Dangerous Combos

Contents 1 Alcohol 2 Benzodiazepines 3 CNS Depressants 4 DXM 4.1 MDMA 4.1.1 Ways to avoid this combo 4.2 Other recreational drugs 4.3 Prescription drugs 5 GHB 6 Hallucinogens 7 Ketamine 8 Marijuana 9 Methadone 10 Opiates and Opioids 11 Remeron (mirtazapine) 11.1 Mushroons 12 Stimulants 13 Tramadol 14 Bluelight Combination Fatality Reports 15 Remember: Dosages 16 Protease Inhibitors and other Anti-HIV/AIDS drugs 16.1 Speed/ecstacy 16.2 Alcohol and sedatives 16.3 Heroin, marijuana and cocaine 16.4 GHB 17 MAOIs

Alcohol

It is dangerous to combine anything with alcohol that makes you sleepy (see CNS section). This includes opiates/opiods (heroin, morphine, Demerol, Percocet, Oxycontin), barbiturates, benzodiazepines (Xanax, Valium, Ativan) and GHB. It should also be noted that a large percentage of deaths and hospitalizations associated with Ecstasy have usually involved a combination with alcohol.

Benzodiazepines

This is a class of drugs that is intended for the relief of short-term anxiety. Alprazolam (Xanax), bromazepam (Lexotan), clobazam (Frisium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), prazeman (Centrex), oxazepam (Serenid), flunitrazepam (Rophynol), temazepam (Euhypnos), and Triazolam (Halcion) are all benzodiazepines. While these drugs are not particularly toxic by themselves, at certain doses, amnesia-like side effects result in reduced inhibition, impaired judgment, poor coordination, and slower reaction time. All of these things can lead to unsafe behavior. When combined with other CNS depressants (see above), like alcohol, and/or opiates, benzodiazepines can lead to shallow breathing, respiratory failure, and even death.

CNS Depressants

Central nervous system [CNS] depressants are drugs that slow down brain activity. CNS depressants include a wide range of drugs such as alcohol, barbiturates (Amytal, Nembutal, Seconal), benzodiazepines (Ativan, Halcion, Librium, Valium, Xanax), chloral hydrate, GHB, GBL, methaqualone (Quaaludes), buspirone (Buspar), and zolpidem (Ambien). CNS depressants can cause confusion and dizziness, and impair judgment, memory, intellectual performance, and motor coordination, especially when taken in excess and combined with one another. When mixed together, CNS depressants amplify each other's effects, which can cause severely reduced heart rate and even death. Overdoses of depressants produce effects that are the same as alcohol overdoses. The person becomes extremely drowsy and passes out. Their heartbeat slows and respiration will become shallow. Their skin may feel cold and clammy, and death may result from respiratory failure. CNS depressants are also dangerous when combined with opiates and opioids (like codeine, hydrocodone, oxycodone, and heroin).

DXM

MDMA

MDMA inhibits the body's ability to regulate its temperature, often overheating the user. DXM inhibits sweating and when combined with MDMA can induce hyperthermia.

Also, DXM and MDMA are broken down by the same enzyme in the liver. When both drugs are taken, the enzyme can't break them both down and liver damage may occur.

Ways to avoid this combo

Don't roll if you have been using cold medicines with DXM in them. Don't mix brands of pills that haven't been EZ-Tested (because DXM is sometimes found in pills).

If you've taken this combo, stay cool. If you are in a rave or party, go to an outside chill area. Drink enough water to stay hydrated, but no more than 2 liters per hour.

Other recreational drugs

Do not mix:

• DXM & barbiturates
• DXM & moderate or more benzodiazpeines
• DXM & amphetamines - high blood pressure
• DXM & opiates - risk of respiratory failure
• DXM & yohimbine or any other alpha-2 adrenergic antagonist - Olney's Lesions

Prescription drugs

Antidepressants: MAOIs (monoamine oxidase inhibitors) are the worst; DXM + a MAOI will kill you. DXM with other antidepressants can cause serotonin syndrome, an unpleasant and occasionally fatal condition.

Diet drugs like phentermine, fenfluramine (Redux), or phen-fen. Again, a risk of serotonin syndrome.

Non-drowsy antihistamines (allergy medicines) like Allegra, Seldane, or Hisminal.

