Harm Reduction ⫸DANGEROUS Drug Combos⫷

[Fiori di Bella]

Just 48 hours ago I took 20mg of Baclofen, with a 20mg Oxy, about 8 ounces of wine.
I had taken 20mg of Baclofen earlier in the day, as well as 2 Oxys, 20mg each, 600mg Gabapentin and I had a Vyvanse, as well. I passed out >12 hours and when I got up I was completely shaking, I experienced muscle spasms and I kept dropping things. I went back to bed and I felt better only after about 35 hours had elapsed since I’d taken anything. I hope never to repeat this undesirable experience again!
Edited to include Gabapentin, which I’d forgotten about until now.

 

[sewerslide.666mg]

Just 48 hours ago I took 20mg of Baclofen, with a 20mg Oxy, about 8 ounces of wine.
I had taken 20mg of Baclofen earlier in the day, as well as 2 Oxys, 20mg each, 600mg Gabapentin and I had a Vyvanse, as well. I passed out >12 hours and when I got up I was completely shaking, I experienced muscle spasms and I kept dropping things. I went back to bed and I felt better only after about 35 hours had elapsed since I’d taken anything. I hope never to repeat this undesirable experience again!
Edited to include Gabapentin, which I’d forgotten about until now.

dam that sucks, I always get shaky after I drink n pills, but my nerves are sencitve,
how u feeling, are u back to base line,
that shit can get scary

 

[mokele]

CYP2D6
Cytochrome P450 2D6 is an enzyme that in humans is encoded by the CYP2D6 gene and a member of the cytochrome P450 mixed-function oxidase system.It's one of the most important enzymes involved in the metabolism of xenobiotics in the body. In particular, CYP2D6 is responsible for the metabolism and elimination of approximately 25% of clinically used drugs, in a process referred to as O-demethylation.

CYP2D6 shows the largest phenotypical variability among the CYPs, largely due to genetic polymorphism.
There are 4 types:

poor metabolizer – little or no CYP2D6 function (those people won't feel much from codeine, as codeine is a prodrug and needs to be metabolized into morphine)
intermediate metabolizers – metabolize drugs at a rate somewhere between the poor and extensive metabolizers
extensive metabolizer – normal CYP2D6 function
ultrarapid metabolizer – multiple copies of the CYP2D6 gene are expressed, and therefore greater-than-normal CYP2D6 function

Warnings:
poor metabolizer -> Don't take Dextromethorphan, as even normal therapeutical doses can make you trip for hours or even days, because you don't metabolize DXM well. This could potentially be lethal
ultrarapid metabolizer -> Don't take codeine, as you will metabolise codeine rapidly into morphine, thus increasing the risk of an overdose


Drugs that are metabilized by CYP2D6:

All tricyclic antidepressants, e.g.
imipramine, amitriptyline
Most SSRIs , e.g.
fluoxetine, paroxetine, fluvoxamine
venlafaxine
duloxetine
mianserin
mirtazapine
opioids
codeine
tramadol
O-desmethyltramadol
N-desmethyltramadol
oxycodone
hydrocodone
tapentadol
antipsychotics, e.g.
haloperidol
risperidone
perphenazine
thioridazine
zuclopenthixol
iloperidone
aripiprazole
chlorpromazine
levomepromazine
remoxipride
minaprine
tamoxifen
beta-blockers
metoprolol
timolol
alprenolol
carvedilol
bufuralol
nebivolol
propranolol
debrisoquine
Class I antiarrhythmics
flecainide
propafenone
encainide
mexiletine
lidocaine
sparteine
ondansetron
donepezil
phenformin
tropisetron
stimulants
amphetamine
methoxyamphetamine
dextromethamphetamine
atomoxetine
chlorphenamine
dexfenfluramine
dextromethorphan
metoclopramide
perhexiline
phenacetin
promethazine


