combos.json

{
  "2c-t-x": {
    "2c-x": {
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "Both classes of compounds can be unpredictable alone",
      "status": "Caution"
    },
    "alcohol": {
      "note": "Both these classes of compound can interact unpredictably. Caution should be exercised.",
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and heart failure.",
      "status": "Unsafe"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.",
      "status": "Unsafe"
    },
    "dextromethorphan": {
      "status": "Unsafe"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series",
      "status": "Caution"
    },
    "mdma": {
      "status": "Caution"
    },
    "mescaline": {
      "status": "Caution"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Caution"
    },
    "nbomes": {
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.",
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Dangerous"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "status": "Unsafe"
    }
  },
  "2c-x": {
    "2c-t-x": {
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics",
      "status": "Caution"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.",
      "status": "Caution"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably",
      "status": "Caution"
    },
    "mdma": {
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "status": "Caution"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.",
      "status": "Unsafe"
    }
  },
  "5-meo-xxt": {
    "2c-t-x": {
      "note": "Both classes of compounds can be unpredictable alone",
      "status": "Caution"
    },
    "2c-x": {
      "note": "The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics",
      "status": "Caution"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. ",
      "status": "Unsafe"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. ",
      "status": "Unsafe"
    },
    "dextromethorphan": {
      "note": "Little information exists about this combination.",
      "status": "Unsafe"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.",
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "status": "Dangerous"
    },
    "mdma": {
      "note": "Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care",
      "status": "Caution"
    },
    "mescaline": {
      "note": "The 5-MeO class of tryptamines can be unpredictable in their interactions",
      "status": "Caution"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "Little information exists about this combination.",
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "note": "The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided",
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Dangerous"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "status": "Unsafe"
    }
  },
  "alcohol": {
    "2c-t-x": {
      "note": "Both these classes of compound can interact unpredictably. Caution should be exercised.",
      "status": "Low Risk & Decrease"
    },
    "2c-x": {
      "status": "Low Risk & Decrease"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.",
      "status": "Caution"
    },
    "amt": {
      "note": "aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable",
      "status": "Caution"
    },
    "benzodiazepines": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "In excess, this combination can cause nausea.",
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Cocaine can decrease some of the intoxicating effects of alcohol, causing some people to drink more than they otherwise would, which leads to greater behavioral and physical health risks. There is also some debate about cocaethylene, a metabolite produced when combining alcohol and cocaine, with some researchers positing that it is more cardiotoxic than cocaine on its own. Use moderation when combining these substances.",
      "sources": [
        {
          "author": "McCance-Katz, E. F., Kosten, T. R., & Jatlow, P. ",
          "title": "Concurrent use of cocaine and alcohol is more potent and potentially more toxic than use of either alone—A multiple-dose study.",
          "url": "https://doi.org/10.1016/S0006-3223(97)00426-5"
        },
        {
          "author": "Pergolizzi, J., Breve, F., Magnusson, P., LeQuang, J. A. K., & Varrassi, G.",
          "title": "Cocaethylene: When cocaine and alcohol are taken together.  (2022)",
          "url": "https://doi.org/10.7759/cureus.22498"
        },
        {
          "author": "Shastry, S., Manoochehri, O., Richardson, L. D., & Manini, A. F. ",
          "title": "Cocaethylene cardiotoxicity in emergency department patients with acute drug overdose.",
          "url": "https://doi.org/10.1111/acem.14584"
        },
        {
          "author": "Wiener, S. E., Sutijono, D., Moon, C. H., Subramanian, R. A., Calaycay, J., Rushbrook, J. I., & Zehtabchi, S.",
          "title": "Patients with detectable cocaethylene are more likely to require intensive care unit admission after trauma. ",
          "url": "https://doi.org/10.1016/j.ajem.2009.06.014"
        }
      ],
      "status": "Unsafe"
    },
    "dextromethorphan": {
      "note": "Both drugs increase the CNS depressant effects of each other. At moderate-to-high doses, there is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well. Avoid on anything higher than 1st plateau.",
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Decrease"
    },
    "dox": {
      "note": "Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also  allow you to drink past a point where you might normally pass out, increasing the risk.",
      "status": "Low Risk & Decrease"
    },
    "ghb/gbl": {
      "note": "Even in very low doses this combination rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.",
      "status": "Dangerous"
    },
    "ketamine": {
      "note": "Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Decrease"
    },
    "maois": {
      "note": "Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.",
      "status": "Unsafe"
    },
    "mdma": {
      "note": "The combination of MDMA and alcohol may increase strain on the cardiovascular system and lead to increased alcohol consumption. MDMA may also impair one's ability to recognize their level of drunkenness, leading to increased alcohol consumption and poor decision-making. Alcohol may also increase the risk of dehydration and hyperthermia (increased body temperature) when combined with MDMA.",
      "sources": [
        {
          "author": "Hamida, S. B., Plute, E., Cosquer, B., Kelche, C., Jones, B. C., & Cassel, J.-C. ",
          "title": "Interactions between ethanol and cocaine, amphetamine, or MDMA in the rat: thermoregulatory and locomotor effects. (2008)",
          "url": "https://doi.org/10.1007/s00213-007-1007-5"
        },
        {
          "author": "Ramaekers, J. G., & Kuypers, K. P. C.",
          "title": "Acute Effects of 3,4-Methylenedioxymethamphetamine (MDMA) on Behavioral Measures of Impulsivity: Alone and in Combination with Alcohol. (2006)",
          "url": "https://doi.org/10.1038/sj.npp.1300894"
        },
        {
          "author": "Hernández-López, C., Farré, M., Roset, P. N., Menoyo, E., Pizarro, N., Ortuño, J., Torrens, M., Camı́, J., & Torre, R. de la.",
          "title": "3,4-Methylenedioxymethamphetamine (Ecstasy) and Alcohol Interactions in Humans: Psychomotor Performance, Subjective Effects, and Pharmacokinetics. (2002)",
          "url": "https://doi.org/10.1124/jpet.300.1.236"
        },
        {
          "author": "van Amsterdam, J., Brunt, T. M., Pierce, M., & van den Brink, W.",
          "title": "Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: a Systematic Review. (2021)",
          "url": "https://doi.org/10.1007/s12640-021-00416-z"
        }
      ],
      "status": "Caution"
    },
    "mescaline": {
      "status": "Low Risk & Decrease"
    },
    "mushrooms": {
      "status": "Low Risk & Decrease"
    },
    "mxe": {
      "note": "There is a high risk of memory loss, vomiting and severe ataxia from this combination.",
      "status": "Dangerous"
    },
    "nbomes": {
      "status": "Low Risk & Decrease"
    },
    "nitrous": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "opioids": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "pcp": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Unsafe"
    },
    "ssris": {
      "note": "Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and  psychomotor skills.",
      "status": "Caution"
    },
    "tramadol": {
      "note": "Heavy CNS depressants, risk of seizures. Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place the affected individual in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.",
      "status": "Dangerous"
    }
  },
  "amphetamines": {
    "2c-t-x": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences. In extreme cases, they can result in severe vasoconstriction, tachycardia, hypertension, and heart failure.",
      "status": "Unsafe"
    },
    "2c-x": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.",
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. ",
      "status": "Unsafe"
    },
    "alcohol": {
      "note": "Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also allow you to drink past a point where you might normally pass out, increasing the risk. If you do decide to do this then you should set a limit of how much you will drink each hour and stick to it, bearing in mind that you will feel the alcohol and the stimulant less. Extended release formulations may severely impede sleep, further worsening the hangover.",
      "status": "Caution"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "note": "Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction",
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.",
      "status": "Caution"
    },
    "cannabis": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "cocaine": {
      "note": "This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine",
      "status": "Caution"
    },
    "dextromethorphan": {
      "note": "Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.",
      "status": "Unsafe"
    },
    "dmt": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dox": {
      "note": "The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic. ",
      "status": "Unsafe"
    },
    "ghb/gbl": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the individual and cause respiratory arrest.",
      "status": "Caution"
    },
    "ketamine": {
      "note": "No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.",
      "status": "Caution"
    },
    "lithium": {
      "note": "Lithium may be neuroprotective when taken with amphetamines and Lithium may decrease the hyperactive effects of amphetamines. Studies indicate this combination is safe.",
      "sources": [
        {
          "author": "Ago, Y., Tanaka, T., Kita, Y., Tokumoto, H., Takuma, K., & Matsuda, T.",
          "title": "Lithium attenuates methamphetamine-induced hyperlocomotion and behavioral sensitization via modulation of prefrontal monoamine release. (2012)",
          "url": "https://doi.org/10.1016/j.neuropharm.2011.10.004"
        },
        {
          "author": "Gould, T. D., O’Donnell, K. C., Picchini, A. M., & Manji, H. K.",
          "title": "Strain Differences in Lithium Attenuation of d-Amphetamine-Induced Hyperlocomotion: A Mouse Model for the Genetics of Clinical Response to Lithium.  (2007)",
          "url": "https://doi.org/10.1038/sj.npp.1301254"
        },
        {
          "author": "Zhou, Z., Wang, Y., Tan, H., Bharti, V., Che, Y., & Wang, J.-F. ",
          "title": "Chronic treatment with mood stabilizer lithium inhibits amphetamine-induced risk-taking manic-like behaviors. (2015)",
          "url": "https://doi.org/10.1016/j.neulet.2015.07.027"
        },
        {
          "author": "Silverstone, P. H., Pukhovsky, A., & Rotzinger, S.",
          "title": "Lithium does not attenuate the effects of d-amphetamine in healthy volunteers. (1998)",
          "url": "https://doi.org/10.1016/S0165-1781(98)00037-7"
