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St John’s Ward interactions

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I got a quick question:

I’ve started taking St. John’s Wort extract with amazing results (treating a mild – moderate depression).Do you know how long before taking MDMA I have to discontinue St. John’s in order not to get into a dangerous situation like serotonin syndrome or spoil the roll?

What about Amphetamines? Are they dangerous whilst on St. John’s (I figured no because they are not acting on serotonin that much)? Are you aware of any other drugs that might be dangerous with St. John’s?

Do just the same rules apply to St. John’s as to any «regular» SSRI in regards to drug use? I have done an extensive research on the internet but couldn’t find an answer

Originally posted in SR 2.0 7/5/23 . Reviewed 4/2/23

St. John’s Wort is a popular herbal supplement often used to help with depression and anxiety. Some people think that because it comes from a plant, it’s a more natural and healthier option. But it can interact with other drugs and medicines.

St John´s Wort acts like a monoamine oxidase inhibitor. So, theoretically, it could induce severe adverse effects in combination with drugs whose mechanism of action is related to dopamine, norepinephrine and/or serotonin liberation.

This includes MDMA, LSD, amphetamines, cocaine, psilocybin.

The use of ketamine , GHB or cannabis is probably safe .No toxicity has been reported and according the pharmacological mechanisms an interaction does not seem likely. Anyway this combinations are no recommended, as they could worsen or trigger depressive symptoms.

To be safe, it’s a good idea to stop taking St. John’s Wort for a couple of weeks before starting any other new drugs

LSD and nitrous oxid combination

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I have a more specific question concerning N2O (mixed with other substances like LSD).Over the last couple of months it has become somewhat if a ritual for me to induce myself into an LSD trip once or twice a month, very often with the assistance of short nitrous oxide «flashes».Now I know the effects it creates: Next to light headedness, slight euphoria and halluzinogenic coloring, I get a strong visual and sonic «echoing». Visual in the case that it’s like you are only able to see one still picture, and after the effects of the N2O slowly wear off, more and more of your surrounding increasingly starts to move again, but in an «echoey» way.This lasts for around 1-2 minutes, as usual.The last time I did such a LSD-N2O session though, one of these echoing «flashes» lasted worryingly long… I’m guessing well over half an hour!Does anyone remember the movie Riddick, when the Lord Marshal had this ghosting effect on his body? Imagine that, but on everything that is moving in your viewing field, and at much stronger effect!During that time you begin to panic because the effect isn’t wearing off, until you settle down and consider that a) the LSD is prolonging the effect and it will slowly wear off with the drug, or b) you have caused yourself an irreversible amount of brain damage.Thankfully it did wear off and I’m feeling fine again, but obviously it made me reconsider this practise of mixing both drugs to that extent. We’re talking about 300-400ug LSD plus ten capsules of gas in a five hour time frame…I know that neither LSD nor N2O have been tested scientifically to an extent, or even combined, and that a high amount of nitrous oxide can cause brain damage and B12 deficiency.But I’m asking myself HOW dangerous this mix is, and if there have been reports of N2O effects lasting that long, and/or if the effects are «normal» and how dangerous they are…Sorry for writing down the whole story, but it genuinely scared me and I wanted you to have a detailed picture of the situation, maybe you can help me out with some insight!

Originally posted in SR2.0 5/4/14 . Reviewed 4/2/23

LSD, is a powerful psychoactive substance known for its mind-altering effects. Effects can vary widely, and this variability is wider if it is combined with any other psychoactive substance. 

LSD is generally considered to be non-neurotoxic, even at high and frequent doses. 

Long-term exposure to high doses of nitrous oxide (N2O) can lead to neurotoxicity. N2O is a potent anesthetic and can cause a decline in vitamin B12 levels, which can lead to nerve damage. Chronic exposure to N2O can also lead to other adverse effects, such as memory impairment, balance problems, and cognitive decline. However, occasional or low-dose exposure to N2O is not considered to be neurotoxic

However, it is important to be cautious when combining LSD and other substances, including N2O. While the combination of these substances may not have serious neurobiological effects, it can still trigger panic attacks or unpleasant experiences for some individuals, depending on the doses used and personal characteristics.

Tooth ache, LSD and 2C-B

DoctorXFiles

For tooth pain, would it be safe to use a topical cream such as Orajel when taking LSD & 2cb?

Originally posted in SR 2.0 4/6/22 . Reviewed 3/2/22

Topical creams and psychedelics usually do not interact with each other.

However, it is important to note that psychedelics can significantly affect pain and bodily sensations, potentially altering them, intensifying them, or even giving them a different meaning.

If you have previous experience with psychedelics, you may understand this concept.

When considering the use of psychedelics, it is important to take this factor into account. To get the most out of your experience, it is advisable to use psychedelics when you are in good physical health, if possible

MDMA, amphetamines and breast-feeding

DoctorXFiles

Should MDMA and amphetamines be avoided during lactation? Is it strictly forbidden or risks are acceptable?

Originally posted in SR 2.0 31/10/2013. Reviewed 20/2/22

The relation between MDMA and lactation is not clear. As far as I know, there are no published studies on this particular issue. Available data on amphetamine show that «In dosages prescribed for medical indications, some evidence indicates that amphetamine might not affect nursing infants adversely.». On the other hand, data from methamphetamine show that meth is secreted to breast milk and it should be avoided.

