Talk:Dextromethorphan: Difference between revisions

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:

 

On the other hand, [[Wikipedia:Dextromethorphan/bupropion|dextromethorphan/bupropion]] is an approved combination drug; each ''extended-release'' tablet contains 45&nbsp;mg DXM and 105&nbsp;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.

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.

--~~