        }
      ],
      "status": "Low Risk & No Synergy"
    },
    "lsd": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "maois": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.",
      "status": "Dangerous"
    },
    "mdma": {
      "note": "This combination of stimulants will increase strain on the heart, may cause some physical discomfort, and has the chance to cause cardiovascular issues. The anxiogenic and focusing effects of stimulants can increase the chance of unpleasant thought loops and make the experience more uncomfortable, this combination raises these chances. Amphetamines will increase the neurotoxic effects of MDMA, in addition to causing further concerns of hyperthermia due to the inherent nature of the combination. It will also raise one's body temperature, also likely making the combination more neurotoxic.",
      "sources": [
        {
          "author": "Kelly J. Clemens, Iain S. McGregor, Glenn E. Hunt, Jennifer L. Cornish",
          "title": "MDMA, methamphetamine and their combination: possible lessons for party drug users from recent preclinical research",
          "url": "https://doi.org/10.1080/09595230601036945"
        },
        {
          "author": "Kelly J. Clemens, Iain S. McGregor, Glenn E. Hunt, Jennifer L. Cornish",
          "title": "Repeated weekly exposure to MDMA, methamphetamine or their combination: long-term behavioural and neurochemical effects in rats ",
          "url": "https://doi.org/10.1016/j.drugalcdep.2006.06.004"
        },
        {
          "author": "P. Leon Brown, Eugene A. Kiyatkin",
          "title": "Brain hyperthermia induced by MDMA (‘ecstasy’): modulation by environmental conditions",
          "url": "https://doi.org/10.1111/j.0953-816X.2004.03453.x"
        }
      ],
      "status": "Caution"
    },
    "mescaline": {
      "note": "The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops",
      "status": "Caution"
    },
    "mushrooms": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "mxe": {
      "note": "Risk of tachycardia, hypertension, and manic states",
      "status": "Caution"
    },
    "nbomes": {
      "note": "Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.",
      "status": "Unsafe"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "Stimulants increase respiration rate, which can allow for a higher dose of opiates normal . If the stimulant wears off first then the opiate may overcome the individual and cause respiratory arrest.",
      "status": "Caution"
    },
    "pcp": {
      "note": "This combination can easily lead to hypermanic states",
      "status": "Unsafe"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Tramadol and stimulants both increase the risk of seizures.",
      "status": "Dangerous"
    }
  },
  "amt": {
    "2c-t-x": {
      "status": "Dangerous"
    },
    "2c-x": {
      "status": "Dangerous"
    },
    "5-meo-xxt": {
      "status": "Dangerous"
    },
    "alcohol": {
      "note": "aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable",
      "status": "Caution"
    },
    "amphetamines": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Caution"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.",
      "status": "Caution"
    },
    "cocaine": {
      "status": "Dangerous"
    },
    "dextromethorphan": {
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Dangerous"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.",
      "status": "Dangerous"
    },
    "mdma": {
      "status": "Dangerous"
    },
    "mescaline": {
      "status": "Dangerous"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Dangerous"
    },
    "nbomes": {
      "status": "Dangerous"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "No unexpected interactions",
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Dangerous"
    },
    "ssris": {
      "status": "Dangerous"
    },
    "tramadol": {
      "status": "Dangerous"
    }
  },
  "benzodiazepines": {
    "2c-t-x": {
      "status": "Low Risk & Decrease"
    },
    "2c-x": {
      "status": "Low Risk & Decrease"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Decrease"
    },
    "alcohol": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "Both can dull each other's effects, so if one wears off before the other it's possible to overdose due to the lack of counteraction",
      "status": "Low Risk & Decrease"
    },
    "amt": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "status": "Low Risk & Decrease"
    },
    "cannabis": {
      "status": "Low Risk & Decrease"
    },
    "cocaine": {
      "status": "Low Risk & Decrease"
    },
    "dextromethorphan": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.",
      "status": "Caution"
    },
    "dmt": {
      "status": "Low Risk & Decrease"
    },
    "dox": {
      "status": "Low Risk & Decrease"
    },
    "ghb/gbl": {
      "note": "The two substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position.",
      "status": "Dangerous"
    },
    "ketamine": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.",
      "status": "Caution"
    },
    "lsd": {
      "status": "Low Risk & Decrease"
    },
    "maois": {
      "status": "Low Risk & Synergy"
    },
    "mdma": {
      "status": "Low Risk & Decrease"
    },
    "mescaline": {
      "status": "Low Risk & Decrease"
    },
    "mushrooms": {
      "status": "Low Risk & Decrease"
    },
    "mxe": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place the affected individual in the recovery position to prevent vomit aspiration from excess.",
      "status": "Caution"
    },
    "nbomes": {
      "status": "Low Risk & Decrease"
    },
    "nitrous": {
      "status": "Low Risk & Decrease"
    },
    "opioids": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "pcp": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely",
      "status": "Unsafe"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    }
  },
  "caffeine": {
    "2c-t-x": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Low Risk & No Synergy"
    },
    "2c-x": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Low Risk & No Synergy"
    },
    "5-meo-xxt": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Low Risk & No Synergy"
    },
    "alcohol": {
      "status": "Low Risk & No Synergy"
    },
    "amphetamines": {
      "note": "This combination of stimulants is not generally necessary and may increase strain on the heart, as well as potentially causing anxiety and greater physical discomfort.",
      "status": "Caution"
    },
    "amt": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating the combination may cause some physical discomfort.",
      "status": "Caution"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "cannabis": {
      "status": "Low Risk & No Synergy"
    },
    "cocaine": {
      "note": "Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.",
      "status": "Caution"
    },
    "dextromethorphan": {
      "note": "High doses of caffeine can potentially exacerbate anxiety, especially during a dissociative experience, due to its stimulating effects. This combination might also lead to physical discomfort. However, individual responses to caffeine can vary significantly, often influenced by factors like habitual versus occasional usage.",
      "sources": [
        {
          "author": "Chad J Reissig, Lawrence P Carter, Matthew W Johnson, Miriam Z Mintzer, Margaret A Klinedinst, Roland R Griffiths",
          "title": "High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens ",
          "url": "https://pubmed.ncbi.nlm.nih.gov/22526529/"
        },
        {
          "author": "Arthur Eumann Mesas, Luz M Leon-Muñoz, Fernando Rodriguez-Artalejo, Esther Lopez-Garcia",
          "title": "The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis ",
          "url": "https://pubmed.ncbi.nlm.nih.gov/21880846/"
        },
        {
          "author": "M-L Nurminen, L Niittynen, R Korpela & H Vapaatalo",
          "title": "Coffee, caffeine and blood pressure: a critical review",
          "url": "https://www.nature.com/articles/1600899"
        }
      ],
      "status": "Caution"
    },
    "dmt": {
      "status": "Low Risk & No Synergy"
    },
    "dox": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.",
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & No Synergy"
    },
    "ketamine": {
      "note": "No unexpected interactions.",
      "status": "Low Risk & No Synergy"
    },
    "lsd": {
      "status": "Low Risk & No Synergy"
    },
    "maois": {
      "status": "Low Risk & No Synergy"
    },
    "mdma": {
      "note": "Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA",
      "status": "Caution"
    },
    "mescaline": {
      "note": "High doses of caffeine are uncomfortable and this will be magnified by psychedelics",
      "status": "Low Risk & No Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & No Synergy"
    },
    "mxe": {
      "note": "No likely interactions",
      "status": "Low Risk & No Synergy"
    },
    "nbomes": {
      "note": "Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping",
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & No Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Caution"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "status": "Low Risk & No Synergy"
    }
  },
  "cannabis": {
    "2c-t-x": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "2c-x": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "alcohol": {
      "note": "In excess, this combination can cause nausea.",
      "status": "Low Risk & Synergy"
    },
    "amphetamines": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "amt": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.",
      "status": "Caution"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cocaine": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "dox": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Synergy"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lsd": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "maois": {
      "status": "Low Risk & Synergy"
    },
    "mdma": {
      "note": "Large amounts of cannabis may cause strong and somewhat unpredictable experiences in combination with MDMA. Cannabis should be saved for towards the end of the experience if possible.",
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "mushrooms": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "status": "Low Risk & Synergy"
    }
  },
  "cocaine": {
    "2c-t-x": {
      "note": "Cocaine and 2c-t-x both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.",
      "status": "Unsafe"
    },
    "2c-x": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.",
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally unnecessary because of the stimulating effects of psychedelics. ",
      "status": "Unsafe"
    },
    "alcohol": {
      "note": "Cocaine can decrease some of the intoxicating effects of alcohol, causing some people to drink more than they otherwise would, which leads to greater behavioral and physical health risks. There is also some debate about cocaethylene, a metabolite produced when combining alcohol and cocaine, with some researchers positing that it is more cardiotoxic than cocaine on its own. Use moderation when combining these substances.",
      "sources": [
        {
          "author": "McCance-Katz, E. F., Kosten, T. R., & Jatlow, P. ",
          "title": "Concurrent use of cocaine and alcohol is more potent and potentially more toxic than use of either alone—A multiple-dose study.",
          "url": "https://doi.org/10.1016/S0006-3223(97)00426-5"
        },
        {
          "author": "Pergolizzi, J., Breve, F., Magnusson, P., LeQuang, J. A. K., & Varrassi, G.",
          "title": "Cocaethylene: When cocaine and alcohol are taken together.  (2022)",
          "url": "https://doi.org/10.7759/cureus.22498"
        },
        {
          "author": "Shastry, S., Manoochehri, O., Richardson, L. D., & Manini, A. F. ",
