin C and magnesium can significantly damper the effects if taken close together.

Off the top of my head I would speculate about bioperine but will let some others chime in

Last time I had a large meal about 5 hours before I took the first one, and the supplements I consumed was during the trip and not after (since I heard it could reduce come-downs etc.). Have read some about bioperine and piracetam but have not tried it yet. I thought next time I would go with eating less prior to the trip, doing grapefruit juice and do supplements by the end of the evening when it is wearing out. And if that doesn't work I would try bioperine/piracetam or something similar to see if that has any effect.
 
MDMA enters serotonin neurons using the serotonin transporter protein SERT. SSRIs inhibit the action of SERT, and hence they block MDMA from entering neurons. This doesn't really have anything to do with liver enzymes.

https://dancesafe.org/drug-information/ecstasy-slideshow/

Before you try combining MDMA with enzyme inhibitors (I think you are wise to be wary about this), have you tried any similar drugs, like bk-MDMA / methylone for example?

So doing something similar to SSRIs would not effect my CYP2D6 activity?




I have not tried bk or methylone, and afaik they are not really available in my country, would you consider them to be a substitute for me? Are those drugs not metabolized by CYP2D6?
 
You both seem to be very well educated in this area, do you have any thoughts on my first question regarding the potential increase in neurotoxicity subject to taking more than a standard dose while being a ultra rapid metabolizer?


Thanks in advance,
 
So doing something similar to SSRIs would not effect my CYP2D6 activity
Not exactly, it's just that the major intended effect of SSRI's is on SERT, while any effect they have on CYP2D6 is a side effect and doesn't have as much impact on an MDMA experience.

I have not tried bk or methylone, and afaik they are not really available in my country, would you consider them to be a substitute for me?
bk-MDMA is methylone, they're both the same drug. It's in some way similar to MDMA, in other ways different.

Are those drugs not metabolized by CYP2D6?
Methylone is metabolized by CYP2D6, so if you ever have the chance to try it it might be an interesting test for your fast-metabolism theory.
https://www.ncbi.nlm.nih.gov/pubmed/23545806

do you have any thoughts on my first question regarding the potential increase in neurotoxicity subject to taking more than a standard dose while being a ultra rapid metabolizer?

Unfortunately I'm not well educated enough to say much about this, and I suspect nobody really knows. You are right to be concerned with the potential risks. Combining MDMA with antidepressants is almost certainly a bad idea, since they will affect your brain at least as much as your liver and the experience you get will probably not be what you want. In terms of something like grapefruit juice... I still would suggest you explore other drugs as an option first (or talk to a doctor and find some way to get more information about your metabolism). AFAIK, combining MDMA with an enzyme blocker isn't safe enough for me or anyone on BL to endorse.
 
Unfortunately I'm not well educated enough to say much about this, and I suspect nobody really knows. You are right to be concerned with the potential risks. Combining MDMA with antidepressants is almost certainly a bad idea, since they will affect your brain at least as much as your liver and the experience you get will probably not be what you want. In terms of something like grapefruit juice... I still would suggest you explore other drugs as an option first (or talk to a doctor and find some way to get more information about your metabolism). AFAIK, combining MDMA with an enzyme blocker isn't safe enough for me or anyone on BL to endorse.

Thanks for the answers, regarding the above I was thinking more about my initial question (posting it below):

1. A "simple" solution to my problem is to try to take more at the same time. But I do not really understand how it works with AT / neurotoxicity when it comes to being a ultra-rapid metabolizer. Assuming that I do have the enzyme defect; will the body ”take care” of all the MDMA immediately? Or is it like I am not experiencing that much positive effects but I am still getting all the negative stuff from taking more? Let’s say hypothetically that I take a 200mg dose, will I then ”experience” positive effects of lets say 80mg but my body still has to cope with the negative effects of taking 200mg? Or would it even out that I ”only” get the negative things from the amount that actually seems to be taken up by the body (~80mg postive effects and 80mg negative effects).
 
