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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by SalArmy4me on September 8, 2001, at 16:59:07
Why do they put Dextromethorphan in Ecstasy pills? Is it serotonergic?
Posted by MB on September 8, 2001, at 17:19:30
In reply to DXM in Ecstasy, posted by SalArmy4me on September 8, 2001, at 16:59:07
In large doses, it's a dissociative like PCP or ketamine. They put it in there because it's cheap, legal, and it gets people "high." Then they can skimp on the MDMA which is a lot more expensive.
> Why do they put Dextromethorphan in Ecstasy pills? Is it serotonergic?
Posted by fachad on September 8, 2001, at 18:00:53
In reply to DXM in Ecstasy, posted by SalArmy4me on September 8, 2001, at 16:59:07
DXM, dextromethorphan, is the active ingredient in Robatussin Cough syrup.
It is an OTC medication that is widely used in a recreational context. In medical doses, it suppresses cough.
In higher doses it is dopanergic, and it has affinity for the NDMA receptor, as do other disassociate psychedelics like ketamine and ecstasy.
I'm sure they put it in pills and sell it as ecstasy for the same reason they used to put caffeine in pills and sell it as amphetamine - DXM is legal and easy to obtain and could fool a naive user into thinking that what they paid for and are tripping on is really ecstasy.
And Sal, just in case you're thinking of trying it, to add to your cocktail, don't. There is solid evidence that it causes PERMANENT BRAIN DAMAGE, in the form of "Olney's Lesions".
Here is a link with plenty of subjective descriptions of the DXM psychedelic experience, as well as links to scientific papers on the psycho-neuro-pharmaceutical properties of the drug as well as the new evidence for "Olney's Lesions".
http://www.erowid.org/chemicals/dxm/dxm.shtml
> Why do they put Dextromethorphan in Ecstasy pills? Is it serotonergic?
Posted by Cam W. on September 8, 2001, at 18:22:42
In reply to Re: DXM in Ecstasy » SalArmy4me, posted by fachad on September 8, 2001, at 18:00:53
> DXM, dextromethorphan, is the active ingredient in Robatussin Cough syrup.
Fachad - Actually guaifenecine is the active ingredient in Robitussin™ and dextromethorphan is an active component of Robitussin DM™.
DM has also been tried, in high doses, for neuropathic pain, in British Columbia (Victoria, I believe). It does seem to have nocieceptive activity, in some people; but researchers say that, because of the psychotomimetic side effects, it should not be used as a first line agent.
- Cam
Posted by kazoo on September 9, 2001, at 0:01:45
In reply to DXM in Ecstasy, posted by SalArmy4me on September 8, 2001, at 16:59:07
Posted by Tony P on September 9, 2001, at 1:07:58
In reply to Re:DXM in Ecstasy (For Ravers with sinus problems) (nm) » SalArmy4me, posted by kazoo on September 9, 2001, at 0:01:45
CAUTION - DXM/DM is detoxed by the liver via the same pathway as Tylenol and some A/D - specifically Serzone (nefazodone). This pathway has the particular property that at high doses, it quite suddenly hits a ceiling, and starts causing potentially severe, even life threatening, liver damage. I took Serzone 24 hr after a large dose of DXM and experienced severe liver pains (my liver is somewhat compromised from past excesses).
Anyone on A/D, esp. serzone and possibly trazodone, if you're thinking of taking DXM, do your research first - there's LOTS of info on the net. Including the little known fact that anything over 2,000mg of ordinary Tylenol - just 4 extra-strength - in 24 hr. is risky for anyone with a compromised liver or who drinks alcohol regularly . The effects are cross-cumulative between the three drugs (and no doubt others - Cam?).
Be Thou Warned.
Tony P
Posted by stjames on September 9, 2001, at 2:00:21
In reply to Re: DXM in Ecstasy » SalArmy4me, posted by fachad on September 8, 2001, at 18:00:53
> I'm sure they put it in pills and sell it as ecstasy for the same reason they used to put caffeine in pills and sell it as amphetamine - DXM is legal and easy to obtain and could fool a naive user into thinking that what they paid for and are tripping on is really ecstasy.
james here....Actually one usually finds DMX and MDMA in the same pill. MDMA (and other like compounds) will not bind to itself, to make a pill you need a binder. Since DMX is an abused drug, and you need to add a binder, why not use it for an extra high ?