          "title": "Cocaethylene cardiotoxicity in emergency department patients with acute drug overdose.",
          "url": "https://doi.org/10.1111/acem.14584"
        },
        {
          "author": "Wiener, S. E., Sutijono, D., Moon, C. H., Subramanian, R. A., Calaycay, J., Rushbrook, J. I., & Zehtabchi, S.",
          "title": "Patients with detectable cocaethylene are more likely to require intensive care unit admission after trauma. ",
          "url": "https://doi.org/10.1016/j.ajem.2009.06.014"
        }
      ],
      "status": "Unsafe"
    },
    "amphetamines": {
      "note": "This combination of stimulants will increase strain on the heart. It is not generally worth it as cocaine has a mild blocking effect on dopamine releasers like amphetamine",
      "status": "Caution"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.",
      "status": "Caution"
    },
    "cannabis": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dextromethorphan": {
      "note": "Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues",
      "status": "Unsafe"
    },
    "dmt": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dox": {
      "note": "The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic",
      "status": "Unsafe"
    },
    "ghb/gbl": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of sedatives than normal. If the stimulant wears off first the opiate may overcome the individual and cause respiratory arrest. Likewise the ghb/gbl can wear off and leave a dangerous concentration of cocaine behind",
      "status": "Caution"
    },
    "ketamine": {
      "note": "No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.",
      "status": "Caution"
    },
    "lithium": {
      "note": "Lithium may inhibit some of the recreational effects of cocaine.",
      "sources": [
        {
          "author": "Flemenbaum, A.",
          "title": "Antagonism of behavioral effects of cocaine by lithium. (1977)",
          "url": "https://doi.org/10.1016/0091-3057(77)90015-6"
        },
        {
          "author": "Cronson, A. J., & Flemenbaum, A.",
          "title": "Antagonism of Cocaine Highs by Lithium. (1981)",
          "url": "https://doi.org/10.1007/978-1-4684-3614-3_132"
        }
      ],
      "status": "Low Risk & Decrease"
    },
    "lsd": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "maois": {
      "note": "This combination is poorly explored",
      "status": "Dangerous"
    },
    "mdma": {
      "note": "Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.",
      "status": "Caution"
    },
    "mescaline": {
      "note": "The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops",
      "status": "Caution"
    },
    "mushrooms": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "mxe": {
      "note": "Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.",
      "status": "Caution"
    },
    "nbomes": {
      "note": "Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.",
      "status": "Unsafe"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of opiates than normal. If the stimulant wears off first then the opiate may overcome the individual and cause respiratory arrest.",
      "status": "Dangerous"
    },
    "pcp": {
      "note": "This combination can easily lead to hypermanic states",
      "status": "Unsafe"
    },
    "ssris": {
      "note": "May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.",
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Tramadol and stimulants both increase the risk of seizures.",
      "status": "Dangerous"
    }
  },
  "dextromethorphan": {
    "2c-t-x": {
      "status": "Unsafe"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "note": "Little information exists about this combination.",
      "status": "Unsafe"
    },
    "alcohol": {
      "note": "Both drugs increase the CNS depressant effects of each other. At moderate-to-high doses, there is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well. Avoid on anything higher than 1st plateau.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.",
      "status": "Unsafe"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and this can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.",
      "status": "Caution"
    },
    "caffeine": {
      "note": "High doses of caffeine can potentially exacerbate anxiety, especially during a dissociative experience, due to its stimulating effects. This combination might also lead to physical discomfort. However, individual responses to caffeine can vary significantly, often influenced by factors like habitual versus occasional usage.",
      "sources": [
        {
          "author": "Chad J Reissig, Lawrence P Carter, Matthew W Johnson, Miriam Z Mintzer, Margaret A Klinedinst, Roland R Griffiths",
          "title": "High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens ",
          "url": "https://pubmed.ncbi.nlm.nih.gov/22526529/"
        },
        {
          "author": "Arthur Eumann Mesas, Luz M Leon-Muñoz, Fernando Rodriguez-Artalejo, Esther Lopez-Garcia",
          "title": "The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis ",
          "url": "https://pubmed.ncbi.nlm.nih.gov/21880846/"
        },
        {
          "author": "M-L Nurminen, L Niittynen, R Korpela & H Vapaatalo",
          "title": "Coffee, caffeine and blood pressure: a critical review",
          "url": "https://www.nature.com/articles/1600899"
        }
      ],
      "status": "Caution"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues",
      "status": "Unsafe"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.",
      "status": "Unsafe"
    },
    "ghb/gbl": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "ketamine": {
      "note": "Both substances primarily exert their effects through NMDA antagonism. Currently, there is no evidence regarding mechanisms that might reduce these effects.",
      "sources": [
        {
          "author": "Jeanna M. Marraffa",
          "title": "Dextromethorphan",
          "url": "https://doi.org/10.1016/B978-0-12-824315-2.00127-5"
        },
        {
          "author": "Georges Mion, Thierry Villevieille",
          "title": "Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings)",
          "url": "https://doi.org/10.1111/cns.12099"
        },
        {
          "author": "P. Klepstad, P. C. Borchgrevink",
          "title": "Four years' treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia",
          "url": "https://doi.org/10.1111/j.1399-6576.1997.tb04709.x"
        },
        {
          "author": "Stephen M. Stahl",
          "title": "Mechanism of action of dextromethorphan/quinidine: comparison with ketamine",
          "url": "https://doi.org/10.1017/S109285291300062X"
        },
        {
          "author": "A M Hughes,1 J Rhodes,1 G Fisher,2 M Sellers,3 and J W Growcott1",
          "title": "Assessment of the effect of dextromethorphan and ketamine on the acute nociceptive threshold and wind-up of the second pain response in healthy male volunteers",
          "url": "https://doi.org/10.1046%2Fj.1365-2125.2002.01602.x"
        },
        {
          "author": "Keiji Tabuchi, MD, Zenya Ito, MD, Shigeki Tsuji, MD, Akira Hara, MD, Tetsuro Wada, MD, Jun Kusakari, MD",
          "title": "Effect of Ketamine, Dextromethorphan, and MK-801 on Cochlear Dysfunction Induced by Transient Ischemia",
          "url": "https://doi.org/10.1177/000348940211100107"
        }
      ],
      "status": "Low Risk & Synergy"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "High risk of serotonin syndrome",
      "status": "Dangerous"
    },
    "mdma": {
      "status": "Dangerous"
    },
    "mephedrone": {
      "note": "Risk of serotonin syndrome as both drugs raise serotonin levels. In addition to concerns of high blood pressure and unnecessary strain on the heart. As well as potentially causing anxiety and greater physical discomfort due to the combination.",
      "sources": [
        {
          "author": "J Kehr,  F Ichinose,  S Yoshitake,  M Goiny,  T Sievertsson,  F Nyberg,  T Yoshitake",
          "title": "Mephedrone, compared with MDMA (ecstasy) and amphetamine, rapidly increases both dopamine and 5-HT levels in nucleus accumbens of awake rats",
          "url": "https://doi.org/10.1111/j.1476-5381.2011.01499.x"
        },
        {
          "author": "Gregory C. Hadlock, Katy M. Webb, Lisa M. McFadden, Pei Wen Chu, Jonathan D. Ellis, Scott C. Allen, David M. Andrenyak, Paula L. Vieira-Brock, Christopher L. German, Kevin M. Conrad, Amanda J. Hoonakker, James W. Gibb, Diana G. Wilkins, Glen R. Hanson and Annette E. Fleckenstein",
          "title": "4-Methylmethcathinone (Mephedrone): Neuropharmacological Effects of a Designer Stimulant of Abuse",
          "url": "https://doi.org/10.1124/jpet.111.184119 "
        },
        {
          "author": "Anna R. Schwartz, Anthony F. Pizon & Daniel E. Brooks",
          "title": "Dextromethorphan-induced serotonin syndrome",
          "url": "https://doi.org/10.1080/15563650701668625"
        },
        {
          "author": "DrugBank",
          "title": "Dextromethorphan",
          "url": "https://go.drugbank.com/drugs/DB00514"
        },
        {
          "author": "Henderson MG, Fuller RW",
          "title": "Dextromethorphan antagonizes the acute depletion of brain serotonin by p-chloroamphetamine and H75/12 in rats",
          "url": "https://doi.org/10.1016/0006-8993(92)91144-4"
        },
        {
          "author": "Reissig CJ, Carter LP, Johnson MW, Mintzer MZ, Klinedinst MA, Griffiths RR",
          "title": "High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens ",
          "url": "https://doi.org/10.1007/s00213-012-2680-6"
        },
        {
          "author": "Meng H, Cao J, Kang J, Ying X, Ji J, Reynolds W, Rampe D.",
          "title": "Mephedrone, a new designer drug of abuse, produces acute hemodynamic effects in the rat ",
          "url": "https://doi.org/10.1016/j.toxlet.2011.10.010"
        }
      ],
      "status": "Dangerous"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "There is a risk of serotonin syndrome when combining DXM with MXE, due to DXM and MXE both being SRI’s. MXE and DXM having notable affinities for the serotonin transporter.",
      "sources": [
        {
          "author": "Bryan L. Roth, Simon Gibbons, Warunya Arunotayanun, Xi-Ping Huang, Vincent Setola, Ric Treble, Les Iversen",
          "title": "The Ketamine Analogue Methoxetamine and 3- and 4-Methoxy Analogues of Phencyclidine Are High Affinity and Selective Ligands for the Glutamate NMDA Receptor",
          "url": "https://doi.org/10.1371/journal.pone.0059334"
        },
        {
          "author": "Matteo Marti, Giuseppe Talani, Cristina Miliano, Sabrine Bilel, Francesca Biggio, Jessica Bratzu, Marco Diana, Maria Antonietta De Luca, Liana Fattore",
          "title": "New insights into methoxetamine mechanisms of action: Focus on serotonergic 5-HT2 receptors in pharmacological and behavioral effects in the rat ",
          "url": "https://doi.org/10.1016/j.expneurol.2021.113836"
        },
        {
          "author": "Laura Hondebrink, Emma E.J. Kasteel, Anke M. Tukker, Fiona M.J. Wijnolts, Anouk H.A. Verboven, Remco H.S. Westerink",
          "title": "Neuropharmacological characterization of the new psychoactive substance methoxetamine",
          "url": "https://doi.org/10.1016/j.neuropharm.2017.04.035"
        },
        {
          "author": "Linda L. Werling, Ashleigh Keller, Julie G. Frank, Samer J. Nuwayhid",
          "title": "A comparison of the binding profiles of dextromethorphan, memantine, fluoxetine and amitriptyline: Treatment of involuntary emotional expression disorder",
          "url": "https://doi.org/10.1016/j.expneurol.2007.06.013"
        },
        {
          "author": "Linda Nguyen, Kelan L. Thomas, Brandon P. Lucke-Wold, John Z. Cavendish, Molly S. Crowe, Rae R. Matsumoto",
          "title": "Dextromethorphan: An update on its utility for neurological and neuropsychiatric disorders",