I mean, you could try "Wellburin SR 150mgs" by Sandoz. It's a very potent CYP2D6 inhibitor and has negligible effects on Serotonin re-uptake inhibition. Just be careful regarding the seizure threshold risk.
Some users report it enhances the effect/experience and others find a slight dimunition or No change. Start with 75 mgs. If you notice blunting or no change, maybe try building up the Welly first for 2-3 weeks, than stop for 2- 3 days . This should work.
From what I understood and have studied, it could actually decrease the slight stimulating properties that some users experience when taking MDMA and the associated anger/irritability. This is def unwanted for most users. Even though Wellbutrin in itself has some slight agitating components, it is def the lesser of 2 evil's in this regard. Especially when implementing the 2-3 day mini- holiday.
The percentage of inhibition on re-uptake is as follows : Dopamine-100% , NE- 27%, SERT 5HT-2% and a1 Nicotinic- 12% , It also possesses an elimination half-life of 17hrs for the SR format.
 
You both seem to be very well educated in this area, do you have any thoughts on my first question regarding the potential increase in neurotoxicity subject to taking more than a standard dose while being a ultra rapid metabolizer?


Thanks in advance,

Not incredibly well educated compared to some but I would speculate that it likely wouldn't increase the neurotoxicity risks if what is happening is due to rapid metabolism.

Neurotoxicity, although argued about, is likely due to dopamine and its interaction with 5HT receptors seeing as some analogs have high serotonin release but little to no dopamine release and little to no neurotoxicity although other mechanisms are very likely involved in different circumstances.

Blocking the metabolizing enzyme is not going to drastically elevate your serum levels compared to 'normal' (if the cause is rapid metabolism) like it would in someone else. Grapefruit juice and/or bioperine is what I'd personally try first and actually I have used them both before and am not a rapid metabolizer like yourself. Neither were extraordinary but I didn't use a crazy amount (probably 10mg bioperine and 1cup juice on separate occasions). If I were you I'd try both and double those amounts...that's just me though.
 
Neurotoxicity, although argued about, is likely due to dopamine and its interaction with 5HT receptors seeing as some analogs have high serotonin release but little to no dopamine release and little to no neurotoxicity although other mechanisms are very likely involved in different circumstances.
Methylone (MDMC/bk-MDMA) and other cathinones seem to have less affinity for SERT, in addition to being less potent VMAT inhibitors (which will vastly affect 5-HT terminal neurotoxicity), the hepatic metabolites aside

For what its worth, hepatic metabolites of MDMA are thought to play a role in the observed 5-HT neurotoxicity in animals. Direct injection into the brain can however still produce neurotoxicity.

There is also the issue of adverse effects (What we're ultimately aiming to avoid) not necessarily being due to 5-HT neurotoxicity
 
Hello again,

Thanks for the replies. I thought I'd give you a brief update from my last experience:

Started of around four days before the roll by taking Noopept 10mg once per day sublingually, could really feel the effect of these after a couple of days so that was excellent. Took 30mg on roll day.
Had 3 glasses of grapefruit juice during the course of the day prior to the roll.
Did not each that much during the day.

Took first pill (~130mg MDMA) at 00.30 and got similar effects after an hour to my previous rolls; incremental positive change in mood and energy.
At 02.30, I took a second one. About 30 mins after I started to experience more severe effects than previously, (last time I took two I did not get any effect). Happier, but wouldn't say euphoric, a general feeling of "intoxication". Felt very good but def not the feelings that some other users describe.

4,5 hours after I took the last pill, I was able to sleep without any problem. But noticed from my Fitbit that I basically had no REM sleep. Had strict water rules of 50cl an hour, + one sodium tablet once during the roll, no alcohol and no other drugs. Then took magnesium, water replenishment tablets/sodium and multivitamins before going to bed. Slept for ~7 hours, woke up and were just feeling tired (no comedown whatsoever). The day after, I got a good nights sleep and today I am feeling exactly as before the roll (despite taking a two day break from the Noopept).

So I think I have find something that I would feel comfortable with, I have my suspicion that the product was not optimal so I will do Marquis and purity test next time in order to verify the quality.

Would you say that I will be able to continue with this on a once a month basis? (Subject to getting the same effects/side effects ofc.) Since I am experiencing no come down I assume that I am not depleting my serotonin levels (nor experiencing euphoria during the roll). But would love to get the input from some more experienced people, might add some 5-htp as well. If I were to experience some negative effects I would def extend the time between the occasions.

Thanks in advance,
 
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