Drugs that inhibit CYP2D6 (this will result in higher and longer blood concentration of the drugs mentioned above, this could lead to increased side effects and could even be lethal or to no effects at all):
White grapefruit juice
Strong
Certain SSRIs
fluoxetine
paroxetine
bupropion
quinidine
cinacalcet
ritonavir

Moderate
sertraline
duloxetine
terbinafine

Weak
amiodarone
buprenorphine
cimetidine
citalopram
escitalopram

Unspecified potency

antipsychotics
haloperidol
perphenazine
thioridazine
zuclopenthixol
risperidone
chlorpromazine
hyperforin (St. Johns Wort)
antihistamines
promethazine
chlorphenamine
diphenhydramine
hydroxyzine
tripelennamine
clemastine
celecoxib
clomipramine
cocaine
doxorubicin
metoclopramide
methadone
moclobemide
doxepin
halofantrine
levomepromazine
mibefradil
midodrine
ticlopidine
cannabidiol


Inducers of CYP2D6:
Strong

glutethimide

Unspecified potency

dexamethasone
rifampicin




From Wikipedia

Sorry to bump this oold Thread but i am a rapid metabolizer with methadone ,yet get NOTHING out of codein and barely to nil from DHC except unwanted sides like red face. My oral MSer dose is max to what they allow or it wouldnt hold me 24h. I take cimetidine cuz of exactly that. How can i then be a poor metabolizer AND a fast one at the same time if no cimetidine in play???? And fluoxetin would help more than cimetidine?? Worth a try? If anyone could clear that up i'd be very grateful!!!!

 

[Fiori di Bella]

dam that sucks, I always get shaky after I drink n pills, but my nerves are sencitve,
how u feeling, are u back to base line,
that shit can get scary

Thanks for asking, yes, I’m totally fine.
What’s interesting is that I get all of those prescriptions from the same doctor, with the exception of Vyvanse and the alcohol. I think I learned my lesson.

 

[TumajNuri]

seizures

Seizures and spams are common side effects of tramadol overdose. Some tramadol users think that redosing would enhance the euphoria and then they experience spasms that sound scary and can be avoided by anti-seizures (such as benzos)
Note that it's my own opinion. Plz do not combine trama with other drugs unless u have the idea of what u are doing. According to my personal exp. Benzos can overcome the spasms/seizures but could also put an end to euphoria caused by Trama.

 

[CuriosityMonster]

This is purely anecdotal and also likely redundant since we know the dangers of SSRIs+(most) stimulants, but since many people ignore these dangers - myself included - and even do so without ill effect (serotonin syndrome) I feel it is relevant to mention. Perhaps it might help somebody.

A friend and I are prescribed 20mg of paroxetine which we take every day. We took over the course of 11-13 hours 450-550mg of methamphetamine - a drug we had never tried before - and shortly after the last dose - we finished our halves at approximately the same time - we began experiencing serotonin syndrome. This is not something that particularly surprises me - paroxetine is an SSRI and methamphetamine is a powerful serotonin-influencing stimulant. However, we both have taken many, many different stimulant drugs - including amphetamine - whilst on 20mg of paroxetine without ill effect. We've insufflated grams of cocaine, smoked crack (for the first time), taken huge doses of LSD - all without any problems related to serotonin syndrome. I am merely stating this for reference: do not do drugs and if you do don't do large amounts or take them with drugs that dangerously interact with them.

Therefore I think it is possible that methamphetamine - again, this is purely anecdotal, but it did happen to both of us in the same manner and it makes logical sense - is more likely to trigger serotonin syndrome than many if not all other drugs. I don't think it's an unlikely theory to be true that a drug as powerful as methamphetamine that strongly and directly interacts with serotonin receptors in the brain, which involves (likely) acute neurotoxicity of these receptors - something other drugs do not do - would be a particularly dangerous combination paired with SSRIs, which also directly interact with serotonin receptors. Certainly, my friend and I will not be doing this drug again, or at least not if we're still taking any SSRI drug.

