Talk:Dangerous drug combinations

WARNING! For educational purposes: We do not endorse any of these combinations. This page will always be 'work in progress'. It is extremely important to be safe at all times! See below the graphic for important information regarding specific combinations.

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & lsd Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

cocaine & lsd Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

tramadol & lsd Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

cannabis & mushrooms Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & mushrooms Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

cocaine & mushrooms Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

tramadol & mushrooms Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

cannabis & dmt Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & dmt Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

cocaine & dmt Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

tramadol & dmt Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

5-meo-xxt & mescaline Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions

cannabis & mescaline Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & mescaline Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

cocaine & mescaline Status: Caution

Note: The focus and anxiety caused by stimulants is magnified by psychedelics and results in an increased risk of thought loops

caffeine & mescaline Status: Low Risk & No Synergy

Note: High doses of caffeine are uncomfortable and this will be magnified by psychedelics

tramadol & mescaline Status: Unsafe

Note: This combination can cause seizures due to the lowering of the threshold by tramadol and the potential of mescaline to cause seziures.

5-meo-xxt & dox Status: Caution

Note: The 5-MeO class of tryptamines can be unpredictable in their interactions, particularly increasing the risk of unpleasant physical side effects.

cannabis & dox Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

ketamine & dox Status: Low Risk & Synergy

Note: Ketamine and psychedelics tend to potentiate each other - go slowly.

mxe & dox Status: Caution

Note: As an NMDA antagonist MXE potentiates DOx which can be unpleasantly intense

dxm & dox Status: Unsafe

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.

pcp & dox Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

amphetamines & dox Status: Unsafe

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.

mdma & dox Status: Caution

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.

cocaine & dox Status: Unsafe

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

caffeine & dox Status: Caution

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.

alcohol & dox Status: Low Risk & Decrease

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.

opioids & dox Status: Low Risk & No Synergy

Note: No unexpected interactions.

tramadol & dox Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics also cause occasional seizures.

maois & dox Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

5-meo-xxt & nbomes Status: Caution

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

cannabis & nbomes Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

mxe & nbomes Status: Caution

Note: As an NMDA antagonist MXE potentiates NBOMes which can be unpleasantly intense

amphetamines & nbomes Status: Unsafe

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.

cocaine & nbomes Status: Unsafe

Note: Cocaine and NBOMes both provide considerable stimulation. When combined they can result in severe vasoconstriction, tachycardia, hypertension, and in extreme cases heart failure.

caffeine & nbomes Status: Caution

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

tramadol & nbomes Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and NBOMes have also shown a tendency to cause severe seizures

maois & nbomes Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

5-meo-xxt & 2c-x Status: Caution

Note: The 5-MeO psychedelics can interact unpredictably to potentiate other psychedelics

cannabis & 2c-x Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & 2c-x Status: Caution

Note: The anxiogenic and focusing effects of stimulants increase the chance of unpleasant thought loops. The combination is generally uneccessary because of the stimulating effects of psychedelics. Combination of the stimulating effects may be uncomfortable.

cocaine & 2c-x Status: Caution

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.

caffeine & 2c-x Status: Low Risk & No Synergy

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.

tramadol & 2c-x Status: Unsafe

Note: Tramadol is well known to lower seizure threshold and psychedelics raise the risk of seizures.

maois & 2c-x Status: Caution

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably

5-meo-xxt & 2c-t-x Status: Caution

Note: Both classes of compounds can be unpredictable alone

cannabis & 2c-t-x Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & 2c-t-x Status: Unsafe

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 in extreme cases heart failure.

cocaine & 2c-t-x Status: Unsafe

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.

caffeine & 2c-t-x Status: Low Risk & No Synergy

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.

alcohol & 2c-t-x Status: Low Risk & Decrease

Note: Both these classes of compound can interact unpredictably. Caution should be exercised.

opioids & 2c-t-x Status: Low Risk & No Synergy

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.

maois & 2c-t-x Status: Caution

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

cannabis & amt Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics. Small amounts can reduce nausea with aMT but take care.

caffeine & amt Status: Caution

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.

alcohol & amt Status: Caution

Note: aMT has a broad mechanism of action in the brain and so does alcohol so the combination can be unpredictable

opioids & amt Status: Low Risk & No Synergy

Note: No unexpected interactions

maois & amt Status: Dangerous

Note: aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.