SS and possible death is why. MDMA has MAOI activity. DMX in large doses should be avoided when taking anything that has an antidepressant like action. SS could be the result.
james
Posted by djmmm on September 10, 2001, at 9:00:24
In reply to DXM in Ecstasy, posted by SalArmy4me on September 8, 2001, at 16:59:07
> Why do they put Dextromethorphan in Ecstasy pills? Is it serotonergic?
salarmy4me...it is slightly seotonergic at the 5ht2 receptor and the 5ht reuptake sites. People mask any serotonergic drug as MDMA, and since DXM is very inexpensive and easy to obtain...also, the main problem with the combination is that people take a DXM pill, think that it is "fake" then take another pill which may contain MDMA, there is an interaction between the two drugs, that usually results in a hypertensive crisis-like reaction.
Posted by Elizabeth on September 11, 2001, at 15:04:10
In reply to Re: DXM in Ecstasy » SalArmy4me, posted by fachad on September 8, 2001, at 18:00:53
> It is an OTC medication that is widely used in a recreational context. In medical doses, it suppresses cough.
I'm dubious about this one! I tried using some -- 10 mL or two spoonfuls, the recommended therapeutic dose -- and, while I got dreadfully f---ed up (slow metabolism seems to have been the cause), I was still coughing!
For a cough, I recommend Tessalon Perles (prescription-only, unfortunately).
BTW, DXM is (I think) a monoamine uptake inhibitor. It appears that DXM can cause the "serotonin syndrome" in combination with some drugs such as SSRIs and MAOIs. Probably MDMA too.
-e
Posted by Elizabeth on September 12, 2001, at 5:37:06
In reply to Re: DXM in Ecstasy » fachad, posted by Cam W. on September 8, 2001, at 18:22:42
> Fachad - Actually guaifenecine is the active ingredient in Robitussin™ and dextromethorphan is an active component of Robitussin DM™.
Actually, Robitussin DM has multiple active (?) ingredients. Robitussin Maximum Strength contains only DXM, no other actives.
Interestingly (to me, anyway), DXM appears to slow the development of tolerance to morphine.
> It does seem to have nocieceptive activity, in some people; but researchers say that, because of the psychotomimetic side effects, it should not be used as a first line agent.
AFAIK, it does not have any "psychotomimetic" effects. "Psychotomimetic" is a word that's been misused a lot to describe hallucinogenic or psychedelic drugs. I think the appropriate term for drugs like DXM and ketamine would be "dissociative."
Jason: could you provide some references about the putative MAOI activity of DXM? TIA. To my knowledge, reactions with MAOIs are quite possible (though not as serious as, say, with Demerol), but interactions with SSRIs are relatively rare. (I'd still avoid it with SSRIs, especially if you're using it in recreational doses.)
-elizabeth
Posted by stjames on September 12, 2001, at 10:26:59
In reply to Re: DXM in Ecstasy, posted by Elizabeth on September 12, 2001, at 5:37:06
> Jason: could you provide some references about the putative MAOI activity of DXM? TIA. To my knowledge, reactions with MAOIs are quite possible (though not as serious as, say, with Demerol), but interactions with SSRIs are relatively rare. (I'd still avoid it with SSRIs, especially if you're using it in recreational doses.)
>
> -elizabethjames here....
It's the MDMA that has MAOI activity, as do all amphetamines. DMX efects seritonin, as do many opioids. Do some searches for SS caused by thaking AD's and DMX (or other opioids)
james
Posted by MB on September 12, 2001, at 13:07:50
In reply to Re: DXM in Ecstasy, posted by Elizabeth on September 12, 2001, at 5:37:06
> AFAIK, it does not have any "psychotomimetic" effects. "Psychotomimetic" is a word that's been misused a lot to describe hallucinogenic or psychedelic drugs. I think the appropriate term for drugs like DXM and ketamine would be "dissociative."Could we say that amphetamine in high doses is "psychotomimetic" because it induces "psychosis"? I like to use the word "psychotomimetic" because it makes me feel smart (heh heh heh...) but I guess I should only use it when refering to a drug that actual induces psychosis. If someone has latent psychosis, and a drug causes it to manifest, can we say that that drug was psychotomimetic for that person?
