The Big & Dandy Dangerous Combinations Thread

[Survived Abortion]

[Please note: this list is just a rough draft and has not been proofread by the moderation team. Please go here to see the actual updated list. Alternatively, browse to the top of the forum to find the actual list amongst the sticky threads.]

This thread is for the discussion of dangerous and potentially unsafe drug combinations between psychedelic drugs and other drugs. If you think you know of a specific drug combination which is unsafe or potentially fatal - and is not on the list in the sticky thread linked to in the previous paragraph - please post it in here for discussion.

Original post: Inspired by a post by p-helix in the Big and Dandy Thread 4-HO-MET, I would like to propose that we make a sticky thread at the top of the forum for all to see (emblazoned in bold neon swirly trimmings for the n00bs) listing all the contraindicated combos we know of.

I believe this is especially important now that most of us have incredibly easy access to such a wide array of chemicals without the knowledge that goes with it. It would be a good one-stop info centre for the unfamiliar wanting quick advice on potential combos of their choice, and it could save some asses.

So carrying on from what p-helix asked about venlafaxine, here is my contribution:

[Important: Just because a specific combination is not listed here, does not necessarily mean it is safe. If the combo you are searching for is not in this list, please ask about it in the relevant thread or make a new thread.]

5-HTP:

X aMT (alphamethyltryptamine)

X ayahuasca/pharmahuasca

X 2C-T-7


Alcohol (beer, wine, vodka):

X Methoxetamine

X Ketamine

X PCP (and analogues)

X Ibogaine

Additionally, tyramine-containing alcoholic beverages such as draught beer and wine should not be combined with the following MAOIs:

X aMT

X ayahuasca/pharmahuasca

X 2C-T-7


Amphetamines and other Stimulants (MDPV etc.)

X Ibogaine


Anticonvulsants (lithium, valproate):

X All tryptamines

X All 2C-x

X All DOx

X LSD/LSA

X Ibogaine


Empathogens (MDMA, Cathinones):

X aMT (alphamethyltryptamine)

X ayahuasca/pharmahuasca

X DXM (dextromethorphan)

X 2C-T-7

X Ibogaine


Ibogaine:

X Alcohol

X DXM

X All SSRIs/SNRIs

X All empathogens (MDMA etc.)

X All stimulants (amphetamine etc.)

X All anticonvulsants (lithium, valproate etc.)

X Opiates (Specifically: Codeine, Hydrocodone, Oxycodone, Tramadol)

X Anti-biotics

X Grapefruit Juice

X Quinine (tonic water)


MAOIs (phenelzine, tranylcypramine, selegiline)

X All phenthylamine psychedelics (DOx, 2Cx, TMA-x, 25x-NBOMe)

X aMT (alphamethyltryptamine)

X MDMA

X 6-APB

X All cathinones

X All DOx

X DXM (dextromethorphan)

X Ibogaine

X Ketamine

Opioids (tramadol, meperidine):

X aMT (alphamethyltryptamine)

X ayahuasca/pharmahuasca

X 2C-T-7

X Ibogaine


Opioids (tramadol, meperidine):

X aMT (alphamethyltryptamine)

X ayahuasca/pharmahuasca

X 2C-T-7


SSRI/SNRI antidepressants:

X aMT (alphamethyltryptamine)

X ayahuasca/pharmahuasca

X DXM (dextromethorphan)

X 2C-T-7

X Ibogaine


Triptans (sumatriptan, rizatriptan, zolmitriptan):

X aMT

X ayahuasca/pharmahuasca

X 2C-T-7

X LSD/LSA

Unsure but Unwise 5-HTP: X MDMA (On the same day) Amphetamines & other Stimulants (MDPV etc): X All NBOMes X 5-MeO-MiPT X Bromo-dragonfly Beta-blockers (propranolol, atenolol): X MDMA X 6-APB X Cathinones X LSD/LSA X Datura/Belladonna/Brugmansia Empathogens (MDMA, Cathinones): X 5-MeO-MiPT X Methoxetamine Opioids (tramadol, pethidine) X LSD

to be continued (please add your knowledge to the base)...