I also think taking any different drugs (meth and paroxetine in this case) which both interact strongly with the same receptor in the brain (again, other drugs are not directly neurotoxic in the brain) in vastly different manners is a bad idea inherently, perhaps as harmful in the long-term as serotonin syndrome is in the short-term. Why take an SSRI which influences serotonin receptors in a positive way to make you feel better and also methamphetamine which increasing evidence suggests is ACUTELY toxic and damaging to these same receptors? You might as well not be taking the SSRI if you're going to do that.

TL;DR: Don't take SSRIs and stimulants, but perhaps think extra hard about taking SSRIs and meth; it's potentially extra dangerous in the short-term and in the long-term would make the reason you're taking SSRIs redundant.

 

[S.M.F.G]

Just 48 hours ago I took 20mg of Baclofen, with a 20mg Oxy, about 8 ounces of wine.
I had taken 20mg of Baclofen earlier in the day, as well as 2 Oxys, 20mg each, 600mg Gabapentin and I had a Vyvanse, as well. I passed out >12 hours and when I got up I was completely shaking, I experienced muscle spasms and I kept dropping things. I went back to bed and I felt better only after about 35 hours had elapsed since I’d taken anything. I hope never to repeat this undesirable experience again!
Edited to include Gabapentin, which I’d forgotten about until now.

Worst mistake I've made in a long time from what happened and the searching for interactions between opiates and this baclofen we stumbled upon 20mg tablets my company took 60mg and took only 150 mg of codeine, and I took 80mg baclofen with my 360mg of codeine had a litre of beer (3-4standard). Then decided that a Xanax would possibly be too much so didn't touch it, 30 to 40 minutes later I am falling over dropping drinks excessive sweating fucked up bad I vomited about 3 times wandered off in a daze got something to eat returned ate vomited I then tried to flip down with up and have a good point to get my shit together and I'm now 15 hours later headache feel like horrible as hell upset stomach and can say that was a bad mix I have been alright to look at this online and know I should have looked at this baclofen more as my gf( who took the lesser) and had same symptoms and dropped and had a siesure now feeling those after effects and both of us are not feeling too awesome at all, my tolerance with pharmaceuticals is higher with what I take, when stocked, Valium, lyrica, Seroquel and Xanax to top I am lucky to have not had those on top as I am sure that I just fucked up and this was pretty dangerous and never get into that again. And with the other ones I could well have taken a fatal mix.

 

[dus_aster]

Warning to wellbutrin XR users

Do not take psychedelics while using wellbutrin.

Cannabis
Mushrooms
LSD
Ketamine
Misc designer psychedelics and dissociatives

All have grossly augmented effects leading to a very unpleasant experience (best case scenario). WB and Ketamine in particular nearly killed me and using the above suvstances in low doses led to a very unpleasant and dirty experience

I appreciate what you're saying, and am sorry you experienced those effects, but I have to forcefully disagree with the idea that all users of bupropion experience this.

I've been taking bupropion (brand name Wellbutrin) for three or four years; started on 150mg XR/day and moved up to 300mg XR a few months after. I'm also on citalopram, at 40mg/day.

I've have never had any problems using ketamine and the aforementioned bupropion. I used to use a lot of ketamine via IM injection, and found the effects inseparable from the effects of ketamine before I began taking bupropion.

Additionally, I'm an on/off cannabis smoker (2 months on, 1 month off for tolerance's sake), and have been since 2014, and bupropion has never resulted in any undesirable effects. I also use psychedelics. I also use research chemicals.

Use the same caution one should always use with drugs; start with an allergy test and then titrate up. If something is going to mix poorly with the bupropion, you'll likely know it before exceeding the threshold dose of x drug.

I will give you this; if you're **just starting** a course of treatment using bupropion (Wellbutrin), I would be careful mixing it with stimulants and psychedelics, due to risk of high BP for the former and an anxiety attack for the latter. Bupropion, in the short-term, can increase agitation/aggression, like many stimulants. Mixing stimulants is usually a bad idea.