GHB

Do not take GHB if you are taking:

• benzodiazepines ("minor tranquillisers" such as Valium and Xanax)
• phenothiazines ("major tranquillisers" like Thorazine and Stellazine)
• various painkillers (barbiturates and opiates)
• alcohol
• anticonvulsants (Dilantin and phenobarbital)
• many over-the-counter allergy and sleep remedies
• any other CNS depressants

The absolute minimum time between taking GHB and taking alcohol is four hours, and you should make it six-eight hours if you are really drunk . GHB's effects last maximum 3 hours unless you boost of course.

Also, do not take GHB if you suffer from any of the following conditions:

• severe illness of any kind
• epilepsy
• convulsions
• bradycardia or slowed heart-beat
• Cushing's syndrome
• severe cardiovascular disease
• severe hypertension.

This information was obtained from a vendor, so the original author didn't post a link.

Hallucinogens

This is a class of drugs that includes LSD, PCP, ketamine, mushrooms, mescaline, and Ecstasy. The most dangerous combination is the combination of PCP-like drugs with alcohol or other sedatives. This combination can kill you. Taking atropine-like drugs with anything that stimulates the cardiovascular system or raises the body temperature (like Ecstasy) can lead to dangerous disturbances of heart rhythms or increased body temperature. Hallucinogens with amphetamine-like actions (like mescaline) can be dangerous when taken in combination with other stimulants. This goes for Ecstasy (MDMA) also. MDMA, which has stimulant properties, may cause a user's heart rate to rise to dangerous levels when used in combination with other stimulants, like cocaine or methamphetamine (also see Stimulants below). Reactions may vary from person to person. As always, err on the side of caution.

Ketamine

Using ketamine and alcohol is a dangerous combination. At lower levels, nausea and sickness will result. At higher levels serious health problems can occur. Ketamine, by itself, is valuable in a medical setting since it slows breathing at a lower rate than other anaesthetics. But combining ketamine with another CNS depressant, including GHB, can slow down breathing to a dangerously low or even fatal level (see CNS Depressant section). PCP (phencyclidine), like ketamine, is also an NMDA antagonist. As such, combinations with ketamine, alcohol, and other CNS depressants can also lead to negative health consequences.

Marijuana

Possible dangerous combinations include a mix of marijuana with heart or blood pressure medication or with drugs that supress the function of the immune system. One recent study shows that the combination of marijuana with cocaine can lead to very dangerous effects on the heart.another dangerous combination is alcohal and marijuana because it can cause dizziness,tiredness, depression, nauseousnes, and crossfaded. these are some side effects with alcohal and marijuana combination.

Methadone

Methadone magnifies the effects of alcohol and other central nervous system [CNS] depressants, such as antihistamines, cold medicines, sedatives, tranquilizers, other prescription and over-the-counter (OTC) pain medications, barbiturates, seizure medications, muscle relaxants, other opiates, and certain anesthetics including some dental anesthetics. Some dentists use a drug called Stadol (butorphanol artrate) which is a narcotic agonist/antagonist that reportedly will send a methadone user into acute withdrawl. Opioid partial agonist and agonist/antagonist drugs such as Buprenex, Talwin, Stadol, and Nubaine should never be used in the methadone-tolerant individual. Severe opiate withdrawal syndrome can be precipitated by drugs of this type. Alcohol and other central nervous system depressants should not be taken or consumed while methadone is being taken. Combinations taken in excess can lead to shallow breathing, respiratory failure, and, ultimately, death.

Opiates and Opioids

This is a class of drugs that includes opium, heroin, morphine (MS Contin), codeine (Tylenol 2, Tylenol 3, Tylenol 4), hydromorphone (Dilaudid), oxycodone (Percodan, Percocet, and Oxycontin), meperidine (Demerol), hydrocodone (Vicodin, Norco, Lortab), propxyphene (Darvocet and Darvon), fentanyl (Duragesic and Actiq), and others. Like alcohol, opiates are dangerous when used in combination with drugs that suppress breathing. These include alcohol, barbiturates, benzodiazepines (Xanax, Valium, Ativan), CNS depressants (see above) and GHB. Combining opiates with other drugs that make you sleepy can basically lead the user into a sleep from which they will never wake up. It should be noted that opiate overdose is easily treatable and can be counteracted with Narcan available at your local emergency room. Some opioids, such as pethidine/meperdine (Demerol), can be dangerous in combination with stimulants, SSRIs and MAOIs, as they are also serotogenic and can lead to seizures, serotonin toxidrome and death. Be aware of synthetic opioids and anti-depressants and ask or look up if that opioid is known to interact in that manner before dosing.

