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Talk:Dextromethorphan: Difference between revisions
>Seanspy7 →Please remove the bolding of the first paragraph: new section |
>Acesofspades →Legality: new section |
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--[[User:JH556|JH556]] ([[User talk:JH556|talk]]) 19:55, 13 July 2023 (UTC) | --[[User:JH556|JH556]] ([[User talk:JH556|talk]]) 19:55, 13 July 2023 (UTC) | ||
== Drug interactions | ==Drug interactions== | ||
I'll preface this by saying I am not suggesting Wikipedia be cited as a source, but if the sources Wikipedia cites in this case could be verified as accurate and credible and consulted to contain said information, the following could be added under "Drug Interactions" for harm reduction purposes. Apparently, Bupropion (Wellbutrin), which is both dopaminergic and affects norepinephrine, but not serotonergic, is purported to interact with dextromethorphan and thus, lower the seizure threshold because a metabolite of bupropion is a strong inhibitor of the enzyme that metabolizes dextromethorphan. | I'll preface this by saying I am not suggesting Wikipedia be cited as a source, but if the sources Wikipedia cites in this case could be verified as accurate and credible and consulted to contain said information, the following could be added under "Drug Interactions" for harm reduction purposes. Apparently, Bupropion (Wellbutrin), which is both dopaminergic and affects norepinephrine, but not serotonergic, is purported to interact with dextromethorphan and thus, lower the seizure threshold because a metabolite of bupropion is a strong inhibitor of the enzyme that metabolizes dextromethorphan. | ||
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Jefferson JW, Pradko JF, Muir KT (November 2005). "Bupropion for major depressive disorder: Pharmacokinetic and formulation considerations". Clin Ther. 27 (11): 1685–95. doi:10.1016/j.clinthera.2005.11.011. PMID 16368442. | Jefferson JW, Pradko JF, Muir KT (November 2005). "Bupropion for major depressive disorder: Pharmacokinetic and formulation considerations". Clin Ther. 27 (11): 1685–95. doi:10.1016/j.clinthera.2005.11.011. PMID 16368442. | ||
== Antidepressant, anti-agression effects, sweating. | ==Antidepressant, anti-agression effects, sweating.== | ||
Dextromethorphan has now been shown to have antidepressant effects in as little as 3 days. Could someone add this to the cognitive effects? I can't figure out how to edit the effect matrix. It's also been investigated for anti-aggressive effects. | Dextromethorphan has now been shown to have antidepressant effects in as little as 3 days. Could someone add this to the cognitive effects? I can't figure out how to edit the effect matrix. It's also been investigated for anti-aggressive effects. | ||
Lastly, based on the reports it looks like it can cause sweating, even if there isn't a change in body temperature. May want to add this. | Lastly, based on the reports it looks like it can cause sweating, even if there isn't a change in body temperature. May want to add this. | ||
== Dextromethorphan/Bupropion == | ==Dextromethorphan/Bupropion== | ||
Dextromethorphan now can be obtained in a combination medication known as Auvelity in the US. It is perscription only, however, the interaction between dextromethorphan and bupropion seems to potentiate the antidepressant effects of dextromethorphan and bupropion together. Just a thought though, maybe include it at the bottom, near interactions? | Dextromethorphan now can be obtained in a combination medication known as Auvelity in the US. It is perscription only, however, the interaction between dextromethorphan and bupropion seems to potentiate the antidepressant effects of dextromethorphan and bupropion together. Just a thought though, maybe include it at the bottom, near interactions? -- (unsigned by [[User:Rosesareblue]] at 2023-01-09T14:07:37 UTC) | ||
----------- | This combination of DXM and Bupropion surprises me, given Bupropion has deliriant-like effects through antagonism of the nicotinic acetylcholine receptors. If a page about it is made, for harm reduction purposes there needs to be significant warning about the dysphoric, nauseating, and especially seizure inducing properties which become an extreme danger at high dosages; since Auvelity contains 45mg of DXM & 105mg of Bupropion per tablet, if someone took 3 tablets they would be at 315mg of Bupropion which is just 10mg away from the danger-threshold of Bupropion @325mg. Taking more than three tablets of Auvelity would be extremely dangerous, and three tablets would be rather dangerous. If a page about Auvelity is made, then this needs to be mentioned for safety reasons. | ||
--[[User:JH556|JH556]] ([[User talk:JH556|talk]]) 20:24, 13 July 2023 (UTC) | |||