          "url": "https://doi.org/10.1016/j.pharmthera.2016.01.016"
        }
      ],
      "status": "Unsafe"
    },
    "nbomes": {
      "status": "Unsafe"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well. Additionally if one takes DXM, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.",
      "status": "Dangerous"
    },
    "pcp": {
      "status": "Dangerous"
    },
    "ssris": {
      "note": "High risk of serotonin syndrome.",
      "status": "Dangerous"
    },
    "tramadol": {
      "note": "This combination can dangerously increase serotonin levels in the brain leading to serotonin syndrome in addition to increased CNS depression.",
      "status": "Dangerous"
    }
  },
  "diphenhydramine": {
    "ghb/gbl": {
      "note": "Both substances are CNS depressants, potentiating each other strongly and unpredictably, raising the chances of memory loss, severe ataxia, and unconsciousness. The interaction will cause greater inhibition and risk of injury. If the user falls unconscious it is strongly recommended to put them into the recovery position and monitor breathing.",
      "sources": [
        {
          "author": "William J Tharion, Donna J. McMenemy, Terry M. Rauch",
          "title": "Antihistamine Effects on the Central Nervous System, Cognitive Performance and Subjective States. ",
          "url": "https://doi.org/10.1159/000119069"
        },
        {
          "author": "Sicari V, Zabbo CP. Diphenhydramine.",
          "title": "Diphenhydramine",
          "url": "https://www.ncbi.nlm.nih.gov/books/NBK526010/"
        },
        {
          "author": "Couper FJ, Marinetti LJ.",
          "title": "γ-Hydroxybutyrate (GHB) - Effects on Human Performance and Behavior ",
          "url": "https://pubmed.ncbi.nlm.nih.gov/26256488/"
        },
        {
          "author": "Busardò FP, Jones AW.",
          "title": "GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome",
          "url": "https://doi.org/10.2174%2F1570159X13666141210215423"
        }
      ],
      "status": "Dangerous"
    }
  },
  "dmt": {
    "2c-t-x": {
      "status": "Low Risk & Synergy"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Synergy"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "amt": {
      "status": "Low Risk & Synergy"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Low Risk & Synergy"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "status": "Low Risk & Synergy"
    },
    "mdma": {
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "status": "Low Risk & Synergy"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    }
  },
  "dox": {
    "2c-t-x": {
      "status": "Caution"
    },
    "2c-x": {
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.",
      "status": "Caution"
    },
    "alcohol": {
      "note": "Drinking on stimulants is risky because the sedative effects of the alcohol are reduced, and these are what the body uses to gauge drunkenness. This typically leads to excessive drinking with greatly reduced inhibitions, high risk of liver damage and increased dehydration. They will also  allow you to drink past a point where you might normally pass out, increasing the risk.",
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of amphetamine can easily lead to thought loops. Coming down from amphetamines while the DOx is still active can be quite anxiogenic. ",
      "status": "Unsafe"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "High doses of caffeine may cause anxiety which is less manageable when tripping, and since both are stimulating it may cause some physical discomfort.",
      "status": "Caution"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "The combined stimulating effects of the two can lead to an uncomfortable body-load, while the focusing effects of cocaine can easily lead to thought loops. Coming down from cocaine while the DOx is still active can be quite anxiogenic",
      "status": "Unsafe"
    },
    "dextromethorphan": {
      "note": "The DOx class as psychedelic stimulants have the potential to mask the effects of DXM and could lead to redosing to an unsafe level. DXM can also potentiate DOx resulting in an unpleasantly intense experience.",
      "status": "Unsafe"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "note": "Ketamine and psychedelics tend to potentiate each other - go slowly.",
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably",
      "status": "Caution"
    },
    "mdma": {
      "note": "The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic. ",
      "status": "Caution"
    },
    "mescaline": {
      "status": "Caution"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense",
      "status": "Caution"
    },
    "nbomes": {
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "No unexpected interactions.",
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Unsafe"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    }
  },
  "ghb/gbl": {
    "2c-t-x": {
      "status": "Low Risk & Decrease"
    },
    "2c-x": {
      "status": "Low Risk & Decrease"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Decrease"
    },
    "alcohol": {
      "note": "Even at relatively low doses, both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of sedatives than normal. If the stimulant wears off first the opiate may overcome the individual and cause respiratory arrest.",
      "status": "Caution"
    },
    "amt": {
      "status": "Low Risk & Decrease"
    },
    "benzodiazepines": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of sedatives than normal. If the stimulant wears off first the opiate may overcome the individual and cause respiratory arrest. Likewise the ghb/gbl can wear off and leave a dangerous concentration of cocaine behind",
      "status": "Caution"
    },
    "dextromethorphan": {
      "note": "Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the individual falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position. This combination is hard to predict",
      "status": "Dangerous"
    },
    "diphenhydramine": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "sources": [
        {
          "author": "William J Tharion, Donna J. McMenemy, Terry M. Rauch",
          "title": "Antihistamine Effects on the Central Nervous System, Cognitive Performance and Subjective States. ",
          "url": "https://doi.org/10.1159/000119069"
        },
        {
          "author": "Sicari V, Zabbo CP. Diphenhydramine.",
          "title": "Diphenhydramine",
          "url": "https://www.ncbi.nlm.nih.gov/books/NBK526010/"
        },
        {
          "author": "Couper FJ, Marinetti LJ.",
          "title": "γ-Hydroxybutyrate (GHB) - Effects on Human Performance and Behavior ",
          "url": "https://pubmed.ncbi.nlm.nih.gov/26256488/"
        },
        {
          "author": "Busardò FP, Jones AW.",
          "title": "GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome",
          "url": "https://doi.org/10.2174%2F1570159X13666141210215423"
        }
      ],
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Decrease"
    },
    "dox": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "note": "Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Decrease"
    },
    "maois": {
      "status": "Low Risk & Synergy"
    },
    "mdma": {
      "note": "Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.",
      "status": "Caution"
    },
    "mescaline": {
      "status": "Low Risk & Decrease"
    },
    "mushrooms": {
      "status": "Low Risk & Decrease"
    },
    "mxe": {
      "note": "Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the individual falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "nbomes": {
      "status": "Low Risk & Decrease"
    },
    "nitrous": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "opioids": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "pcp": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Dangerous"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    }
  },
  "ketamine": {
    "2c-t-x": {
      "status": "Low Risk & Synergy"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Synergy"
    },
    "alcohol": {
      "note": "Both substances cause ataxia and bring a very high risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.",
      "status": "Caution"
    },
    "amt": {
      "status": "Low Risk & Synergy"
    },
    "benzodiazepines": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position.",
      "status": "Caution"
    },
    "caffeine": {
      "note": "No unexpected interactions.",
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of this combination may be ill advised due to risk of physical injury.",
      "status": "Caution"
    },
    "dextromethorphan": {
      "note": "Both substances primarily exert their effects through NMDA antagonism. Currently, there is no evidence regarding mechanisms that might reduce these effects.",
      "sources": [
        {
          "author": "Jeanna M. Marraffa",
          "title": "Dextromethorphan",
          "url": "https://doi.org/10.1016/B978-0-12-824315-2.00127-5"
        },
        {
          "author": "Georges Mion, Thierry Villevieille",
          "title": "Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings)",
          "url": "https://doi.org/10.1111/cns.12099"
        },
        {
          "author": "P. Klepstad, P. C. Borchgrevink",
          "title": "Four years' treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia",
          "url": "https://doi.org/10.1111/j.1399-6576.1997.tb04709.x"
        },
        {
          "author": "Stephen M. Stahl",
          "title": "Mechanism of action of dextromethorphan/quinidine: comparison with ketamine",
          "url": "https://doi.org/10.1017/S109285291300062X"
        },
        {
          "author": "A M Hughes,1 J Rhodes,1 G Fisher,2 M Sellers,3 and J W Growcott1",
          "title": "Assessment of the effect of dextromethorphan and ketamine on the acute nociceptive threshold and wind-up of the second pain response in healthy male volunteers",
          "url": "https://doi.org/10.1046%2Fj.1365-2125.2002.01602.x"
        },
        {
          "author": "Keiji Tabuchi, MD, Zenya Ito, MD, Shigeki Tsuji, MD, Akira Hara, MD, Tetsuro Wada, MD, Jun Kusakari, MD",
          "title": "Effect of Ketamine, Dextromethorphan, and MK-801 on Cochlear Dysfunction Induced by Transient Ischemia",
          "url": "https://doi.org/10.1177/000348940211100107"
        }
      ],
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "Ketamine and psychedelics tend to potentiate each other - go slowly.",
      "status": "Low Risk & Synergy"
    },
    "ghb/gbl": {
      "note": "Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available",
      "status": "Caution"
    },
    "mdma": {
      "note": "No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of  this combination may be ill advised due to risk of physical injury.",
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "status": "Low Risk & Synergy"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "status": "Dangerous"
    }
  },
  "lithium": {
    "2c-t-x": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "2c-x": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "cocaine": {
      "note": "Lithium may inhibit some of the recreational effects of cocaine.",
      "sources": [
        {
          "author": "Flemenbaum, A.",
          "title": "Antagonism of behavioral effects of cocaine by lithium. (1977)",
          "url": "https://doi.org/10.1016/0091-3057(77)90015-6"
        },
        {
          "author": "Cronson, A. J., & Flemenbaum, A.",
          "title": "Antagonism of Cocaine Highs by Lithium. (1981)",
          "url": "https://doi.org/10.1007/978-1-4684-3614-3_132"
        }
      ],
      "status": "Low Risk & Decrease"
    },
    "dmt": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "dox": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        },
        {
          "author": "Edwards, C., Van Gerpen, S., & Anand, V.",