mxe & 5-meo-xxt Status: Low Risk & Synergy

Note: Little information exists about this combination.

dxm & 5-meo-xxt Status: Unsafe

Note: Little information exists about this combination.

cannabis & 5-meo-xxt Status: Caution

Note: Cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics.

amphetamines & 5-meo-xxt Status: Unsafe

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.

mdma & 5-meo-xxt Status: Caution

Note: Some of the 5-MeO tryptamines are a bit unpredictable and should be mixed with MDMA with care

cocaine & 5-meo-xxt Status: Unsafe

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.

caffeine & 5-meo-xxt Status: Low Risk & No Synergy

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.

amphetamines & cannabis Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

mdma & cannabis Status: Low Risk & Synergy

Note: Large amounts of either or both may cause strong and somewhat unpredictable experiences, which can be as intense as psychedelics. Consider rather Set and Setting are good, before you combine these. Cannabis should be saved for towards the end of the MDMA experience if possible, where the psychedelic alike effect won't come to play.

cocaine & cannabis Status: Caution

Note: Stimulants increase anxiety levels and the risk of thought loops which can lead to negative experiences

alcohol & cannabis Status: Low Risk & Synergy

Note: In excess, this combination can cause nausea.

amphetamines & ketamine Status: Caution

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.

mdma & ketamine Status: Low Risk & Synergy

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.

cocaine & ketamine Status: Caution

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.

caffeine & ketamine Status: Low Risk & No Synergy

Note: No unexpected interactions.

alcohol & ketamine Status: Dangerous

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.

ghb/gbl & ketamine Status: Dangerous

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.

opioids & ketamine Status: Dangerous

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.

benzodiazepines & ketamine Status: Caution

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.

maois & ketamine Status: Caution

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

pcp & mxe Status: Caution

Note: There are no reports available about this combination

amphetamines & mxe Status: Caution

Note: Risk of tachycardia, hypertension, and manic states

mdma & mxe Status: Caution

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.

cocaine & mxe Status: Caution

Note: Stimulants taken with MXE can lead to hypermanic states much more easily, especially if sleep is avoided.

caffeine & mxe Status: Low Risk & No Synergy

Note: No likely interactions

alcohol & mxe Status: Dangerous

Note: There is a high risk of memory loss, vomiting and severe ataxia from this combination.

ghb/gbl & mxe Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient falls unconscious while under the influence there is a severe risk of vomit aspiration if they are not placed in the recovery position.

opioids & mxe Status: Dangerous

Note: This combination can potentiate the effects of the opioid

benzodiazepines & mxe Status: Caution

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess.

maois & mxe Status: Unsafe

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

ssris & mxe Status: Caution

Note: Depending on the SSRI this combination can be unpredictable

amphetamines & dxm Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues.

cocaine & dxm Status: Unsafe

Note: Both substances raise heart rate, in extreme cases, panic attacks caused by these drugs have led to more serious heart issues

caffeine & dxm Status: Low Risk & No Synergy

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.

alcohol & dxm Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Additionally CNS depression can lead to difficulty breathing. Avoid on anything higher than 1st plateau.

ghb/gbl & dxm Status: Dangerous

Note: Both substances cause ataxia and bring a risk of vomiting and unconsciousness. If the patient 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

opioids & dxm Status: Dangerous

Note: CNS depression, difficult breathing, heart issues, hepatoxic, just very unsafe combination all around. Additionally if one takes dxm, their tolerance of opiates goes down slightly, thus causing additional synergistic effects.

benzodiazepines & dxm Status: Caution

Note: Small doses of benzos can end a bad trip, but 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.

maois & dxm Status: Dangerous

Note: High risk of serotonin syndrome

ssris & dxm Status: Dangerous

Note: High risk of serotonin syndrome.

