Oral contraceptive and drugs interactions

Hi Doc,

My girlfriend has been in a panic lately about her contraceptive pill (mercilon). Previously she has always had a bar in her arm but switched 2 months ago to the pill. Do any of the following affect how well the pill works: Mephedrone, methylone, cocaine, mdma, alcohol or in any combination of the above?

Originally posted in SR 2.0 7/4/14 . Reviewed 8/2/23

There are no  significant pharmacological interactions between common  drugs and birth control pills. The use of substances you mention does not alter efficacy of birth control pills. Neither any other hormone-based method: patches, transdermal implants, vaginal rings …

Equally important, contraceptive efficacy of the «morning-after pill» is also not affected

There are some studies that suggest  pharmacological interactions between cannabinoids and some contraceptives . But these are experiments «in vitro» and do not seem to have any practical relevance in humans.

And the same goes for combinations. We will consider «combination» the use of moderate doses and reasonable frequencies of a few substances. «Drug salads» ( taking whatever anyone offers to you without  criteria) often have unpredictable effects, regardless of the use of contraceptives or any other medication.

In relation to drugs and hormonal contraceptives, one important exception is tobacco. Women who smoke tobacco are at increased risk of certain adverse effects.  Smoking increases hormone levels in the blood, which can lead to an increased risk of blood clots, myocardial infarction and stroke.

In addition, smoking is associated with a decrease in good (HDL) cholesterol levels and an increase in bad (LDL) cholesterol levels. This contributes also to cardiovascular problems.

It is therefore recommended that women using oral contraceptives do not smoke (especially women over 35 years of age). If a woman is unwilling or unable to quit smoking, it is reasonable to consider another method of contraception.

Like many other drugs, oral contraceptives are used on a daily basis.So, it is important not to forget doses in order to maintain their effectiveness. This can be significant in the context of a rave or party lasting several days. In any case, weekly or monthly contraceptives are available for people who have a tendency to forget to take a drug every day.

High dosage MDMA risks

Doctor, very important question:

I am concerned risks about high dosage MDMA. I took MDMA with a friend, for each was the first time. I guess i may think that i have a strange natural tolerance to any drugs, since I’ve tried speed, coke, also DOM, and less more than nothing came. And so i decided to use a quite large amount of the substance, it would has been 0,5 for me 0,4 for him.

The fact is before we was pretty drunk too, and after 10 minutes I drank it in a glass of water I was beginning to fell the effects, some time after I WAS NO LONGER MYSELF. I’ve never felt, like i said, something that before. my friend was having a great time too. We hugged, danced, even while there were moments in which I struggled my friend was ever felt good.
the day after him was acting in a strange way, kinder than usual, talkative with people who didn’t know, and what fears me, a bit stupid, asking stupid question… and this not only the day after, but the second and the following

this is the fourth day, we have returned from holiday and I won’t longer see him very often… ah, I am 80 kg and him… mmh he’s tall 2 metres so will be 90 kg or so.

my question is: I’m have to be afraid? or him are experiencing only longer side effect? i’m really worried…

I can definitely say that it was my first experience whit a drug, weed isn’t ever comparable with this, that sensation to be out of mind… but what’s the reason? why only md has affected me? it can be the setting of the moment, while I was in good mood by alchool?
I didn’t expect to fell sensations this great, I am a little afraid now although i don’t fell particularly strange, only tired for lack of sleep, so I hope nothing happened at least to me

really thank you doctor

Originally posted in SR 2.0 3/8/14 . Reviewed 10/02/23

Common recreational dosage of MDMA are is 1.5- 2 mg/kg, or 100-150 mg for someone of average weight. These are the same dosages used in clinical trials. For beginners, a somewhat lower dose of 70-100 mg is recommended.Women need slightly lower doses to achieve same effects than men.

Taking a high dosage of 400 or 500 mg can be dangerous and result in adverse or toxic effects. Additionally, mixing with large amounts of alcohol can worsen the situation.

It’s important to remember that just because you may have tried other drugs in the past or require a high dosage to feel the effects, this does not mean that the same is true for MDMA.

In most cases, high doses of MDMA are not typically associated with long-term toxic effects.Usually, symptoms diminish with time and dissapear in a few days. Good quality sleep helps.

In reality, high doses of MDMA are not typically associated with long-term toxic effects. Symptoms may diminish and eventually disappear in the days following use. However, if they persist for more than 7-10 days, it’s advisable to seek medical advice. This is, however, a rare occurrence. Most people recover after a few days of rest and good quality sleep.

High dosages increase risk of appearance and severity of MDMA adverse effects

MDMA, SSRI antidepressants and serotonin syndrome risk

Does combining MDMA with an SSRI lead to an increased risk of serotonin syndrome?

Originally posted in SR forum 6/7/13 . Reviewed 9/2/23

There have been many clinical trials in humans co-administrating different SSRIs (paroxetine, citalopram, sertraline…) to study pharmacological properties.




There is a theoretical risk but it is probably overestimated. According to a recent systematic review (one of the highest quality methods of scientific research)  this situation is exceptional.


Anyway, combination of MDMA and SSRI is not recommended.

First because, in general, it lowers MDMA effects.

Second because people under SSRI treatment usually suffer problems as depression or anxiety disorders and, MDMA is not recommended because of these problems.

In animal models combination of MDMA and some SSRI showed lower neurotoxicity.But doses and patterns of administration make that these results can´t be extrapolated to humans. It is not likely that SSRIs have a neuroprotective effect in humans at doses available.