Remeron (mirtazapine)

Mushroons

Reported by Fairnymph: no medical evidence, just my own personal experience. I had extreme difficulty breathing for 1-2 hours, irregular, slowed heart rate. I almost went to the ER, but fortunately I got through the breathing bit. It may be because I run daily that my heart got me through, so I expect that for normal people the interaction would be even worse.

Stimulants

This is a class of drugs that includes cocaine, methamphetamine (Desoxsyn), amphetamine (Adderall), MDMA (ecstasy -- which has hallucinogen and stimulant characteristics), dextroamphetamine (Dexedrine), methylphenidate (Ritalin), and dexmethylphenidate (Focalin). Stimulants can be dangerous when taken in combination with over-the-counter cold remedies that contain decogestants because the combined effect of the two can raise blood pressure to a dangerous level. Stimulants can also be dangerous when taken in combination with MAOIs. Cocaine is dangerous in combination with anything that makes people more sensitive to seizures, such as the prescription medication buspirone or extremly high levels of xanithines, like caffeine or theophylline. Stimulants are also dangerous when taken in combination with one another. Negative effects include heart attack, stroke, and death. People with a history of hypertension or other heart problems are especially susceptible problems associated stimulant and stimulant combinations.

Tramadol

Reports have indicated that tramadol (Ultram and Ultracet) is more likely to induce seizure activity when given together with a selective serotonin reuptake inhibitor (SSRI. Use of tramadol with MAO inhibitors or SSRIs increases the risk of adverse events, including seizure, serotonin syndrome, and even death. Use of tramadol with CNS depressants increases the rate of respiratory depression.

Bluelight Combination Fatality Reports

• Methadone + Xanax
• Tramadol + SSRI
• Morphine + Xanax

Remember: Dosages

Please note that while some may use one of the dangerous drug combinations listed above at low doses without negative consequences, even a small step up in dose can multiply the health risk by a greater factor where drug combinations are concerned. A person in an altered state of consciousness does not always use the best judgment – so please be careful and ALWAYS err on the side of caution.

This is mostly a list of cytochrome P450-2D6 inhibitors, which i suggested for addition here earlier. It mostly applies to DXM, but note that mixing any two drugs on the list may potentially be dangerous, since mixing a drug with potentially harmful effects (like DXM) with even small amounts of another cyp-2D6 inhibitor can cause both drugs to accumulate to dangerous levels in the body (since they can't be broken down). There's also some other stuff about MAOIs.

MAOIs DXM + an MAOI is a dangerous combination; Robitussin DM is not okay, probably not even in normal doses. for a while, i took Manerix (moclobemide), which is a reversible MAOI, and was expressly warned never to mix it with cough medicines containing DXM. even though the dietary limitations for tyramine intake (like, no tomatoes, no cheese) don't apply to reversible MAOIs, there are still a few restrictions: no more than 300 g of aged cheese or 1000 g of any cheese, and no products derived from yeast, like Marmite and Vegemite. you also cannot mix them with DXM. to many people, this may be irrelevant, because there are no reversible MAOIs approved for use in the US.

CYP-2D6 Inhibitors There are a large number of drugs that inhibit the action of the liver oxidoreductase enzyme cyp-2d6 (cytochrome p450-2d6). This enzyme is responsible for metabolizing a number of drugs, including MDMA and methamphetamine. Mixing a cyp-2d6 inhibitor with MDMA or crystal, or mixing two or more inhibitors, is considered highly dangerous because it prevents you from eliminating the drug, meaning that it will be present in higher concentrations for a longer time.