Posted by Elizabeth on September 12, 2001, at 13:31:26
In reply to Re: DXM in Ecstasy, posted by stjames on September 12, 2001, at 10:26:59
> james here....
>
> It's the MDMA that has MAOI activity, as do all amphetamines.Ahh, okay. I thought you were saying DXM (the more common abbreviation) was a MAOI. MDMA is, no doubt, a competitive MAO inhibitor, like amphetamine. It's not an irreversible one, I don't think. I attribute the cases of CSS to its promotion of serotonin release (in a way analogous to the way amphetamine promotes dopamine release).
> DMX efects seritonin, as do many opioids.
"Many?" I'm aware of Demerol and Ultram, but...?
-elizabeth
Posted by Elizabeth on September 12, 2001, at 13:34:12
In reply to Re: DXM in Ecstasy » Elizabeth, posted by MB on September 12, 2001, at 13:07:50
> > AFAIK, it does not have any "psychotomimetic" effects. "Psychotomimetic" is a word that's been misused a lot to describe hallucinogenic or psychedelic drugs. I think the appropriate term for drugs like DXM and ketamine would be "dissociative."
>
> Could we say that amphetamine in high doses is "psychotomimetic" because it induces "psychosis"?Yes. A psychosis can be induced by amphetamine overdose, which very closely resembles what's become known as "schizophrenia, paranoid type."
> I like to use the word "psychotomimetic" because it makes me feel smart (heh heh heh...)
< g >
> but I guess I should only use it when refering to a drug that actual induces psychosis. If someone has latent psychosis, and a drug causes it to manifest, can we say that that drug was psychotomimetic for that person?
I suppose. I would just say that it triggered an episode -- the drug effect isn't believed to be the ultimate cause of psychosis, the predisposition is.
-elizabeth
Posted by stjames on September 12, 2001, at 13:53:34
In reply to Re: DXM in Ecstasy » stjames, posted by Elizabeth on September 12, 2001, at 13:31:26
> "Many?" I'm aware of Demerol and Ultram, but...?
>
> -elizabethjames here....
I have read a well reported case of AD + Demerol
causing SS. The reports of SS because of opioids + AD's are anecdotal.Keep in mind that SS is very uncommon.
James
Posted by Elizabeth on September 12, 2001, at 21:33:21
In reply to Re: DXM in Ecstasy, posted by stjames on September 12, 2001, at 13:53:34
> I have read a well reported case of AD + Demerol
> causing SS.I know that. But Demerol and Ultram are the only ones that I know to be a problem. Are you saying there are others? (You did say that "many" opioids affect 5-HT.)
> The reports of SS because of opioids + AD's are anecdotal.
>
> Keep in mind that SS is very uncommon.Of course (says the person who's had it three times, perhaps more).
-elizabeth
Posted by stjames on September 13, 2001, at 11:53:10
In reply to Re: DXM in Ecstasy » stjames, posted by Elizabeth on September 12, 2001, at 21:33:21
>
> I know that. But Demerol and Ultram are the only ones that I know to be a problem. Are you saying there are others? (You did say that "many" opioids affect 5-HT.)That is what I ment when I said anecdotal. There are clear cut cases of Demerol or DMX + AD causing SS. It has been sugested other opioids could do this too.
> >
> > Keep in mind that SS is very uncommon.
>
> Of course (says the person who's had it three times, perhaps more).
>
> -elizabethSome are predisposed. From what I read one is more likely to to have additional SS attacks after the first one.
James
Posted by Elizabeth on September 13, 2001, at 15:09:24
In reply to Re: DXM in Ecstasy, posted by stjames on September 13, 2001, at 11:53:10
> > I know that. But Demerol and Ultram are the only ones that I know to be a problem. Are you saying there are others? (You did say that "many" opioids affect 5-HT.)
>
> That is what I ment when I said anecdotal. There are clear cut cases of Demerol or DMX + AD causing SS. It has been sugested other opioids could do this too.Okay, I looked into this. Codeine, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine, diamorphine, and fentanyl don't have any serious interactions with MAOIs. Butorphanol, propoxyphene, and methadone might. Ultram and Demerol definitely do. Not sure about pentazocine and nalbuphine.