amphetamines & pcp Status: Unsafe

Note: This combination can easily lead to hypermanic states

mdma & pcp Status: Unsafe

Note: This combination can easily lead to hypermanic states

cocaine & pcp Status: Unsafe

Note: This combination can easily lead to hypermanic states

caffeine & pcp Status: Caution

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

alcohol & pcp Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

ghb/gbl & pcp Status: Dangerous

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

opioids & pcp Status: Caution

Note: PCP can reduce opioid tolerance, increasing the risk of overdose

benzodiazepines & pcp Status: Unsafe

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

maois & pcp Status: Dangerous

Note: This combination is very poorly explored

ssris & pcp Status: Unsafe

Note: Details of this combination are not well understood but PCP generally interacts in an unpredictable manner.

alcohol & nitrous Status: Caution

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.

ghb/gbl & nitrous Status: Caution

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.

opioids & nitrous Status: Caution

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.

tramadol & nitrous Status: Caution

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.

mdma & amphetamines Status: Low Risk & Synergy

Note: Amphetamines increase the neurotoxic effects of MDMA

cocaine & amphetamines Status: Caution

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

caffeine & amphetamines Status: Caution

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.

alcohol & amphetamines Status: Caution

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.

ghb/gbl & amphetamines Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

opioids & amphetamines Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

tramadol & amphetamines Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

benzodiazepines & amphetamines Status: Low Risk & Decrease

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

maois & amphetamines Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.

cocaine & mdma Status: Caution

Note: Cocaine blocks some of the desirable effects of MDMA while increasing the risk of heart attack.

caffeine & mdma Status: Caution

Note: Caffiene is not really necessary with MDMA and increases any neurotoxic effects from MDMA

alcohol & mdma Status: Caution

Note: Both MDMA and alcohol cause dehydration. Approach this combination with caution, moderation and sufficient hydration. More than a small amount of alcohol will dull the euphoria of MDMA

ghb/gbl & mdma Status: Caution

Note: Large amounts of GHB/GBL may overwhelm the effects of MDMA on the comedown.

tramadol & mdma Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

maois & mdma Status: Dangerous

Note: MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.

caffeine & cocaine Status: Caution

Note: Both stimulants, risk of tachycardia, hypertension, and in extreme cases heart failure.

alcohol & cocaine Status: Unsafe

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 less. Cocaine is potentiated somewhat by alcohol because of the formation of cocaethylene.

ghb/gbl & cocaine Status: Caution

Note: Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest. Likewise the G can wear off and leave a dangerous concentration of cocaine behind

opioids & cocaine Status: Dangerous

Note: Stimulants increase respiration rate allowing a higher dose of opiates. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

tramadol & cocaine Status: Dangerous

Note: Tramadol and stimulants both increase the risk of seizures.

maois & cocaine Status: Dangerous

Note: This combination is poorly explored

ssris & cocaine Status: Low Risk & No Synergy

Note: May reduce each others' effectiveness. Cocaine can reduce mental stability and therefore exacerbate conditions which SSRIs are used to treat.

ghb/gbl & alcohol Status: Dangerous

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.

opioids & alcohol Status: Dangerous

Note: Both substances potentiate the ataxia and sedation caused by the other and can lead to unexpected loss of consciousness at high doses. Place affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely

tramadol & alcohol Status: Dangerous

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 affected patients in the recovery position to prevent vomit aspiration from excess. Memory blackouts are likely.

benzodiazepines & alcohol Status: Dangerous

Note: Ethanol ingestion may potentiate the CNS effects of many benzodiazepines. 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. Blacking out and memory loss is almost certain.

maois & alcohol Status: Unsafe

Note: Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.

ssris & alcohol Status: Caution

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.

opioids & ghb/gbl Status: Dangerous

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

tramadol & ghb/gbl Status: Dangerous

Note: The sedative effects of this combination can lead to dangerous respiratory depression.

benzodiazepines & ghb/gbl Status: Dangerous

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.

tramadol & opioids Status: Dangerous

Note: Concomitant use of tramadol increases the seizure risk in patients 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

benzodiazepines & opioids Status: Dangerous

Note: Central nervous system and/or respiratory-depressant effects may be additively or synergistically present. 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 Blackouts/memory loss likely

maois & opioids Status: Caution

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.

ssris & opioids Status: Low Risk & No Synergy

Note: There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.

benzodiazepines & tramadol Status: Dangerous

Note: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present. Vomit aspiration a risk when passed out, lay down in recovery position if ingested.