This list of CYP-2D6 and CYP-3A inhibitors is from the DXM FAQ, with some annotations:

   * ajmalicine 2D6 strongest (164)
   * carbon monoxide poison 2D6 (160)
   * chloroquine antiparasitic 2D6 med-low (172)
   * chlorpheniramine (found in some cough medicines and anti-allergic preparations) antihistamine 2D med-high (151)
   * citalopram antidepressant 2D6 med-low (166)
   * clozapine antipsychotic 2D6 low (171)
   * desipramine tricyclic antidepressant 2D6 low (152)
   * diphenhydramine (Dramamine, Gravol, Benadryl) antihistamine 2D med-high (151)
   * doxorubicin anticancer 2D6 med-low (165)
   * fluoxetine (Prozac) antidepressant 2D6 med-high (152)
   * fluvoxamine (Luvox) antidepressant 2D6 med-high (152)
   * imipramine tricyclic antidepressant 2D6 med (152)
   * lomustine anticancer 2D6 med (165)
   * mepyramine antihistamine 2D6 high (151)
     methadone addiction treatment 2D6 med (162
   * moclobemide (Manerix) MAO-A Inh. (reversible) 2D6, also 2C19, 1A2 (147)
   * nortryptiline (Elavil) antidepressant 2D6 med-low (155)
   * oxamniquine antiparasitic 2D6 med-low (172)
   * paroxetine (Paxil) antidepressant 2D6 high (152)
   * PCP recreational 2D (150)
     - if this is true, then ketamine may be an inhibitor as well.
   * primaquine antiparasitic 2D6 med-low (172)
   * propranolol beta-blocker 2D6 low (156)
   * quinidine 2D6 (148)
   * quinine antiparasitic 2D (151)
   * sertraline antidepressant 2D6 med-high (167)
   * triprolidine antihistamine 2D med-high (151)
   * vinblastine anticancer 2D6 med-low (165)
   * vinorelbine anticancer 2D6 med-low (165)
     - Drug Uses P450-3A Enzymes Potency Ref
   * 7,8-benzoflavone 3A4 (activator) (153)
   * cannabidiol component of marijuana 3A med (161)
   * cocaine recreational 3A low (157)
   * clotrimazole agricultural fungicide 3A (activator) very high (154)
   * cyclophosphamide 3A low? (158)
   * ifosfamide 3A low? (158)
   * ketoconazole 3A (145)
   * pilocarpine cholinomimetic 3A low (149)
     - Drug Uses P450-3A Enzymes Potency Ref
   * 1-aminobenzotriazole Nonspecific med-high (159)
   * chlorophyllin geriatric Nonspecific (146)
   * general anaesthetics Nonspecific (163)

Protease Inhibitors and other Anti-HIV/AIDS drugs

(Taken from "Medical Drug Interactions with Street Drugs" by Julie Klems, Needle Exchange Emergency Distribution (NEED), Berkeley, CA, USA).

Speed/ecstacy

Can be deadly when taking these medications. Anecdotally, people say that you become very sensitive to speed, ecstasy and ketamine when on protease inhibitors.

Alcohol and sedatives

Tolerance is also lowered by these medications.

Heroin, marijuana and cocaine

Anecdotally people say that they have typical/usual reactions when taking anti-HIV/AIDS medications. Be warned, however, that cocaine dramatically increases the proliferation of the virus in your body. Avoid speedballs if at all possible; if you must get a fix, try to use heroin by itself.

GHB

The interaction of GHB with these medications is unknown but people are encouraged to exercise extreme caution.

MAOIs

Drugs to avoid when taking MAOIs, and two weeks after stopping MAOIs are:

• Amphetamines --- speed
• MDMA --- Ecstasy and related substances (MDE, MDA etc)
• Cocaine and crack
• DXM
• All SSRIs (prozac, zoloft, and several other anti-depressants): SSRIs block the reuptake of serotonin in the brain. Because MAOIs inhibit the breakdown of serotonin, the combination of MAOIs and SSRIs can lead to dangerously high levels of serotonin in the brain (serotonin syndrome).
• Demerol
• Cold preparations (tablets, capsules, or liquids such as Comtrex)
• Cough medications containing decongestants or Demerol (Plain Robitussin is OK)
• Sinus medications
• Nose drops or nasal sprays, nasal decongestants
• Hay fever medications
• Diet pills

This is sourced from Erowid

Reversible MAOIs, such as Syrian Rue will potentiate LSAs, Psilocybin/Psilocin, DMT, Mescaline, various other phenethylamines & tryptamines. It's possible to overdose by going overboard with MAOI potentiation.

Finally, there are foods to be avoided with MAOIs, detailed at Erowid.