Dextromethorphan (DXM) & Benzodiazepine tranquilizers
Dextromethorphan (DXM) is a common ingredient in over-the-counter cough suppressants. Its mechanism of action involves several pathways and receptors in the brain, contributing to both its therapeutic and psychoactive effects.
DXM and its active metabolite, dextrorphan, act as non-competitive antagonists of the N-methyl-D-aspartate (NMDA) receptors. These receptors play a key role in synaptic plasticity and memory function. By blocking NMDA receptors, DXM disrupts normal neurotransmission, which can result in dissociative effects at high doses.
DXM binds to sigma-1 receptors, which are involved in modulating neurotransmitter release and cell signaling. Activation of these receptors can influence mood, cognition, and neuroprotection.
DXM inhibits the reuptake of serotonin, increasing its levels in the synaptic cleft. This action is similar to that of some antidepressants and can contribute to the mood-enhancing effects of DXM. However, this also raises the risk of serotonin syndrome if combined with other serotonergic agents. DXM may also affect other neurotransmitter systems, including norepinephrine and dopamine. These interactions can contribute to its complex psychoactive profile.
Benzodiazepines are a class of psychoactive drugs known primarily for their tranquilizing effects. They are commonly prescribed for conditions such as anxiety, insomnia, seizures, and muscle spasms. Here’s a detailed look at how benzodiazepines work and some examples of commonly used benzodiazepines.
Benzodiazepines exert their effects by enhancing the action of gamma-aminobutyric acid (GABA), the principal inhibitory neurotransmitter in the central nervous system. They bind to a specific site on the GABA-A receptor, distinct from where GABA itself binds. This binding increases the affinity of the receptor for GABA, leading to an increase in the frequency of chloride channel opening events.
The influx of chloride ions into neurons hyperpolarizes the cell membrane, making it more resistant to excitation. This hyperpolarization reduces neuronal activity, producing the sedative, anxiolytic, anticonvulsant, and muscle-relaxant effects characteristic of benzodiazepines.
Examples of Benzodiazepines:
- Diazepam (Valium): Used for anxiety, muscle spasms, and seizure disorders. It has a long half-life, making it suitable for prolonged effects.
- Lorazepam (Ativan): Often prescribed for anxiety and insomnia. It has a shorter half-life than diazepam and is also used for acute seizure management.
- Alprazolam (Xanax): Commonly used for anxiety and panic disorders. It has a relatively short half-life and a rapid onset of action, which makes it effective for acute anxiety episodes.
- Clonazepam (Klonopin): Used for seizure disorders and panic disorders. It has a long half-life, providing prolonged relief from symptoms.
- Temazepam (Restoril): Prescribed for short-term treatment of insomnia. It has an intermediate half-life, making it effective for maintaining sleep.
- Midazolam (Versed): Used primarily as a preoperative sedative and for procedural sedation due to its rapid onset and short duration of action.
Combining DXM and benzodiazepine tranquilizers can have significant and potentially dangerous effects due to their overlapping impacts on the central nervous system.
- Enhanced Sedation and Drowsiness: Both DXM and benzodiazepines can cause sedation. When taken together, these effects can be significantly enhanced, leading to pronounced drowsiness, dizziness, and lethargy. This can impair cognitive and motor functions, increasing the risk of accidents and injuries.
- Respiratory Depression: One of the most serious risks of combining these drugs is respiratory depression. Benzodiazepines depress the respiratory centers in the brain, and high doses of DXM can exacerbate this effect. This can lead to shallow or slowed breathing, which can be life-threatening, especially in the context of overdose.
- Cognitive and Motor Impairment: The combination can impair thinking, judgment, and motor coordination. This can increase the risk of falls and traumas.
- Increased Risk of Overdose: The sedative properties of benzodiazepines combined with the dissociative effects of high doses of DXM can mask the signs of overdose, making it more likely that an individual may take excessive amounts of either substance. Symptoms of overdose include extreme drowsiness, confusion, loss of consciousness, and respiratory failure.
- Psychological Effects: Both substances can cause confusion and hallucinations at high doses. Combining them can intensify these effects, leading to severe disorientation and potentially dangerous behavior.
We have not come across confirmed data on acute and fatal conditions associated with this combination. At the same time, there are no signs of worthwhile positive recreational effects that could cover the risks of this combination.
All things considered, we recommend avoiding this combination under any conditions.
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