          "title": "New-Onset Seizures in an Adolescent Following Use of LSD while on Low-Dose Lithium Therapy: A Case Study. (2024)",
          "url": "https://doi.org/10.1177%2F1941874414528939"
        }
      ],
      "status": "Dangerous"
    },
    "mdma": {
      "note": "High risk of serotonin syndrome",
      "sources": [
        {
          "author": "Lokesh Shahani",
          "title": "Venlafaxine Augmentation With Lithium Leading to Serotonin Syndrome",
          "url": "https://doi.org/10.1176/appi.neuropsych.11080196"
        },
        {
          "author": "Charles DeBattista, Mehmet Sofuoglu, and Alan F. Schatzberg",
          "title": "Serotonergic Synergism: The Risks and Benefits of Combining the Selective Serotonin Reuptake Inhibitors with Other Serotonergic Drugs",
          "url": "https://www.biologicalpsychiatryjournal.com/article/S0006-3223(98)00161-9/pdf"
        },
        {
          "author": "Olivier Massot Ph.D, Jean-Claude Rousselle Ph.D, Marie-Paule Fillion MSc, Dominique Januel MD, Mathieu Plantefol MSc & Gilles Fillion Ph.D ",
          "title": "5-HT1B Receptors: A Novel Target for Lithium: Possible Involvement in Mood Disorders",
          "url": "https://doi.org/10.1016/S0893-133X(99)00042-1"
        },
        {
          "author": "Philip J. Cowen",
          "title": "New drugs, old problems: Revisiting… Pharmacological management of treatment-resistant depression",
          "url": "https://doi.org/10.1192/apt.11.1.19"
        }
      ],
      "status": "Dangerous"
    },
    "mescaline": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "mushrooms": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "nbomes": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        },
        {
          "author": "Umemura, Y., Andrew, T. A., Jacobs, V. L., Giustini, A. J., Lewis, L. D., & Filiano, J. J.",
          "title": "Fatal 251-NBOMe Intoxication: A New Recreational Risk. (2015)",
          "url": "https://doi.org/10.23907/2015.009"
        }
      ],
      "status": "Dangerous"
    },
    "nitrous": {
      "note": "We are unable to find a report of concerns for CNS depression caused by Lithium.",
      "sources": [
        {
          "author": "Drugbank",
          "title": "Lithium Carbonate",
          "url": "https://go.drugbank.com/drugs/DB14509"
        }
      ],
      "status": "Low Risk & No Synergy"
    },
    "ssris": {
      "note": "This interaction is used in medical settings without reported issues. If this combination is taken, caution would be recommended if any other drugs are planned to be taken on top of these that may have serotonergic activity.",
      "sources": [
        {
          "author": "Finley, P. R.",
          "title": "Drug Interactions with Lithium: An Update. (2016)",
          "url": "https://doi.org/10.1007/s40262-016-0370-y"
        },
        {
          "author": "Hawley CJ, Loughlin PJ, Quick SJ, Gale TM, Sivakumaran T, Hayes J, McPhee S.",
          "title": "Efficacy, safety and tolerability of combined administration of lithium and selective serotonin reuptake inhibitors: a review of the current evidence. (2000)",
          "url": "https://doi.org/10.1097/00004850-200015040-00002"
        },
        {
          "author": "Müller-Oerlinghausen, B.",
          "title": "Drug Interactions with Lithium. (1999)",
          "url": "https://doi.org/10.2165/00023210-199911010-00004"
        },
        {
          "author": "Bauer, Michael PhD, MD; Linden, Michael MD; Schaaf, Berthold; Weber, Hans J. MD.",
          "title": "Adverse Events and Tolerability of the Combination of Fluoxetine/Lithium Compared With Fluoxetine. (1996)",
          "url": "https://doi.org/10.1097/00004714-199604000-00005"
        }
      ],
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Tramadol and Lithium both increase the risk of seizures and serotonin syndrome.",
      "sources": [
        {
          "author": "Steven C. Julius, Richard P. Brenner",
          "title": "Myoclonic seizures with lithium",
          "url": "https://doi.org/10.1016/0006-3223(87)90026-6"
        },
        {
          "author": "Charles DeBattista, Mehmet Sofuoglu, and Alan F. Schatzberg",
          "title": "Serotonergic Synergism: The Risks and Benefits of Combining the Selective Serotonin Reuptake Inhibitors with Other Serotonergic Drugs",
          "url": "https://doi.org/10.1016/s0006-3223(98)00161-9"
        },
        {
          "author": "Massot, O., Rousselle, JC., Fillion, MP. et al.",
          "title": "5-HT1B Receptors: A Novel Target for Lithium: Possible Involvement in Mood Disorders",
          "url": "https://doi.org/10.1016/S0893-133X(99)00042-1"
        },
        {
          "author": "Sameer Hassamal, Karen Miotto, William Dale, Itai Danovitch ",
          "title": "Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures",
          "url": "https://doi.org/10.1016/j.amjmed.2018.04.025"
        },
        {
          "author": "Boostani R, Derakhshan S.",
          "title": "Tramadol induced seizure: A 3-year study.",
          "url": "https://pubmed.ncbi.nlm.nih.gov/24009919/"
        },
        {
          "author": "Lagard, C.; Vodovar, D.; Chevillard, L.; Callebert, J.; Caillé, F.; Pottier, G.; Liang, H.; Risède, P.; Tournier, N.; Mégarbane, B.",
          "title": "Investigation of the Mechanisms of Tramadol-Induced Seizures in Overdose in the Rat ",
          "url": "https://doi.org/10.3390/ph15101254 "
        },
        {
          "author": "Sansone RA, Sansone LA.",
          "title": "Tramadol",
          "url": "https://pubmed.ncbi.nlm.nih.gov/19724727"
        }
      ],
      "status": "Dangerous"
    }
  },
  "lsd": {
    "2c-t-x": {
      "status": "Low Risk & Synergy"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Synergy"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "amt": {
      "status": "Low Risk & Synergy"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Low Risk & Synergy"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        },
        {
          "author": "Edwards, C., Van Gerpen, S., & Anand, V.",
          "title": "New-Onset Seizures in an Adolescent Following Use of LSD while on Low-Dose Lithium Therapy: A Case Study. (2024)",
          "url": "https://doi.org/10.1177%2F1941874414528939"
        }
      ],
      "status": "Dangerous"
    },
    "maois": {
      "status": "Low Risk & Decrease"
    },
    "mdma": {
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "sources": [
        {
          "author": "Umemura, Y., Andrew, T. A., Jacobs, V. L., Giustini, A. J., Lewis, L. D., & Filiano, J. J.",
          "title": "Fatal 251-NBOMe Intoxication: A New Recreational Risk. Academic Forensic Pathology",
          "url": "https://doi.org/10.23907/2015.009"
        }
      ],
      "status": "Low Risk & Synergy"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    }
  },
  "maois": {
    "2c-t-x": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series",
      "status": "Caution"
    },
    "2c-x": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably",
      "status": "Caution"
    },
    "5-meo-xxt": {
      "status": "Dangerous"
    },
    "alcohol": {
      "note": "Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.",
      "status": "Unsafe"
    },
    "amphetamines": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.",
      "status": "Dangerous"
    },
    "amt": {
      "note": "aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.",
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Synergy"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "This combination is poorly explored",
      "status": "Dangerous"
    },
    "dextromethorphan": {
      "note": "High risk of serotonin syndrome",
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably",
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Synergy"
    },
    "ketamine": {
      "note": "MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available",
      "status": "Caution"
    },
    "lsd": {
      "status": "Low Risk & Decrease"
    },
    "mdma": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.",
      "status": "Dangerous"
    },
    "mescaline": {
      "status": "Caution"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available",
      "status": "Unsafe"
    },
    "nbomes": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably",
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & No Synergy"
    },
    "opioids": {
      "note": "Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.",
      "status": "Caution"
    },
    "pcp": {
      "note": "This combination is very poorly explored",
      "status": "Dangerous"
    },
    "ssris": {
      "status": "Dangerous"
    },
    "tramadol": {
      "status": "Dangerous"
    }
  },
  "mdma": {
    "2c-t-x": {
      "status": "Caution"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "note": "Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care",
      "status": "Caution"
    },
    "alcohol": {
      "note": "The combination of MDMA and alcohol may increase strain on the cardiovascular system and lead to increased alcohol consumption. MDMA may also impair one's ability to recognize their level of drunkenness, leading to increased alcohol consumption and poor decision-making. Alcohol may also increase the risk of dehydration and hyperthermia (increased body temperature) when combined with MDMA.",
      "sources": [
        {
          "author": "Hamida, S. B., Plute, E., Cosquer, B., Kelche, C., Jones, B. C., & Cassel, J.-C. ",
          "title": "Interactions between ethanol and cocaine, amphetamine, or MDMA in the rat: thermoregulatory and locomotor effects. (2008)",
          "url": "https://doi.org/10.1007/s00213-007-1007-5"
        },
        {
          "author": "Ramaekers, J. G., & Kuypers, K. P. C.",
          "title": "Acute Effects of 3,4-Methylenedioxymethamphetamine (MDMA) on Behavioral Measures of Impulsivity: Alone and in Combination with Alcohol. (2006)",
          "url": "https://doi.org/10.1038/sj.npp.1300894"
        },
        {
          "author": "Hernández-López, C., Farré, M., Roset, P. N., Menoyo, E., Pizarro, N., Ortuño, J., Torrens, M., Camı́, J., & Torre, R. de la.",
          "title": "3,4-Methylenedioxymethamphetamine (Ecstasy) and Alcohol Interactions in Humans: Psychomotor Performance, Subjective Effects, and Pharmacokinetics. (2002)",
          "url": "https://doi.org/10.1124/jpet.300.1.236"
        },
        {
          "author": "van Amsterdam, J., Brunt, T. M., Pierce, M., & van den Brink, W.",
          "title": "Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: a Systematic Review. (2021)",
          "url": "https://doi.org/10.1007/s12640-021-00416-z"
        }
      ],
      "status": "Caution"
    },
    "amphetamines": {
      "note": "This combination of stimulants will increase strain on the heart, may cause some physical discomfort, and has the chance to cause cardiovascular issues. The anxiogenic and focusing effects of stimulants can increase the chance of unpleasant thought loops and make the experience more uncomfortable, this combination raises these chances. Amphetamines will increase the neurotoxic effects of MDMA, in addition to causing further concerns of hyperthermia due to the inherent nature of the combination. It will also raise one's body temperature, also likely making the combination more neurotoxic.",
      "sources": [
        {
          "author": "Kelly J. Clemens, Iain S. McGregor, Glenn E. Hunt, Jennifer L. Cornish",
          "title": "MDMA, methamphetamine and their combination: possible lessons for party drug users from recent preclinical research",
          "url": "https://doi.org/10.1080/09595230601036945"
        },
        {
          "author": "Kelly J. Clemens, Iain S. McGregor, Glenn E. Hunt, Jennifer L. Cornish",
          "title": "Repeated weekly exposure to MDMA, methamphetamine or their combination: long-term behavioural and neurochemical effects in rats ",
          "url": "https://doi.org/10.1016/j.drugalcdep.2006.06.004"