 

[champ]

I think this is a great idea! There should also be a disclaimer at the top of the thread that says something like, just because a specific combination is not listed here does not mean it is safe.

 

[Survived Abortion]

^Yes indeed. This can't be taken as an exhaustive list, so a disclaimer should be appended.

The aggregated data could also be put in to a table for ease of cross-referencing. Let's have some ideas...

 

[Folley]

MDMA/MDA/MDAI/6-APB/5-IAI or any other serotonin releasing drug cannot be mixed with DXM, ayahuasca (due to the MAOI), tramadol, Anti-depressants, and lithium.. to name a few


Basically any drug that antagonizes serotonin will be a risky one to mix with serotonergic releasers or binding agents... as most psychedelics are.

 

[T. Calderone]

Combining opiates with benzos can cause respiratory failure.

 

[Survived Abortion]

MDMA/MDA/MDAI/6-APB/5-IAI or any other serotonin releasing drug cannot be mixed with DXM, ayahuasca (due to the MAOI), tramadol, Anti-depressants, and lithium.. to name a few


Basically any drug that antagonizes serotonin will be a risky one to mix with serotonergic releasers or binding agents... as most psychedelics are.

Thanks, I missed ayahuasca with MDMA. I'll put DXM in there too until somebody challenges it. But tramadol is not a problem with the drugs you mentioned - it's only an SSRI (as well as an opioid), and SSRIs/SNRIs are fine with serotonin releasers.

Also, your last sentence is unclear/untrue. Drugs which "antagonize serotonin" [receptors] are typically in the class of antipsychotic drugs. Do you mean serotonin agonists? In which case, there is no direct contraindication between 5-HT2a agonists (such as mushrooms) and serotonin releasers (such as MDMA). This is why it's okay to candyflip. Furthermore, most psychedelics are not serotonin releasers; those are in the minority.

Alot of myth and misinformation abounds, and this why I'm trying to cut through the crap and get all the correct information in one place.

 

[Folley]

I think antagonist was the wrong word to use. I meant any drug that blocks the re-uptake or release of serotonin, dopamine or NE aren't safe to use with other drugs that act on serotonin. Psychedelics -might- be safe to use with drugs like SSRIs, but to do so is dangerous, in my opinion.. Psychedelics bind to serotonin transporters and SSRIs down regulate serotonin over time, so at anything it will result in a diminished experience.

and tramadol is dangerous with MDMA and similar RCs covered in this forum. Not only does it work on serotonin, but it cases the re-uptake of norepinephrine as well, and with NE releasers like MDxx, amphetamines or a lot of other stimulant RCs that's going to cause problems

I've heard of several people in ED who have had severe reactions from tramadol and MDMA

it's only an SSRI (as well as an opioid), and SSRIs/SNRIs are fine with serotonin releasers.

Alot of myth and misinformation abounds, and this why I'm trying to cut through the crap and get all the correct information in one place.

That's a bit ironic lol.. SSRI's are CERTAINLY not safe with serotonin releasers by ANY means. That will directly cause serotonin syndrome... come on, that's 101 shit... and tramadol isn't even an SSRI anyway

 

[shishigami]

That's a bit ironic lol.. SSRI's are CERTAINLY not safe with serotonin releasers by ANY means. That will directly cause serotonin syndrome... come on, that's 101 shit... and tramadol isn't even an SSRI anyway

http://www.erowid.org/chemicals/mdma/mdma_info9.shtml

?

 

[Dmytry]

SSRIs are safe to use with MDMA, they block the serotonin release from happening in the first place.

SSRIs are NOT safe to use with 5-htp.

MAOIs are not really safe to mix with anything, except in the case of ayahuasca

 

[Survived Abortion]

SSRIs are safe to use with MDMA, they block the serotonin release from happening in the first place.

SSRIs are NOT safe to use with 5-htp.

MAOIs are not really safe to mix with anything, except in the case of ayahuasca

Thanks for the reminder! I'll add 5-htp as a category now. MAOIs should also be included as a category.