In my opinion risk of neurotoxicity associated to MDMA is sometimes exagerated. There is no evidence that occasional moderate doses (lower than 120-150 mg) have any neurotoxic effects. In fact at least four investigation teams have been administrating MDMA to healthy human volunteers in clinical trials with the approval of sanitary authorities and ethical comitees of clinical trials. In this case neuroprotective drugs are unnecessary. People who take large doses during long time are probably more exposed to this risks, and in this case there are no neuroprotective measures that have shown efficacy.

Substances that inhibit monoamine oxidase (MAOI: phenelzine, moclobemide) are most likely to lead to serious increases in serotonin when used with ecstasy, and develop a serotonin syndrome. In people who use these drugs MDMA is absolutely not recommended.

Cocaine dependence potential

Just out of curiosity.

How often a week doing coke up the nose will be heading for a serious habit?

I’ve found my cola usage is going up a bit now I have found some decent quality gear & I’ve been using 1mg Xanax to ease the comedown & help me fall asleep which it does perfectly.

I understand that everybody’s different with regards addiction & tolerance levels but any imput from you would be really appreciated

I’m going through about a gram per week, spread out from the weekend & a session midweek sometimes, would it be a good idea to slow down for a while as I find coke very moorish just lately which has got me thinking…

Thanks Doctor X, your a very worth while addition to the forum

Originally posted in SR 17/5/11 . Reviewed 9/2/23

The question is very difficult to answer…. How much sex is too much sex? How many drugs are too many drugs? In some situations there are objective parameters to measure normality versus disease (from obesity to hypertension). But in drugs things don’t work like that…..

In my opinion, it is not always the professional (doctor or whatever) who has the final say on whether someone is using or abusing drugs. There are scales and classifications that change every few years that can serve as a guide.

But at the end of the day, it is up to the user to measure whether his or her own drug use is appropriate for the personal, social, work or family activities he or she wants to pursue. It is also important to do the exercise of not using for a period of time and to see to what extent one feels (or not) the need to use substances in those circumstances where use is habitual.

In general, routine or cyclical patterns of use of substances with high addiction potential (in the case you mention, cocaine and benzodiazepines) end up causing problems of abuse or dependence (or «use disorder» according to the latest fashions). In my opinion, «a gram of cocaine every week» can cause problems in the medium term if it becomes routine. In your message you suggest that you think/feel you need to curb your pattern of use, follow your instinct….

By the way, this is the correct way to make a coke line.

Adverse effects of synthetic cannabinoids

Hi, Dr. X
About 9 months ago I smoked some synthetic cannabis and had a really horrible time, about 5mins in my vision started to go all cartoony like on a psychedelic then that subsided quickly and a buzzing started in my head, a tiny bit similar to real cannabis, but it kept getting stronger and stronger until it felt like someone was shaking my brain from side to side really violently my vision was also shaking really strongly side to side. When I closed my eyes there were fairly weak CEV’S, I started to panic and was very close to going to the hospital but I just held back ,I can’t tell how long it lasted but I’d guess an hour.

It shook me up a bit but I forgot about it until I started to notice 1-2 months later I wasn’t really enjoying smoking cigarettes anymore, it wasn’t a relaxing break anymore but just something I had to do. It then became quite nasty when I smoked; it tasted bad, it hurt my chest (it never used to) and if I smoked a full cigarette I’d get a bad headache and a tingling in my hands (like pins and needles) and would have to sit down for 5-10 mins.

Worse is that the same has happened to weed, It must have been about 4 months after the synthetic stuff that I tried real weed again. It started to kick in and felt OK for about 5mins then it started to get fuzzy and a bit confusing and it kept on getting worse and was just really not nice I fell asleep and woke up 3-4 hours later feeling really rough. I’ve tried 3 other strains since then with the same results every time. I tried some some cannabis oil I made myself but it was sort of the same feeling but a bit weaker.

Last night I tried DMT for the first time I took roughly 50mg probably less I had trouble vaporizing it ( first time ) but I didn’t really feel anything so I took some more and I started to feel something but it wasn’t nice and no real visuals it started to feel a tiny bit similar to when I smoke weed so I stopped. I want to try again but I’m worried the same thing will happen.

I don’t know if it’s related but about a month after the synthetic weed I took MDMA everyday for 5 days in a row about 2g in total (I know this is really stupid) the week after I had some really bad symptoms. I generally felt ill, when I tried to sleep just before I would fall asleep I would get a feeling like an electric shock through my body and jump up, this would happen 4-5 times before I fell asleep this happened for a week before it stopped then a week later I started getting pins and needles all over my body, it was pretty unpleasant. I guessed it was something to do with the CNS so I started to drink a couple of beers when it started because alcohol is a CNS depressant I think? this did dull the tingling a bit, a week later this stopped too I took a 5 month break and now I’m fine with MDMA.

I’ve had cocaine, LSD, speed, MDMA and methylone several times since and had no problems ( the comedown on the coke was really bad but it was much better quality than I’ve ever had) I’m really starting to worry something permanent has happened to the way my brain reacts to these things any help would really be appreciated. Sorry for the long post and thanks a lot for reading

Originally posted in SR 21/4/14 . Reviewed 8/2/23

The metaphor of drug users as «guinea pigs» when using MDMA, amphetamines or LSD is part of drug legends designed to scare people. However, it seems to have become a self-fulfilling prophecy in recent years.

THC and CBD, key components of cannabis, have been used for millennia and their effects and risks are well known. Synthetic cannabinoids, by contrast, are thousands of different molecules designed to bind to cannabinoid receptors. They are sometimes marketed, because they are not technically illegal, although their potential health risks are much higher than those of cannabis.

Psychotic-like symptoms occur more frequently in synthetic cannabis users than in hashish and marijuana users. These are usually transient symptoms, although they can be reactivated by other psychedelics. It is wise to take a long time off from any psychoactive drugs.

The type of cramp you describe is known as «brain zap» and is a relatively common effect after using very high amounts of MDMA.