        },
        {
          "author": "P. Leon Brown, Eugene A. Kiyatkin",
          "title": "Brain hyperthermia induced by MDMA (‘ecstasy’): modulation by environmental conditions",
          "url": "https://doi.org/10.1111/j.0953-816X.2004.03453.x"
        }
      ],
      "status": "Caution"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA",
      "status": "Caution"
    },
    "cannabis": {
      "note": "Large amounts of cannabis may cause strong and somewhat unpredictable experiences in combination with MDMA. Cannabis should be saved for towards the end of the experience if possible.",
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "The combined stimulating effects of the two can be uncomfortable. Coming down on the MDMA while the DOx is still active can be quite anxiogenic. ",
      "status": "Caution"
    },
    "ghb/gbl": {
      "note": "Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.",
      "status": "Caution"
    },
    "ketamine": {
      "note": "No unexpected interactions, though likely to increase blood pressure but not an issue with sensible doses. Moving around on high doses of  this combination may be ill advised due to risk of physical injury.",
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "High risk of serotonin syndrome",
      "sources": [
        {
          "author": "Lokesh Shahani",
          "title": "Venlafaxine Augmentation With Lithium Leading to Serotonin Syndrome",
          "url": "https://doi.org/10.1176/appi.neuropsych.11080196"
        },
        {
          "author": "Charles DeBattista, Mehmet Sofuoglu, and Alan F. Schatzberg",
          "title": "Serotonergic Synergism: The Risks and Benefits of Combining the Selective Serotonin Reuptake Inhibitors with Other Serotonergic Drugs",
          "url": "https://www.biologicalpsychiatryjournal.com/article/S0006-3223(98)00161-9/pdf"
        },
        {
          "author": "Olivier Massot Ph.D, Jean-Claude Rousselle Ph.D, Marie-Paule Fillion MSc, Dominique Januel MD, Mathieu Plantefol MSc & Gilles Fillion Ph.D ",
          "title": "5-HT1B Receptors: A Novel Target for Lithium: Possible Involvement in Mood Disorders",
          "url": "https://doi.org/10.1016/S0893-133X(99)00042-1"
        },
        {
          "author": "Philip J. Cowen",
          "title": "New drugs, old problems: Revisiting… Pharmacological management of treatment-resistant depression",
          "url": "https://doi.org/10.1192/apt.11.1.19"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.",
      "status": "Dangerous"
    },
    "mephedrone": {
      "note": "Risk of serotonin syndrome as both drugs raise serotonin levels. Stimulants also increase the neurotoxic effects of MDMA, in addition to concerns of high blood pressure and unnecessary strain on the heart. As well as potentially causing anxiety and greater physical discomfort due to the combination.",
      "sources": [
        {
          "author": "J Kehr,  F Ichinose,  S Yoshitake,  M Goiny,  T Sievertsson,  F Nyberg,  T Yoshitake",
          "title": "Mephedrone, compared with MDMA (ecstasy) and amphetamine, rapidly increases both dopamine and 5-HT levels in nucleus accumbens of awake rats",
          "url": "https://doi.org/10.1111/j.1476-5381.2011.01499.x"
        },
        {
          "author": "Gregory C. Hadlock, Katy M. Webb, Lisa M. McFadden, Pei Wen Chu, Jonathan D. Ellis, Scott C. Allen, David M. Andrenyak, Paula L. Vieira-Brock, Christopher L. German, Kevin M. Conrad, Amanda J. Hoonakker, James W. Gibb, Diana G. Wilkins, Glen R. Hanson and Annette E. Fleckenstein",
          "title": "4-Methylmethcathinone (Mephedrone): Neuropharmacological Effects of a Designer Stimulant of Abuse",
          "url": "https://doi.org/10.1124/jpet.111.184119 "
        },
        {
          "author": "Gough B, Ali SF, Slikker W Jr, Holson RR. ",
          "title": "Acute effects of 3,4-methylenedioxymethamphetamine (MDMA) on monoamines in rat caudate. (1991)",
          "url": "https://doi.org/10.1016/0091-3057(91)90137-q"
        },
        {
          "author": "Schmidt CJ, Levin JA, Lovenberg W. ",
          "title": "In vitro and in vivo neurochemical effects of methylenedioxymethamphetamine on striatal monoaminergic systems in the rat brain. (1987)",
          "url": "https://doi.org/10.1016/0006-2952(87)90729-5"
        },
        {
          "author": "Bankson MG, Cunningham KA.",
          "title": "3,4-Methylenedioxymethamphetamine (MDMA) as a unique model of serotonin receptor function and serotonin-dopamine interactions. (2001)",
          "url": "https://pubmed.ncbi.nlm.nih.gov/11356903/"
        },
        {
          "author": "A.C. Parrott",
          "title": "Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity (2002)",
          "url": "https://doi.org/10.1016/S0091-3057(01)00711-0"
        },
        {
          "author": "Lisa H. Gold & George F. Koob ",
          "title": "MDMA produces stimulant-like conditioned locomotor activity. (1989)",
          "url": "https://doi.org/10.1007/BF00445556"
        },
        {
          "author": "Meng H, Cao J, Kang J, Ying X, Ji J, Reynolds W, Rampe D.",
          "title": "Mephedrone, a new designer drug of abuse, produces acute hemodynamic effects in the rat ",
          "url": "https://doi.org/10.1016/j.toxlet.2011.10.010"
        }
      ],
      "status": "Dangerous"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.",
      "status": "Caution"
    },
    "nbomes": {
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "note": "This combination can easily lead to hypermanic states",
      "status": "Unsafe"
    },
    "ssris": {
      "sources": [
        {
          "author": "Feduccia, A. A., Jerome, L., Mithoefer, M. C., & Holland, J.",
          "title": "Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy.",
          "url": "https://doi.org/10.1007/s00213-020-05710-w"
        },
        {
          "author": "Sarparast, A., Thomas, K., Malcolm, B., & Stauffer, C. S.",
          "title": "Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review.",
          "url": "https://doi.org/10.1007/s00213-022-06083-y"
        },
        {
          "author": "Malcolm, B., & Thomas, K. ",
          "title": "Serotonin toxicity of serotonergic psychedelics.",
          "url": "https://doi.org/10.1007/s00213-021-05876-x"
        }
      ],
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol and stimulants both increase the risk of seizures.",
      "status": "Dangerous"
    }
  },
  "mephedrone": {
    "dextromethorphan": {
      "note": "Risk of serotonin syndrome as both drugs raise serotonin levels. In addition to concerns of high blood pressure and unnecessary strain on the heart. As well as potentially causing anxiety and greater physical discomfort due to the combination.",
      "sources": [
        {
          "author": "J Kehr,  F Ichinose,  S Yoshitake,  M Goiny,  T Sievertsson,  F Nyberg,  T Yoshitake",
          "title": "Mephedrone, compared with MDMA (ecstasy) and amphetamine, rapidly increases both dopamine and 5-HT levels in nucleus accumbens of awake rats",
          "url": "https://doi.org/10.1111/j.1476-5381.2011.01499.x"
        },
        {
          "author": "Gregory C. Hadlock, Katy M. Webb, Lisa M. McFadden, Pei Wen Chu, Jonathan D. Ellis, Scott C. Allen, David M. Andrenyak, Paula L. Vieira-Brock, Christopher L. German, Kevin M. Conrad, Amanda J. Hoonakker, James W. Gibb, Diana G. Wilkins, Glen R. Hanson and Annette E. Fleckenstein",
          "title": "4-Methylmethcathinone (Mephedrone): Neuropharmacological Effects of a Designer Stimulant of Abuse",
          "url": "https://doi.org/10.1124/jpet.111.184119 "
        },
        {
          "author": "Anna R. Schwartz, Anthony F. Pizon & Daniel E. Brooks",
          "title": "Dextromethorphan-induced serotonin syndrome",
          "url": "https://doi.org/10.1080/15563650701668625"
        },
        {
          "author": "DrugBank",
          "title": "Dextromethorphan",
          "url": "https://go.drugbank.com/drugs/DB00514"
        },
        {
          "author": "Henderson MG, Fuller RW",
          "title": "Dextromethorphan antagonizes the acute depletion of brain serotonin by p-chloroamphetamine and H75/12 in rats",
          "url": "https://doi.org/10.1016/0006-8993(92)91144-4"
        },
        {
          "author": "Reissig CJ, Carter LP, Johnson MW, Mintzer MZ, Klinedinst MA, Griffiths RR",
          "title": "High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens ",
          "url": "https://doi.org/10.1007/s00213-012-2680-6"
        },
        {
          "author": "Meng H, Cao J, Kang J, Ying X, Ji J, Reynolds W, Rampe D.",
          "title": "Mephedrone, a new designer drug of abuse, produces acute hemodynamic effects in the rat ",
          "url": "https://doi.org/10.1016/j.toxlet.2011.10.010"
        }
      ],
      "status": "Dangerous"
    },
    "mdma": {
      "note": "Risk of serotonin syndrome as both drugs raise serotonin levels. Stimulants also increase the neurotoxic effects of MDMA, in addition to concerns of high blood pressure and unnecessary strain on the heart. As well as potentially causing anxiety and greater physical discomfort due to the combination.",
      "sources": [
        {
          "author": "J Kehr,  F Ichinose,  S Yoshitake,  M Goiny,  T Sievertsson,  F Nyberg,  T Yoshitake",
          "title": "Mephedrone, compared with MDMA (ecstasy) and amphetamine, rapidly increases both dopamine and 5-HT levels in nucleus accumbens of awake rats",
          "url": "https://doi.org/10.1111/j.1476-5381.2011.01499.x"
        },
        {
          "author": "Gregory C. Hadlock, Katy M. Webb, Lisa M. McFadden, Pei Wen Chu, Jonathan D. Ellis, Scott C. Allen, David M. Andrenyak, Paula L. Vieira-Brock, Christopher L. German, Kevin M. Conrad, Amanda J. Hoonakker, James W. Gibb, Diana G. Wilkins, Glen R. Hanson and Annette E. Fleckenstein",
          "title": "4-Methylmethcathinone (Mephedrone): Neuropharmacological Effects of a Designer Stimulant of Abuse",
          "url": "https://doi.org/10.1124/jpet.111.184119 "
        },
        {
          "author": "Gough B, Ali SF, Slikker W Jr, Holson RR. ",
          "title": "Acute effects of 3,4-methylenedioxymethamphetamine (MDMA) on monoamines in rat caudate. (1991)",
          "url": "https://doi.org/10.1016/0091-3057(91)90137-q"
        },
        {
          "author": "Schmidt CJ, Levin JA, Lovenberg W. ",
          "title": "In vitro and in vivo neurochemical effects of methylenedioxymethamphetamine on striatal monoaminergic systems in the rat brain. (1987)",
          "url": "https://doi.org/10.1016/0006-2952(87)90729-5"
        },
        {
          "author": "Bankson MG, Cunningham KA.",
          "title": "3,4-Methylenedioxymethamphetamine (MDMA) as a unique model of serotonin receptor function and serotonin-dopamine interactions. (2001)",
          "url": "https://pubmed.ncbi.nlm.nih.gov/11356903/"
        },
        {
          "author": "A.C. Parrott",
          "title": "Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity (2002)",
          "url": "https://doi.org/10.1016/S0091-3057(01)00711-0"
        },
        {
          "author": "Lisa H. Gold & George F. Koob ",
          "title": "MDMA produces stimulant-like conditioned locomotor activity. (1989)",
          "url": "https://doi.org/10.1007/BF00445556"
        },
        {
          "author": "Meng H, Cao J, Kang J, Ying X, Ji J, Reynolds W, Rampe D.",
          "title": "Mephedrone, a new designer drug of abuse, produces acute hemodynamic effects in the rat ",
          "url": "https://doi.org/10.1016/j.toxlet.2011.10.010"
        }
      ],
      "status": "Dangerous"
    }
  },
  "mescaline": {
    "2c-t-x": {
      "status": "Caution"
    },
    "2c-x": {
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "The 5-MeO class of tryptamines can be unpredictable in their interactions",
      "status": "Caution"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops",
