Combinations - GHB and stimulants info needed - Reward offered

[MrG]

Right you lot, there has been a number of threads recently whereby references are made to the use of GHB and Stimulants, with the discussion pretty much ending along the lines of "mixing uppers and downers is baaaaaad for the body" and yet no actual evidence to support this or explain how mixing GHB and stimulants actually does or does not affect the physiology.

I am going to try giving you an incentive and see if we get a good result. If so we can use this more often in the future.

Myself and Alfa are offering guaranteed positive rep to the first person who can post information relating to the following question

How does taking GHB and Stimulants simultaneously affect the body?

Hint: Xyrem (pharma GHB) is prescribed for Narcoleptics who suffer from cataplexy (daytime muscle weakness slumps), these patients are often prescribed stimulants to help them stay awake. It is likely that there is some medical paper online that will cover this particular topic nicely.

Anything you find should be posted in this thread with links and the first person, who I judge has provided sufficient information as an answer to the question, wins the positive rep.


Fly my pretties!

[Micklemouse]

Well, the BNF 53 - the medics & nurses clinical handbook of prescription drugs, which lists verified reported interactions & unwanted effects via the Yellow Card system lists only other sedatives & older antidepressants , generally noted for their sedative properties, as having potentialy dangerous interactions -

Sodium Oxybate


Sodium Oxybate has the following interaction information:
Antidepressants, Tricyclic - increased risk of side-effects when sodium oxybate given with tricyclics

Antipsychotics - effects of sodium oxybate possibly enhanced by antipsychotics Increased risk of toxicity with myelosuppressive drugs

Barbiturates - effects of sodium oxybate enhanced by barbiturates (avoid concomitant use)

Benzodiazepines - effects of sodium oxybate enhanced by benzodiazepines (avoid concomitant use)

Opioid Analgesics - effects of sodium oxybate enhanced by opioid analgesics (avoid concomitant use)

The BNF does list hypertension, agitation & tremor as possible & reported side effects however, which may cause problems when combined with stimulant use. Among the less common side effects are listed psychosis & seizure - again, combining with a substance known to lower seizure or psychosis thresholds as many stimulants do, could be problematic.

Any combination of central nervous system depressant & stimulant will put undue strain on the cardio-vascular system, & should be approached with caution, especially in a recreational context, and especially given the steep dose/response curve of GHB, & the ease with which people can lose track of dosing in these situations, or even dose themselves accidentally. A Certain Mouse's only experience of ghb was in combination with stimulants, in such a situation (accidentally dosed), & it was not comfortable in the slightest - shallow breathe, rapid heartrate, heightened anxiety.

A major problem will be the lack of studies & evidence. From one review of clinical studies on GHB

www.emea.eu.int/humandocs/PDFs/EPAR/xyrem/324056en6.pdf

In the clinical trial database, more than 80 % of patients maintained concomitant stimulant use.
Stimulants such as methylphenidate, dextroamphetamine, methamphetamine, pemoline or modafinil
are used commonly to treat the symptoms of daytime sleepiness in patients with narcolepsy. Tricyclic
antidepressants (TCAs) - such as protryptiline, amitriptyline, chlomipramine, imipramine and
trimipramine - or serotonin selective reuptake inhibitors (SSRIs) – such as fluoxetine, sertraline and
paroxetine - are used to treat the REM-dissociation phenomena of cataplexy, hypnagogic
hallucinations and sleep paralysis. The seven trials that comprise the clinical trial database did not
include a trial designed to specifically investigate the potential pharmacodynamic interactions of
sodium oxybate with other concomitant medications in this patient population. A re-analysis
considering subgroups defined by the concomitant use of stimulants or tricyclic antidepressants was
performed at the request of CHMP. No signals of a pharmacodynamic interaction were shown.
However, due to the small numbers and the inherent limitation of post-hoc analysis a
pharmacodynamic interactions with CNS stimulants or TCA antidepressants cannot be ruled out and
this is reflected in the SPC.

Another consideration is that the stimulant doses people take recreationally will often be much larger than those taken therapeutically, & often with no titration or tolerance, or cataplexy to combat, so comparisons between clinical studies & recreational use may not stand up to much scrutiny.

Recreational stimulant use may also present problems if dealing with an overdose - Erowid states that GHB's depressive nature is reduced with stimulants (figures), but would there be complications still if an amfetamine overdose for example were treated with benzodiazepines or antipsychotics, leading to rapid cns depression & the depressive nature of ghb kicking back in big time,only this time doubling or more the depression from the sedatives? If smeone were to go nto an unrousable state from GHB, would their stimulant use present problems in treating that?

[MrG]

Originally Posted by Micklemouse

Any combination of central nervous system depressant & stimulant will put undue strain on the cardio-vascular system

Whilst that statement sounds all well and good, I have yet to see any actual evidence to support it. I am not saying that it isn't true but I am saying, however, that statements like that are repeated time and time again throughout this forum, usually with great authority, without there being any verifiable reference to support or, more importantly, explain it.