That's a bit ironic lol.. SSRI's are CERTAINLY not safe with serotonin releasers by ANY means. That will directly cause serotonin syndrome... come on, that's 101 shit... and tramadol isn't even an SSRI anyway

Firstly, as has been pointed out SSRIs are safe in combo with serotonin releasers, because re-uptake inhibition is mutually exclusive with efflux from the same transporter. The two mechanisms cannot happen at the same time. (And secondly, to address your last sentence, tramadol is a re-uptake inhibitor for serotonin as well as norepinephrine, though it may not be selective - check it out on pubmed. But this is getting away from the discussion at hand.)

It seems that you're saying "anything which works on serotonin is dangerous with anything else which works on serotonin", and that's just not the case at all. And it's this kind of sloppy reasoning which results in all the confusing myth and misinformation we see.

 

[Survived Abortion]

To clarify, I have included combos which have been widely reported in anecdotes as being dangerous from the effects (or deaths) they caused, as well as the combos which are pharmacologically contraindicated.

LSD was reported by Shambles to be bad in combo with tramadol, so I have put that in there.

 

[RhythmSpring]

This is a good idea! Are we including non-psychedelic drugs? Someone mentioned benzos+opiates=respiratory failure.

 

[Bagseed]

SSRIs are safe to use with MDMA, they block the serotonin release from happening in the first place.

SSRIs are NOT safe to use with 5-htp.

MAOIs are not really safe to mix with anything, except in the case of ayahuasca

i thought, SSRIs block the reuptake of Serotonin, while the release (due to MDMA or other SRAs) still happens, which might lead to too high levels? can anyone clear that up?

 

[kingme]

MAOIs are not really safe to mix with anything, except in the case of ayahuasca

i think in the right circumstances, you can mix maois with mushrooms for instance... or with certain rc tryptamines for that matter, with similar result to the classical ayahuasca

 

[Folley]

It seems that you're saying "anything which works on serotonin is dangerous with anything else which works on serotonin", and that's just not the case at all. And it's this kind of sloppy reasoning which results in all the confusing myth and misinformation we see.

That's not at all what I was saying. And NO, SSRIs are NOT safe with MDMA. GET THAT THROUGH YOUR HEAD NOW. I've personally seen many people on BL who have reported Serotonin Syndrome from this combination. The SSRIs block the release of serotonin, which is what MDMA does, and as a result of you telling your brain to do two opposite things at once, serotonin syndrome occurs. Some people are lucky and may only receive diminished experiences, but the risk is still very real.

The simple fact that the two cancel each other out means it should have some mention.

i thought, SSRIs block the reuptake of Serotonin, while the release (due to MDMA or other SRAs) still happens, which might lead to too high levels? can anyone clear that up?

Actually yeah, that's exactly what happens. The re-uptake of serotonin is blocked, while MDMA releases massive amounts of it into the synapse, which causes too high levels of serotonin that is responsible for SS


and MDMA and Tramadol is still a dangerous combination, as I have shown. Again, I also have personally heard of people who have had serious, life threatening reactions to the combination.

 

[shishigami]

That's not at all what I was saying. And NO, SSRIs are NOT safe with MDMA. GET THAT THROUGH YOUR HEAD NOW. I've personally seen many people on BL who have reported Serotonin Syndrome from this combination. The SSRIs block the release of serotonin, which is what MDMA does, and as a result of you telling your brain to do two opposite things at once, serotonin syndrome occurs. Some people are lucky and may only receive diminished experiences, but the risk is still very real.

Could you find me some BL reports of this? I'm just curious because erowid says that it's safe and I trust erowid on most things drug related.

 

[Survived Abortion]

This is a good idea! Are we including non-psychedelic drugs? Someone mentioned benzos+opiates=respiratory failure.

Thanks! I thought we'd keep with combos involving psychedelics to keep it manageable for this forum. Other forums, such as 'Other Drugs', could have their own table of contraindications.

i thought, SSRIs block the reuptake of Serotonin, while the release (due to MDMA or other SRAs) still happens, which might lead to too high levels? can anyone clear that up?

No, they cannot happen at the same time (not at the same transporter site where each molecule is docked anyhow).

i think in the right circumstances, you can mix maois with mushrooms for instance... or with certain rc tryptamines for that matter, with similar result to the classical ayahuasca

Yes, I considered this too, which is why I didn't put "all tryptamines" under the MAOI heading. If there are any other tryptamines which you think should be included, please tell us what they are and why.