      "status": "Caution"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "High doses of caffeine are uncomfortable and this will be magnified by psychedelics",
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "status": "Caution"
    },
    "mdma": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.",
      "status": "Unsafe"
    }
  },
  "mushrooms": {
    "2c-t-x": {
      "status": "Low Risk & Synergy"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Synergy"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "amt": {
      "status": "Low Risk & Synergy"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences",
      "status": "Caution"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Low Risk & Synergy"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "status": "Low Risk & Synergy"
    },
    "mdma": {
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "status": "Low Risk & Synergy"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    }
  },
  "mxe": {
    "2c-t-x": {
      "status": "Caution"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "note": "Little information exists about this combination.",
      "status": "Low Risk & Synergy"
    },
    "alcohol": {
      "note": "There is a high risk of memory loss, vomiting and severe ataxia from this combination.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "Risk of tachycardia, hypertension, and manic states",
      "status": "Caution"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place the affected individual in the recovery position to prevent vomit aspiration from excess.",
      "status": "Caution"
    },
    "caffeine": {
      "note": "No likely interactions",
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.",
      "status": "Caution"
    },
    "dextromethorphan": {
      "note": "There is a risk of serotonin syndrome when combining DXM with MXE, due to DXM and MXE both being SRI’s. MXE and DXM having notable affinities for the serotonin transporter.",
      "sources": [
        {
          "author": "Bryan L. Roth, Simon Gibbons, Warunya Arunotayanun, Xi-Ping Huang, Vincent Setola, Ric Treble, Les Iversen",
          "title": "The Ketamine Analogue Methoxetamine and 3- and 4-Methoxy Analogues of Phencyclidine Are High Affinity and Selective Ligands for the Glutamate NMDA Receptor",
          "url": "https://doi.org/10.1371/journal.pone.0059334"
        },
        {
          "author": "Matteo Marti, Giuseppe Talani, Cristina Miliano, Sabrine Bilel, Francesca Biggio, Jessica Bratzu, Marco Diana, Maria Antonietta De Luca, Liana Fattore",
          "title": "New insights into methoxetamine mechanisms of action: Focus on serotonergic 5-HT2 receptors in pharmacological and behavioral effects in the rat ",
          "url": "https://doi.org/10.1016/j.expneurol.2021.113836"
        },
        {
          "author": "Laura Hondebrink, Emma E.J. Kasteel, Anke M. Tukker, Fiona M.J. Wijnolts, Anouk H.A. Verboven, Remco H.S. Westerink",
          "title": "Neuropharmacological characterization of the new psychoactive substance methoxetamine",
          "url": "https://doi.org/10.1016/j.neuropharm.2017.04.035"
        },
        {
          "author": "Linda L. Werling, Ashleigh Keller, Julie G. Frank, Samer J. Nuwayhid",
          "title": "A comparison of the binding profiles of dextromethorphan, memantine, fluoxetine and amitriptyline: Treatment of involuntary emotional expression disorder",
          "url": "https://doi.org/10.1016/j.expneurol.2007.06.013"
        },
        {
          "author": "Linda Nguyen, Kelan L. Thomas, Brandon P. Lucke-Wold, John Z. Cavendish, Molly S. Crowe, Rae R. Matsumoto",
          "title": "Dextromethorphan: An update on its utility for neurological and neuropsychiatric disorders",
          "url": "https://doi.org/10.1016/j.pharmthera.2016.01.016"
        }
      ],
      "status": "Unsafe"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense",
      "status": "Caution"
    },
    "ghb/gbl": {
      "note": "Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the individual falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available",
      "status": "Unsafe"
    },
    "mdma": {
      "note": "There have been reports of risky serotonergic interactions when the two are taken at the same time, but MXE taken to the end of an MDMA experience does not appear to cause the same issues.",
      "status": "Caution"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "note": "As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense",
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "This combination can potentiate the effects of the opioid",
      "status": "Dangerous"
    },
    "pcp": {
      "note": "There are no reports available about this combination",
      "status": "Caution"
    },
    "ssris": {
      "note": "Depending on the SSRI this combination can be unpredictable",
      "status": "Caution"
    },
    "tramadol": {
      "status": "Dangerous"
    }
  },
  "nbomes": {
    "2c-t-x": {
      "status": "Caution"
    },
    "2c-x": {
      "status": "Caution"
    },
    "5-meo-xxt": {
      "note": "The 5-MeO class of tryptamines can be unpredictable in their interactions and the NBOMes are known to be unpredictable even alone. This combination is best avoided",
      "status": "Caution"
    },
    "alcohol": {
      "status": "Low Risk & Decrease"
    },
    "amphetamines": {
      "note": "Amphetamines and NBOMes both provide considerable stimulation. When combined they can result in tachycardia, hypertension, vasoconstriction and in extreme cases heart failure. The anxiogenic and focusing effects of stimulants are also not good in combination with psychedelics as they can lead to unpleasant thought loops. NBOMes are known to cause seizures and stimulants can increase this risk.",
      "status": "Unsafe"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "note": "Caffiene can bring out the natural stimulation from psychedelic drugs to make it uncomfortable. High doses can cause anxiety which is hard to handle while tripping",
      "status": "Caution"
    },
    "cannabis": {
      "note": "Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.",
      "status": "Caution"
    },
    "cocaine": {
      "note": "Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.",
      "status": "Unsafe"
    },
    "dextromethorphan": {
      "status": "Unsafe"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Caution"
    },
    "ghb/gbl": {
      "status": "Low Risk & Decrease"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "There is a large number of reports indicating a high seizure and psychosis risk from this combination.",
      "sources": [
        {
          "author": "Sandeep M Nayak, Natalie Gukasyan, Frederick S Barrett , Earth Erowid , Fire Erowid , Roland R Griffiths",
          "title": "Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports",
          "url": "https://doi.org/10.1055/a-1524-2794"
        },
        {
          "author": "Erowid",
          "title": "Erowid Interactions",
          "url": "https://erowid.org/chemicals/lsd/lsd_interactions.shtml"
        },
        {
          "author": "freshboi88",
          "title": "I Was Only on One Dose",
          "url": "https://erowid.org/experiences/exp.php?ID=93681"
        },
        {
          "author": "YouWerentYouAnymore",
          "title": "Brought My Worst Thoughts to Life",
          "url": "https://erowid.org/experiences/exp.php?ID=110780"
        },
        {
          "author": "Otto Simonsson, Peper S. Hendricks, Richard Chambers, Walter Osika, Simon B. Goldberg",
          "title": "Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics",
          "url": "https://doi.org/10.1016/j.jad.2023.01.073"
        },
        {
          "author": "Umemura, Y., Andrew, T. A., Jacobs, V. L., Giustini, A. J., Lewis, L. D., & Filiano, J. J.",
          "title": "Fatal 251-NBOMe Intoxication: A New Recreational Risk. (2015)",
          "url": "https://doi.org/10.23907/2015.009"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "sources": [
        {
          "author": "Umemura, Y., Andrew, T. A., Jacobs, V. L., Giustini, A. J., Lewis, L. D., & Filiano, J. J.",
          "title": "Fatal 251-NBOMe Intoxication: A New Recreational Risk. Academic Forensic Pathology",
          "url": "https://doi.org/10.23907/2015.009"
        }
      ],
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably",
      "status": "Caution"
    },
    "mdma": {
      "status": "Caution"
    },
    "mescaline": {
      "status": "Caution"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense",
      "status": "Caution"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & Decrease"
    },
    "tramadol": {
      "note": "Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures",
      "status": "Unsafe"
    }
  },
  "nitrous": {
    "2c-t-x": {
      "status": "Low Risk & Synergy"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Synergy"
    },
    "alcohol": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "amphetamines": {
      "status": "Low Risk & Synergy"
    },
    "amt": {
      "status": "Low Risk & Synergy"
    },
    "benzodiazepines": {
      "status": "Low Risk & Decrease"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "status": "Low Risk & Synergy"
    },
    "dextromethorphan": {
      "status": "Low Risk & Synergy"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "status": "Low Risk & Synergy"
    },
    "ghb/gbl": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lithium": {
      "note": "We are unable to find a report of concerns for CNS depression caused by Lithium.",
      "sources": [
        {
          "author": "Drugbank",
          "title": "Lithium Carbonate",
          "url": "https://go.drugbank.com/drugs/DB14509"
        }
      ],
      "status": "Low Risk & No Synergy"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "status": "Low Risk & No Synergy"
    },
    "mdma": {
      "status": "Low Risk & Synergy"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "status": "Low Risk & Synergy"
    },
    "nbomes": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "pcp": {
      "status": "Low Risk & Synergy"
    },
    "ssris": {
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    }
  },
  "opioids": {
    "2c-t-x": {
      "note": "No expected interactions, some opioids have serotonin action, and could lead to Serotonin Syndrome or a seizure. These are pretty much only to Pentazocine, Methadone, Tramadol, Tapenatdol.",
      "status": "Low Risk & No Synergy"
    },
    "2c-x": {
      "status": "Low Risk & No Synergy"
    },
    "5-meo-xxt": {
      "status": "Low Risk & No Synergy"
    },
    "alcohol": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of opiates than normal. If the stimulant wears off first then the opiate may overcome the individual and cause respiratory arrest.",
      "status": "Caution"
    },
    "amt": {
      "note": "No unexpected interactions",
      "status": "Low Risk & No Synergy"
    },
    "benzodiazepines": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Stimulants increase respiration rate allowing for a higher dose of opiates than normal. If the stimulant wears off first then the opiate may overcome the individual and cause respiratory arrest.",
      "status": "Dangerous"
    },
    "dextromethorphan": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well. Additionally if one takes DXM, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.",
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & No Synergy"
    },
    "dox": {
      "note": "No unexpected interactions.",
      "status": "Low Risk & No Synergy"
    },
    "ghb/gbl": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "ketamine": {
      "note": "Both substances bring a risk of vomiting and unconsciousness. If the user falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.",
      "status": "Dangerous"
    },
    "lsd": {
      "status": "Low Risk & No Synergy"
    },
    "maois": {