[[User:Mnbvcxz]] removed the bupropion line at https://psychonautwiki.org/w/index.php?title=Dextromethorphan&diff=158985&oldid=158931. I don't think the change is a good idea: while we know that the combination in ''extended-release'' form is safe enough to be taken twice a day, spaced 8 hours apart,<ref name="p37859435" /> the approval does not cover an instant-release combination like what would likely be done when "hacking things together". My preferred wording, which I wrote into [[Bupropion]], is: | |||
<blockquote> | |||
On the other hand, [[Wikipedia:Dextromethorphan/bupropion|dextromethorphan/bupropion]] is an approved combination drug; each ''extended-release'' tablet contains 45 mg DXM and 105 mg bupropion. The maximum dose for depression is set at 2 tablets per day, spaced at least 8 hours apart.<ref name="p37859435">McCarthy, B; Bunn, H; Santalucia, M; Wilmouth, C; Muzyk, A; Smith, CM (30 November 2023). "Dextromethorphan-bupropion (Auvelity) for the Treatment of Major Depressive Disorder". Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology. 21 (4): 609–616. doi:10.9758/cpn.23.1081. PMID 37859435. PMC [http://www.ncbi.nlm.nih.gov/pmc/articles/pmc10591164/ 10591164]. Retrieved via PMC.</ref> Although this combination drug is safe enough to be approved, the safety of an instant-release combination and of higher doses remains a concern. | |||
</blockquote> | |||
I fixed the error. I don't think [[User:Mnbvcxz]] meant to do that, their description is a minor edit that only fixes bolding and he reversed two different edits in one. [[User:Uzi|Uzi]] ([[User talk:Uzi|talk]]) 03:32, 8 June 2024 (UTC) | |||
So [[User:JH556|JH556]], I ''guess'' the relative safety has something to do with it being extended-release. I don't know how much safety margin goes into the "space doses at least 8hrs apart" disclaimer, but it has to be... decent enough? | |||
The existing source https://sci-hub.se/10.1097/01.jcp.0000162805.46453.e3 speculates at a risk, but it (and the deleted line about Bupropion) does not go into the psychoactive consequences of having less DXM convert to dextrorphan. This should produce a very significant change in the subjective effect, as dextrorphan is much more potent at the hallucinogenic NMDAR than DXM. | |||
*Cafermed (https://www.cafermed.com/post/auvelity) agrees that kicking away CYP2D6 probably prevents the drug from being dissociative. | |||
*https://pubmed.ncbi.nlm.nih.gov/9690700/ shows that people with less functional CYP2D6 has less fun subjective experiences. They also "tolerated" lower doses, lending some credence to the idea that weak CYP2D6 makes DXM less safe. I cannot see the full text, so the important part, a description of adverse effects in non-tolerators, isn't available to me. | |||
*I've taken 180 mg DXM with a different allegedly "strong" CYP2D6 inhibitor, 40 mg fluoxetine (both instant release), as a sort of poor man's Auvelity. It's... not trippy at all. I stopped feeling depressed about 0.8 hour in, and was feeling quite well about 1.5 hours in; but I really could not balance my body while it lasted. Heh. | |||
We also need a source about seizure threshold, I think. | |||
--[[User:Artoria2e5|Artoria2e5]] ([[User talk:Artoria2e5|talk]]) 14:50, 2 June 2024 (UTC) | |||
:I'll work on attaching a source for the seizure threshold of DXM and Bupropion. [[User:Uzi|Uzi]] ([[User talk:Uzi|talk]]) 02:05, 8 June 2024 (UTC) | |||
<references /> | |||
==Plateau Sigma== | |||
I feel like Plateau Sigma shouldn't be called "Fifth Plateau" and should instead be called as its own distinct plateau. By this distinction I think it'll help drive the point that it does not match with the linear dose-effect relationship of the first to fourth plateaus because it involves a certain hepatic phenomenon from redosing that can create a different subjective effect (by dosage tolerability and ↑DXM:↓DXO blood concentration). On a more off-topic note, I think we should talk about warning against redosing DXM too much throughout the day because of this certain effect (e.g. Redosing after CYP2D6 is being pre-occupied by initial dosages). What do you guys think of this? [[User:Uzi|Uzi]] ([[User talk:Uzi|talk]]) 04:07, 8 June 2024 (UTC) | |||
== Legality == | |||
In reference to "''United States: Dextromethorphan is available over the counter and can be found in grocery stores, convenience stores, and online. Many physical locations requires the purchaser to be over the age of 18, however this is not the law.''" | |||
This should be elaborated on to include the states where the selling of DXM-containing products is restricted to those 18+ in some states such as New York and New Jersey | |||
Refs: New York State: https://www.nysenate.gov/legislation/bills/2013/s696/amendment/b, New Jersey: https://legiscan.com/NJ/text/A622/id/926720 | |||