 

[Survived Abortion]

That's not at all what I was saying. And NO, SSRIs are NOT safe with MDMA. GET THAT THROUGH YOUR HEAD NOW. I've personally seen many people on BL who have reported Serotonin Syndrome from this combination. The SSRIs block the release of serotonin, which is what MDMA does, and as a result of you telling your brain to do two opposite things at once, serotonin syndrome occurs. Some people are lucky and may only receive diminished experiences, but the risk is still very real.

The simple fact that the two cancel each other out means it should have some mention.

Actually yeah, that's exactly what happens. The re-uptake of serotonin is blocked, while MDMA releases massive amounts of it into the synapse, which causes too high levels of serotonin that is responsible for SS

and MDMA and Tramadol is still a dangerous combination, as I have shown. Again, I also have personally heard of people who have had serious, life threatening reactions to the combination.

Sigh. Here's a tl;dr for you:

A.N. Singh & J. Catalan: In the laboratory, SSRI block MDMA induced serotonin release and they also block MDMA neurotoxicity and it has also been reported that fluoxetine does not block MDMAs reinforcing subjective effect (McCann &
Recaurte,1993). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957712/pdf/IJPsy-42-195.pdf​

Honestly pal, you just don't know what you're talking about. Please stop posting complete misinformation when you haven't even done the research to know the subject you're preaching about. You're just confusing others needlessly.

And don't you come balling in here telling me to "get it through my head right now" when you don't even have the facts straight yourself! (I think you're just sore about that cannabis thread where everyone disagreed with you.)

You have yet to post a single link to a source for the misinformation you are spouting. If you knew anything about psychopharmacology (instead of just internet quackery) you would understand the reasons why it is NOT particularly dangerous to use SSRIs with serotonin releasing amphetamines (outside of the issues non-related to serotonin efflux).

I have already explained this, but it seems YOU need to get THIS through YOUR head. Read very carefully, because I'm not going to keep wasting my time repeating this for someone who is both ignorant AND rude at the same time: SSRI drugs and SRA drugs (such as MDMA) exert their primary modes of action at the very same receptor - the serotonin transporter.

It is impossible for re-uptake to be inhibited at the same time as efflux of serotonin from that very same transporter. SSRIs stop the transporter from bringing intersynaptic serotonin back in to the neuron. Serotonin releasers REVERSE the normal direction that the serotonin transporter operates (i.e. they cause the transporter to pump serotonin out in to the synaptic gap, instead of the normal operation of bring it back in to the neuron). The serotonin transporter cannot be stopped still whilst simultaneously working to pump serotonin out of the neuron.

You cannot stop a revolving door whilst at the same time have it rotate! No matter how much you may want to believe that SSRIs prevent the mopping up of the floods of serotonin in to the synaptic gap caused by MDMA and similar drugs, it simply does not work like that.

Anyhow, you are pendantically trying to derail the thread away from it's intended purpose, which is to gather as much info as possible on various combos which may be dangerous so that they can be included in the table. If you can cite some good sources to back up anything you are saying, let's see it, because good sources is what we are looking for here. But my logical reasoning tells me you can't in this particular instance, because it defies physics. Here, I'll provide some sources which are contrary to your claims:

Experimental studies of the pharmacological interaction between MDMA and SSRIs in rat models provided evidence for the neuroprotective effects of SSRIs. Fluoxetine blocked the decrease of cortical serotonin concentration after MDMA administration (Schmidt, 1987), and it attenuated MDMA-induced increase of extracellular serotonin in hippocampus (Mechan et al., 2002), although MDMA-induced hyperthermia remained unaffected. A decrease of neurotoxic responses to MDMA was observed when animals received fluoxetine before MDMA administration or when fluvoxamine and MDMA were given concomitantly (Sanchez et al., 2001). In humans exposed to MDMA, the administration of intravenous citalopram seems to attenuate both MDMA-related physiological effects (cardiovascular activity) and subjective effects of positive mood, increase extraversion, and self-confidence (Liechti et al., 2000; Liechti and Vollenweider, 2000b).

http://jpet.aspetjournals.org/content/323/3/954.full

Duloxetine inhibits effects of MDMA ("ecstasy") in vitro and in humans in a randomized placebo-controlled laboratory study.