      "note": "Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.",
      "status": "Caution"
    },
    "mdma": {
      "status": "Low Risk & No Synergy"
    },
    "mescaline": {
      "status": "Low Risk & No Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & No Synergy"
    },
    "mxe": {
      "note": "This combination can potentiate the effects of the opioid",
      "status": "Dangerous"
    },
    "nbomes": {
      "status": "Low Risk & No Synergy"
    },
    "nitrous": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "pcp": {
      "note": "PCP can reduce opioid tolerance, increasing the risk of overdose",
      "status": "Caution"
    },
    "ssris": {
      "note": "There have been some case reports of serotonin syndrome in individuals who were given a combination of opioids and SSRIs. Other research has indicated a small increase in overdose risk for people who are prescribed CYP2D6-inhibiting SSRIs (e.g. fluoxetine and paroxetine) with oxycodone. Overall, risk is low with this combination but, as always, be mindful of your consumption.",
      "status": "Low Risk & No Synergy"
    },
    "tramadol": {
      "note": "Concomitant use of tramadol increases the seizure risk in individuals taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present",
      "status": "Dangerous"
    }
  },
  "pcp": {
    "2c-t-x": {
      "status": "Dangerous"
    },
    "2c-x": {
      "status": "Low Risk & Synergy"
    },
    "5-meo-xxt": {
      "status": "Dangerous"
    },
    "alcohol": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Unsafe"
    },
    "amphetamines": {
      "note": "This combination can easily lead to hypermanic states",
      "status": "Unsafe"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely",
      "status": "Unsafe"
    },
    "caffeine": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Caution"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "This combination can easily lead to hypermanic states",
      "status": "Unsafe"
    },
    "dextromethorphan": {
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Synergy"
    },
    "dox": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Unsafe"
    },
    "ghb/gbl": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Dangerous"
    },
    "ketamine": {
      "status": "Low Risk & Synergy"
    },
    "lsd": {
      "status": "Low Risk & Synergy"
    },
    "maois": {
      "note": "This combination is very poorly explored",
      "status": "Dangerous"
    },
    "mdma": {
      "note": "This combination can easily lead to hypermanic states",
      "status": "Unsafe"
    },
    "mescaline": {
      "status": "Low Risk & Synergy"
    },
    "mushrooms": {
      "status": "Low Risk & Synergy"
    },
    "mxe": {
      "note": "There are no reports available about this combination",
      "status": "Caution"
    },
    "nbomes": {
      "status": "Low Risk & Synergy"
    },
    "nitrous": {
      "status": "Low Risk & Synergy"
    },
    "opioids": {
      "note": "PCP can reduce opioid tolerance, increasing the risk of overdose",
      "status": "Caution"
    },
    "ssris": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Unsafe"
    },
    "tramadol": {
      "status": "Dangerous"
    }
  },
  "ssris": {
    "2c-t-x": {
      "status": "Low Risk & Decrease"
    },
    "2c-x": {
      "status": "Low Risk & Decrease"
    },
    "5-meo-xxt": {
      "status": "Low Risk & Decrease"
    },
    "alcohol": {
      "note": "Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and  psychomotor skills.",
      "status": "Caution"
    },
    "amphetamines": {
      "status": "Low Risk & No Synergy"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "status": "Low Risk & No Synergy"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & No Synergy"
    },
    "cocaine": {
      "note": "May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.",
      "status": "Low Risk & No Synergy"
    },
    "dextromethorphan": {
      "note": "High risk of serotonin syndrome.",
      "status": "Dangerous"
    },
    "dmt": {
      "status": "Low Risk & Decrease"
    },
    "dox": {
      "status": "Low Risk & Decrease"
    },
    "ghb/gbl": {
      "status": "Low Risk & No Synergy"
    },
    "ketamine": {
      "status": "Low Risk & No Synergy"
    },
    "lithium": {
      "note": "This interaction is used in medical settings without reported issues. If this combination is taken, caution would be recommended if any other drugs are planned to be taken on top of these that may have serotonergic activity.",
      "sources": [
        {
          "author": "Finley, P. R.",
          "title": "Drug Interactions with Lithium: An Update. (2016)",
          "url": "https://doi.org/10.1007/s40262-016-0370-y"
        },
        {
          "author": "Hawley CJ, Loughlin PJ, Quick SJ, Gale TM, Sivakumaran T, Hayes J, McPhee S.",
          "title": "Efficacy, safety and tolerability of combined administration of lithium and selective serotonin reuptake inhibitors: a review of the current evidence. (2000)",
          "url": "https://doi.org/10.1097/00004850-200015040-00002"
        },
        {
          "author": "Müller-Oerlinghausen, B.",
          "title": "Drug Interactions with Lithium. (1999)",
          "url": "https://doi.org/10.2165/00023210-199911010-00004"
        },
        {
          "author": "Bauer, Michael PhD, MD; Linden, Michael MD; Schaaf, Berthold; Weber, Hans J. MD.",
          "title": "Adverse Events and Tolerability of the Combination of Fluoxetine/Lithium Compared With Fluoxetine. (1996)",
          "url": "https://doi.org/10.1097/00004714-199604000-00005"
        }
      ],
      "status": "Low Risk & No Synergy"
    },
    "lsd": {
      "status": "Low Risk & Decrease"
    },
    "maois": {
      "status": "Dangerous"
    },
    "mdma": {
      "sources": [
        {
          "author": "Feduccia, A. A., Jerome, L., Mithoefer, M. C., & Holland, J.",
          "title": "Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy.",
          "url": "https://doi.org/10.1007/s00213-020-05710-w"
        },
        {
          "author": "Sarparast, A., Thomas, K., Malcolm, B., & Stauffer, C. S.",
          "title": "Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review.",
          "url": "https://doi.org/10.1007/s00213-022-06083-y"
        },
        {
          "author": "Malcolm, B., & Thomas, K. ",
          "title": "Serotonin toxicity of serotonergic psychedelics.",
          "url": "https://doi.org/10.1007/s00213-021-05876-x"
        }
      ],
      "status": "Low Risk & Decrease"
    },
    "mescaline": {
      "status": "Low Risk & Decrease"
    },
    "mushrooms": {
      "status": "Low Risk & Decrease"
    },
    "mxe": {
      "note": "Depending on the SSRI this combination can be unpredictable",
      "status": "Caution"
    },
    "nbomes": {
      "status": "Low Risk & Decrease"
    },
    "nitrous": {
      "status": "Low Risk & No Synergy"
    },
    "opioids": {
      "note": "There have been some case reports of serotonin syndrome in individuals who were given a combination of opioids and SSRIs. Other research has indicated a small increase in overdose risk for people who are prescribed CYP2D6-inhibiting SSRIs (e.g. fluoxetine and paroxetine) with oxycodone. Overall, risk is low with this combination but, as always, be mindful of your consumption.",
      "status": "Low Risk & No Synergy"
    },
    "pcp": {
      "note": "Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.",
      "status": "Unsafe"
    },
    "tramadol": {
      "note": "Increased risk of serotonin syndrome.",
      "status": "Dangerous"
    }
  },
  "tramadol": {
    "2c-t-x": {
      "status": "Unsafe"
    },
    "2c-x": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.",
      "status": "Unsafe"
    },
    "5-meo-xxt": {
      "status": "Unsafe"
    },
    "alcohol": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of seizures, blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "amphetamines": {
      "note": "Tramadol and stimulants both increase the risk of seizures.",
      "status": "Dangerous"
    },
    "amt": {
      "status": "Dangerous"
    },
    "benzodiazepines": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "caffeine": {
      "status": "Low Risk & No Synergy"
    },
    "cannabis": {
      "status": "Low Risk & Synergy"
    },
    "cocaine": {
      "note": "Tramadol and stimulants both increase the risk of seizures.",
      "status": "Dangerous"
    },
    "dextromethorphan": {
      "status": "Dangerous"
    },
    "dmt": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    },
    "dox": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    },
    "ghb/gbl": {
      "note": "Both drugs increase the CNS depressant effects of each other. There is a high risk of blackouts/memory loss, unconsciousness, and respiratory depression leading to death. While unconscious, may cause vomit aspiration as well.",
      "status": "Dangerous"
    },
    "ketamine": {
      "status": "Dangerous"
    },
    "lithium": {
      "note": "Tramadol and Lithium both increase the risk of seizures and serotonin syndrome.",
      "sources": [
        {
          "author": "Steven C. Julius, Richard P. Brenner",
          "title": "Myoclonic seizures with lithium",
          "url": "https://doi.org/10.1016/0006-3223(87)90026-6"
        },
        {
          "author": "Charles DeBattista, Mehmet Sofuoglu, and Alan F. Schatzberg",
          "title": "Serotonergic Synergism: The Risks and Benefits of Combining the Selective Serotonin Reuptake Inhibitors with Other Serotonergic Drugs",
          "url": "https://doi.org/10.1016/s0006-3223(98)00161-9"
        },
        {
          "author": "Massot, O., Rousselle, JC., Fillion, MP. et al.",
          "title": "5-HT1B Receptors: A Novel Target for Lithium: Possible Involvement in Mood Disorders",
          "url": "https://doi.org/10.1016/S0893-133X(99)00042-1"
        },
        {
          "author": "Sameer Hassamal, Karen Miotto, William Dale, Itai Danovitch ",
          "title": "Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures",
          "url": "https://doi.org/10.1016/j.amjmed.2018.04.025"
        },
        {
          "author": "Boostani R, Derakhshan S.",
          "title": "Tramadol induced seizure: A 3-year study.",
          "url": "https://pubmed.ncbi.nlm.nih.gov/24009919/"
        },
        {
          "author": "Lagard, C.; Vodovar, D.; Chevillard, L.; Callebert, J.; Caillé, F.; Pottier, G.; Liang, H.; Risède, P.; Tournier, N.; Mégarbane, B.",
          "title": "Investigation of the Mechanisms of Tramadol-Induced Seizures in Overdose in the Rat ",
          "url": "https://doi.org/10.3390/ph15101254 "
        },
        {
          "author": "Sansone RA, Sansone LA.",
          "title": "Tramadol",
          "url": "https://pubmed.ncbi.nlm.nih.gov/19724727"
        }
      ],
      "status": "Dangerous"
    },
    "lsd": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    },
    "maois": {
      "status": "Dangerous"
    },
    "mdma": {
      "note": "Tramadol and stimulants both increase the risk of seizures.",
      "status": "Dangerous"
    },
    "mescaline": {
      "note": "This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.",
      "status": "Unsafe"
    },
    "mushrooms": {
      "note": "Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.",
      "status": "Unsafe"
    },
    "mxe": {
      "status": "Dangerous"
    },
    "nbomes": {
      "note": "Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures",
      "status": "Unsafe"
    },
    "nitrous": {
      "note": "Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Memory blackouts are likely.",
      "status": "Caution"
    },
    "opioids": {
      "note": "Concomitant use of tramadol increases the seizure risk in individuals taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present",
      "status": "Dangerous"
    },
    "pcp": {
      "status": "Dangerous"
    },
    "ssris": {
      "status": "Dangerous"
    }
  }
}