But I feel obligated to refute any assertion that taking bupropion precludes, say, smoking cannabis. Be thoughtful and informed when taking stimulants with ALL the drugs you mentioned, because those drugs can mix unpredictably. But don't pin it all on poor bupropion, and scare someone into avoiding psychedelics that can potentially help their mental illness!

(As well, it is worth noting perhaps the most important common interaction you'll find mixing bupropion and drugs: alcohol. Acute alcohol tolerance can be lowered significantly during the early days of a course of bupropion treatment.)


Whenever mixing *any* two substances, be careful, start small, titrate slowly, and be aware of possible interactions. But unless there's science to backup your statement, I disagree with scaring people without evidence, and feel obligated to offer a counter-opinion.

 

[Ontari0]

kratom (8g) and half blunt of k2 (5f-mdmb-pinaca already mixed with tobacco) , nearly got me killed from respiratory depression, its like heroin overdose , i had to force my brain to not stop breathing , i didnt have any narcan at the time , so i puke the kratom out and drank a lot of water and put myself into a recovery position. after 3 hours or so of hell everything went down and i felt better , watchout guys.

 

[Bomb319]

It's about time for a megathread where we can discuss dangerous combos to prevent avoidable deaths, like the passing of the Bluelighter Oxydexmorphetamine, who most likely died due to the combination of DXM and Effexor(SSNRI) leading to Serotonin Syndrom. http://bluelight.org/vb/threads/790985-*WARNING-DEADLY-COMBO*Effexor-600mg-of-DXM-ambien-and-lyrica

Dangerous combos by Banquo from the Dangerous Combos FAQ with a few small changes

Thanks so much for your service to the HR community. The only thing puzzling me - and very sorry if it's already been discussed, as I just skipped straight to the bottom of the thread, is PCP. I would definitely consider it to be a dissociative and not a hallucinogen, though it definitely causes "true" hallucinations like all dissociatives; this means a user truly does NOT know whether or not what he or she is seeing is reality. Shrooms, LSD and typical serotonin-based hallucinogens technically produce pseudohallucinations in the user. They are aware of the anomaly in their perception and recognize it for what it is. High doses of dissociatives on the other hand can produce nightmarish constructs which are indistinguishable from reality to the user.

 

[Cyanoide]

Is there any consensus regarding beta blockers and stimulants (especially cocaine)? I've understood that beta blockers and strong stimulants is a definite no no.

 

[EUPH0RiCRUSH]

I hear you, but at the same time, methadone is probably one of the more dangerous opioids in that it's very easy to overdose due to strength, and it also has a super long half life. in an intolerant user, a dose of 50mg could be fatal, combine that with a xanax bar, and it's not looking too good for you. That being said, the whole time I was on MMT I was taking heaps of benzos, and most of the time was fine, but I did overdose a few times. And now that I think of it, all three of my overdosages included methadone.

Your overdose is more related to the benzos. Let's not try to demonize methadone. Obviously, if you take 50mg the first time every you may OD. That's like doing an oxy 80 the first time or a 3bags the first time of decent dope. You say you were fine most of the time, well yeah, I'd hope you didn't OD the majority of the time lol. Point is, it sounds like your giving the benzos a pass & blaming it on the methadone. The methadone was fine, it was the benzos that put it over the edge. No benzos should be taken with opiates even if you are fine most of the time.

 

[Beetle 6989]

CYP2D6
Cytochrome P450 2D6 is an enzyme that in humans is encoded by the CYP2D6 gene and a member of the cytochrome P450 mixed-function oxidase system.It's one of the most important enzymes involved in the metabolism of xenobiotics in the body. In particular, CYP2D6 is responsible for the metabolism and elimination of approximately 25% of clinically used drugs, in a process referred to as O-demethylation.