This study assessed the effects of the serotonin (5-HT) and norepinephrine (NE) transporter inhibitor duloxetine on the effects of 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy) in vitro and in 16 healthy subjects. The clinical study used a double-blind, randomized, placebo-controlled, four-session, crossover design. In vitro, duloxetine blocked the release of both 5-HT and NE by MDMA or by its metabolite 3,4-methylenedioxyamphetamine from transmitter-loaded human cells expressing the 5-HT or NE transporter. In humans, duloxetine inhibited the effects of MDMA including elevations in circulating NE, increases in blood pressure and heart rate, and the subjective drug effects. Duloxetine inhibited the pharmacodynamic response to MDMA despite an increase in duloxetine-associated elevations in plasma MDMA levels. The findings confirm the important role of MDMA-induced 5-HT and NE release in the psychotropic effects of MDMA. Duloxetine may be useful in the treatment of psychostimulant dependence.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3344887

In the laboratory, SSRI block MDMA induced serotonin release and they also block MDMA neurotoxicity and it has also been reported that fluoxetine does not block MDMAs reinforcing subjective effect (McCann & Recaurte,1993).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957712/pdf/IJPsy-42-195.pdf

 

[Folley]

I'm not trying to derail this thread, it's about dangerous drug combinations. SSRIs and MDMA have a negative interaction, any way you look at it. At the very least, they will dampen or completely block the effects of MDMA, so the interaction should be noted.

I did some research, and came up with a conclusive answer to this.

Firstly, I have my doctorate in pharmacology --

That being said, here's my analysis of the interaction between SSRI's & MDMA: While it seems to make theoretical sense that concurrent use of SSRI's & MDMA could cause serotonin syndrome by stimulating the release of 5HT (serotonin) while also blocking it's reuptake, this is actually NOT the case.

Basically, MDMA hijacks the 5HT reuptake transport protein & transforms it into a channel to pump out from the neuron's axon terminus even more 5HT into the synapse (thus causing the psychedelic effects). SSRI's also bind at this same site & have a higher affinity to the receptor site -- this antagonism to MDMA's receptor site is what makes SSRI's useful in the recovery period when coming down from MDMA's effects allowing a reduction in neurotoxicity.

This is my educated interpretation based on my knowledge & research on the subject but please ask if you need clarification or have something to add!

He means SSRIs used AFTER MDMA, not before... that when it's neuroprotective properties come out. If you take it before, yeah I'm sure it would protect from neurotoxicity, but then again, you won't feel anything. SSRIs by them self can cause Serotonin Syndrome... it's rare, but it can happen. That's sort of what I meant when I said MDMA and SSRIs are dangerous. It wont happen every time, and some people might get lucky, but you wont feel a thing from the combo any way and it could potentially take your life, so it's not worth the risk.

In the laboratory, SSRI block MDMA induced serotonin release and they also block MDMA neurotoxicity and it has also been reported that fluoxetine does not block MDMAs reinforcing subjective effect (McCann & Recaurte,1993).

Right, they block serotonin release, which is how MDMA gets you high, meaning that you will get almost no effects from the combo, at the very least. If you took a high dose of MDMA to try and overcome that Serotonin Syndrome could be a serious concern if the SSRI is blocking the 5-HT release

Could you find me some BL reports of this? I'm just curious because erowid says that it's safe and I trust erowid on most things drug related.

If you search for SSRI and MDMA, you get a bunch of people saying that it's dangerous because they've heard of people who have gotten SS from it... but I don't have the time to go digging through hundreds of threads to find one


At any rate, SSRIs and MDMA is a bad combination, and should be on this list.

 

[shishigami]

If you search for SSRI and MDMA, you get a bunch of people saying that it's dangerous because they've heard of people who have gotten SS from it... but I don't have the time to go digging through hundreds of threads to find one


At any rate, SSRIs and MDMA is a bad combination, and should be on this list.

I'm asking because I did some looking and found that SSRI's dull MDMA effects but not that they will cause SS when used in conjunction. I actually did searching around medical literature as well and found the article Survived Abortion posted.