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~LJwPas:1

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~LJwPas:2

In my opinion, it is basic to avoid use that can be harmful to third persons. A person can asume risks for himself but not for others, even less a baby. So there would be three options:

1) Wait to finish lactation and then use MDMA or amphs

2) Interrupt natural lactation (use artificial milk) and use MDMA or amphs

3) Collect enough milk for 3-4 days (using a breast-pump), keep it in the fridge and use it during the following days to MDMA or amphetamines use.

 

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Tramadol for methadone withdrawal

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Tramadol for methadone withdrawal

I’ve been on methadone for 1.25 Years now, and I’ve been on a steady dosage of 20mg every 24 hours (oral dose). However, I bought it illegally the entire time, as the local methadone clinics have a waiting list that aren’t worthwhile to me.

2 days ago, my «source» sold it off on me, so now I’m left to be sick for the next 6-7 days. I have access to the following pills. But I’m not quite sure if they are worthwhile for someone who is methadone sick. (I know 20mg is not much, but its not comfortable being sick from it for a week).

The pills are: Zytram XL 400mg aka Tramadol Hydrochloride 400mg

Originally posted in SR 2.0 27/10/2013. Reviewed 20/2/22

Compared to other opioids, methadone withdrawal symptoms tend to be slower to onset, longer in duration, and milder in intensity. But it can last for several weeks or even months. This is because methadone has a longer half-life than most other opioids, meaning it stays in the body longer.

Symptoms of methadone withdrawal may include nausea, vomiting, diarrhea, stomach cramps, anxiety, restlessness,  and cravings for the drug. However, unlike other opioids, methadone withdrawal symptoms tend to peak later (around 72 hours after last dose) and last longer (up to 3-4 weeks) due to its slow elimination from the body.

Tramadol is a weak μ-opioid receptor agonist, a serotonin releaser and a reuptake inhibitor of norepinephrine. It has some opioid properties but not acting as a strong opioid. At least in theory it is not a good option for avoid methadone withdrawal.

There are not availabnle studies for methadone detoxification using tramadol. There is a study comparing tramadol (200 mg/8h) and methadone (20 mg/ 8 h), for treating opioid withdrawal in 70 people. The researchers found that both drugs worked similarly well in reducing withdrawal symptoms, but the methadone group experienced more pain. 

Methadone is a medication that is used to treat opioid addiction and is listed as an essential medicine by the World Health Organization (WHO). However, its availability and accessibility vary greatly across different countries and regions.

In some countries, methadone is widely available through government-run treatment programs and healthcare facilities. For example, in Europe, methadone is a commonly used medication-assisted treatment for opioid addiction,  available through licensed clinics and providers.

In other countries, however, access to methadone is severely limited or even illegal. For example, in some parts of Asia, methadone treatment is often inaccessible due to government policies and cultural attitudes towards addiction. This can lead to increased stigma and discrimination against people who use drugs, as well as higher rates of HIV and other health problems.

The availability of methadone is also tied to broader drug policies and human rights issues. In many countries, drug policies prioritize punishment and criminalization over harm reduction and healthcare. This can lead to people who use drugs to deal with stigmatized, criminalized, and denied access to vital healthcare services.

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Ketamine as antidepressant

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How can I use ketamine as antidepressant?

Originally posted in SR 2.0 27/10/2013. Reviewed 20/2/22

Ketamine is a drug that works as a non-competitive antagonist at glutamate N-methyl-D-aspartate (NMDA) receptors. Its main use is  dissociative anesthesia. It was found to have antidepressant properties in 2000. Then,  subsequent studies have shown it to be effective in treating treatment-resistant depression (TRD) with a rapid clinical effect within several hours.

However, its antidepressant properties are transient. It lasts around  1 week following a single infusion and 18-19 days following repeated infusions. Ketamine has also been reported to have anti-suicidal and anti-anhedonic actions

Ketamine has been found to have a rapid antidepressant effect in several studies, with multiple meta-analyses concluding that it is effective for major depressive episodes in both unipolar and bipolar depression. While some studies suggest the effect can last up to 7 days, others suggest it may be shorter in bipolar depression. And other modalities of ketamine administration such as intranasal and oral routes have been studied. But their efficacy is less clear.

Intranasal esketamine has been approved by the FDA for major depression that has failed treatment with two or more antidepressants, with studies showing significant improvement in depression at 4 weeks compared to placebo. Ongoing trials are being conducted to track safety outcomes up to 5 years and explore the efficacy of R-ketamine.

Recent studies show that ketamine has strong antidepressant properties. Typical dosage is 0.5 mg/kg intravenous in infussion in 30-40 minutes; oral route seems also effective at that dosage (0.5 mg/kg). The effect is fast and strong but not lasting in time, it disappears in hours or days and further dosages do not reply this effect.

With actual knowledge, Ketamine may prove useful in a select group of patients but current medical knowledge looks to other treatments as the first line against depression
http://www.ncbi.nlm.nih.gov/pubmed/23661785

http://www.ncbi.nlm.nih.gov/pubmed/23805864

http://www.ncbi.nlm.nih.gov/pubmed/23825857

http://www.ncbi.nlm.nih.gov/pubmed/23893490

 

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