CYP2D6 shows the largest phenotypical variability among the CYPs, largely due to genetic polymorphism.
There are 4 types:

poor metabolizer – little or no CYP2D6 function (those people won't feel much from codeine, as codeine is a prodrug and needs to be metabolized into morphine)
intermediate metabolizers – metabolize drugs at a rate somewhere between the poor and extensive metabolizers
extensive metabolizer – normal CYP2D6 function
ultrarapid metabolizer – multiple copies of the CYP2D6 gene are expressed, and therefore greater-than-normal CYP2D6 function

Warnings:
poor metabolizer -> Don't take Dextromethorphan, as even normal therapeutical doses can make you trip for hours or even days, because you don't metabolize DXM well. This could potentially be lethal
ultrarapid metabolizer -> Don't take codeine, as you will metabolise codeine rapidly into morphine, thus increasing the risk of an overdose


Drugs that are metabilized by CYP2D6:

All tricyclic antidepressants, e.g.
imipramine, amitriptyline
Most SSRIs , e.g.
fluoxetine, paroxetine, fluvoxamine
venlafaxine
duloxetine
mianserin
mirtazapine
opioids
codeine
tramadol
O-desmethyltramadol
N-desmethyltramadol
oxycodone
hydrocodone
tapentadol
antipsychotics, e.g.
haloperidol
risperidone
perphenazine
thioridazine
zuclopenthixol
iloperidone
aripiprazole
chlorpromazine
levomepromazine
remoxipride
minaprine
tamoxifen
beta-blockers
metoprolol
timolol
alprenolol
carvedilol
bufuralol
nebivolol
propranolol
debrisoquine
Class I antiarrhythmics
flecainide
propafenone
encainide
mexiletine
lidocaine
sparteine
ondansetron
donepezil
phenformin
tropisetron
stimulants
amphetamine
methoxyamphetamine
dextromethamphetamine
atomoxetine
chlorphenamine
dexfenfluramine
dextromethorphan
metoclopramide
perhexiline
phenacetin
promethazine


Drugs that inhibit CYP2D6 (this will result in higher and longer blood concentration of the drugs mentioned above, this could lead to increased side effects and could even be lethal or to no effects at all):
White grapefruit juice
Strong
Certain SSRIs
fluoxetine
paroxetine
bupropion
quinidine
cinacalcet
ritonavir

Moderate
sertraline
duloxetine
terbinafine

Weak
amiodarone
buprenorphine
cimetidine
citalopram
escitalopram

Unspecified potency

antipsychotics
haloperidol
perphenazine
thioridazine
zuclopenthixol
risperidone
chlorpromazine
hyperforin (St. Johns Wort)
antihistamines
promethazine
chlorphenamine
diphenhydramine
hydroxyzine
tripelennamine
clemastine
celecoxib
clomipramine
cocaine
doxorubicin
metoclopramide
methadone
moclobemide
doxepin
halofantrine
levomepromazine
mibefradil
midodrine
ticlopidine
cannabidiol


Inducers of CYP2D6:
Strong

glutethimide

Unspecified potency

dexamethasone
rifampicin




From Wikipedia

What is Cyp2d6

 

[Atelier3]

Is there any consensus regarding beta blockers and stimulants (especially cocaine)? I've understood that beta blockers and strong stimulants is a definite no no.

I don’t know about consensus (or coke), but I know from experience and from some other online reports that both alpha and beta blockers as well as other drugs that reduce blood pressure can cause a hypotensive crisis if you are really peaking on amphetamines.

Other drugs in the mix like some antipsychotics (eg seroquel) magnify the risk significantly.

 

[Beetle 6989]

What is Cyp2d6

Thank you for the def

I don’t know about consensus (or coke), but I know from experience and from some other online reports that both alpha and beta blockers as well as other drugs that reduce blood pressure can cause a hypotensive crisis if you are really peaking on amphetamines.

Other drugs in the mix like some antipsychotics (eg seroquel) magnify the risk significantly.

I took an atenolol Seroquel alcohol and did meth before went to bed woke up 8 hours later and had a hypotensive episode. I almost went to the ER and eversince I'm having problems.