> > Of course (says the person who's had it three times, perhaps more).
>
> Some are predisposed.Really? Do you know more about this? I'd be interested.
-elizabeth
Posted by stjames on September 13, 2001, at 15:25:25
In reply to Re: DXM in Ecstasy » stjames, posted by Elizabeth on September 13, 2001, at 15:09:24
> Okay, I looked into this. Codeine, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine, diamorphine, and fentanyl don't have any serious interactions with MAOIs. Butorphanol, propoxyphene, and methadone might. Ultram and Demerol definitely do. Not sure about pentazocine and nalbuphine.
James here....
SS happens to 5HT effecting AD's, not just MAOI's.
Posted by stjames on September 13, 2001, at 16:05:34
In reply to Re: DXM in Ecstasy » stjames, posted by Elizabeth on September 13, 2001, at 15:09:24
Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient
http://opioids.com/oxycodone/oxyplussert.htmlAS I said before, you can find this stuff for yourself if you do a search using "serotonin syndrome opioids"
james
Posted by Elizabeth on September 14, 2001, at 8:24:57
In reply to Re: DXM in Ecstasy, posted by stjames on September 13, 2001, at 15:25:25
> > Okay, I looked into this. Codeine, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine, diamorphine, and fentanyl don't have any serious interactions with MAOIs. Butorphanol, propoxyphene, and methadone might. Ultram and Demerol definitely do. Not sure about pentazocine and nalbuphine.
>
> James here....
>
> SS happens to 5HT effecting AD's, not just MAOI's.But MAOIs are the highest-risk drugs. If something doesn't cause the CSS with MAOIs, it's a good bet that it won't cause it with SSRIs or other serotonergic ADs, either.
I think the oxycodone thing was an idiosyncratic response. The case you cited is the only one in the literature, and it was in a bone marrow transplant patient so there could easily have been other factors involved. There's no objective test for CSS, and other conditions can mimic it.
BTW, it's "DXM," not "DMX." Isn't DMX the name of a band or something? :-)
-elizabeth
Posted by stjames on September 14, 2001, at 10:58:44
In reply to Re: DXM in Ecstasy » stjames, posted by Elizabeth on September 14, 2001, at 8:24:57
> I think the oxycodone thing was an idiosyncratic response. The case you cited is the only one in the literature, and it was in a bone marrow transplant patient so there could easily have been other factors involved. There's no objective test for CSS, and other conditions can mimic it.
James here....
It is not the only one I have found in the literature, but I am finished here.
james
Posted by Elizabeth on September 14, 2001, at 23:29:10
In reply to Re: DXM in Ecstasy, posted by stjames on September 14, 2001, at 10:58:44
> It is not the only one I have found in the literature, but I am finished here.
Oh? What other cases have you found, regarding oxycodone or any of the other natural and semisynthetic ones? I'm interested because I thought I'd looked pretty thoroughly.
Thanks.
-e
Posted by MB on September 15, 2001, at 16:06:24
In reply to Re: DXM in Ecstasy » MB, posted by Elizabeth on September 12, 2001, at 13:34:12
> > but I guess I should only use it when refering to a drug that actual induces psychosis. If someone has latent psychosis, and a drug causes it to manifest, can we say that that drug was psychotomimetic for that person?
>
> I suppose. I would just say that it triggered an episode -- the drug effect isn't believed to be the ultimate cause of psychosis, the predisposition is.
>
> -elizabeth
Gotcha...because the drug effects in that case wouldn't be "mimicking" psychosis, they'd be unveiling a psychosis already present.By the way, I really obsess over semantics. It drives my friends crazy < g > heh heh, sorry.
Posted by Elizabeth on September 16, 2001, at 18:25:53
In reply to Re: DXM in Ecstasy » Elizabeth, posted by MB on September 15, 2001, at 16:06:24
> By the way, I really obsess over semantics. It drives my friends crazy < g > heh heh, sorry.
No apologies necessary; I'm the same way. :-)
-e
This is the end of the thread.
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