Originally Posted by Micklemouse

Another consideration is that the stimulant doses people take recreationally will often be much larger than those taken therapeutically, & often with no titration or tolerance, or cataplexy to combat, so comparisons between clinical studies & recreational use may not stand up to much scrutiny.

Certainly, there is little similarity between carefully controlled clinical studies and SWIM's predilection for combining Columbian Marching Powder and G when he's partying. But, while direct comparison may not be possible, the important point here is to be able to at least begin the process of being able to explain what is happening from a physiological viewpoint when the two are combined.

I'd like to avoid the issue of OD for the time being, certainly within the context of our attempts at sourcing the information concerned. Let's be honest, the majority of cases presenting to the ER as G overdoses end up being resolved simply by allowing the patient to "sleep it off", irrespective of the intubation and drug cocktail they may attempt to administer in their haste to treat the patient.

G is, after all, designed to make people sleep very very heavily. One man's rec OD is another man's medically prescribed dose.

[~lostgurl~]

“Seizure like activity” (also referred to as “Clonus” or “Clonic Movement”) that sometimes occurs with GHB intake, is a series of rapid, repetitive contractions and relaxations in a muscles movement. This seizure like activity has never been noted to cause epileptiform EEGs in humans, though a few studies have shown this in rats.

SWIM has seen this seizure like activity many times and on a regular basis and to many different people, none of which have epilepsy. SWIM has noticed it usually occurs after repeat dosing, when the person is experiencing sleep deprivation, and most commonly when the person is also using methamphetamine.

SWIM has also noted that this activity seems to occur when a person is fighting against the sleep inducing effects of GHB ie; they have taken a dose which should have knocked them out but instead of submitting, they fight it. This is why people who are taking GHB and stimulants simultaneously seem to suffer from this more often.

Also, one can usually take much higher doses of GHB while smoking methamphetamine, then as the methamphetamine wears off the full effect of the GHB is felt, and one becomes much more likely to pass out.

SWIM doesn't have a documented study to back this up, but she is very confident that her theory is headed in the right direction

[tayo]

simply put, not using medscape's drug interaction checker like someone else did in this thread, arythmias from uppers and downers. proof of arythmias from uppers, say dextroamphetamine, and downers like opiates is out there.

[Lehendakari]

I just posted this on the archive:

http://www.drugs-forum.com/forum/loc...=2785&catid=28

Finally, we observed that the coabuse
of stimulant drugs such as cocaine or
Ecstasy with GBL resulted in significantly
deeper and more prolonged coma compared
with patients who used GHB or GBL alone.
In summary, the combined use of GBL with
stimulant drugs may increase the risk for
rhabdomyolysis due to prolonged coma and
immobilization in addition to the known risk
of the stimulant drugs.
The case of Ulrich and colleagues illustrates
the risk of an increasing trend of combined
party drug use in our country. In addition,
it underscores the need to take sufficient
blood and urine samples at first presentation
to be at hand for additional analytical
workups.

Reputation Comments on this post:

many thanks. please add more.

[tayo]

oh nice, better request bonussss poiiints.. haha, swim should have found an article.. bah humbug.

[MrG]

Close, but no Cigar.

CK levels
were (mean ± SD) 435 ± 701 U/l in 9 GBL
mono-intoxicated patients and 420 ± 307 U/l
in 8 patients with combined GBL and cocaine
use. Thus, none suffered from a meaningful
degree of rhabdomyolysis and the CK levels
were not affected by cocaine use in this sample.
However, we found that CK levels were
positively correlated with the duration of coma
in all patients (N = 30; Spearman R = 0,40;
p <0.03) supporting the view that immobilization
leads to increased levels of CK in these
patients.

Trouble is Lehendakari, the article raises the issue of complications brought on by OD when what we are trying to source is detail about *possible* risks, above those normally associated with either drug individually, when used simultaneously.

Cocaine has been widely reported
to produce severe rhabdomyolysis [2,
3] while GBL has never been mentioned to be
associated with this adverse effect. In contrast,
GBL has been shown to have interesting tissue-
protective effects in a wide range of organ
systems on a variety of animal and human
models

What we are left with is the fact that stimulant use has a certain risk factor but, as far as the articles are concerned, the only discussed harm issue concerning G was that increased doses could lead to temporary coma and the associated muscle damage caused by the immobility of the subject whilst passed out.

That is why I wanted to avoid the Emergency Room OD reports as they are not objectively discussing the physiology of concomitant use, rather they are reacting to patient presentation, usually associated with negative reactions caused by other factors such as excessive dosage.

It is still a wide open race!

Edge of the seat stuff!

[Drakzon]

Swim would like to give this game a try, since swim took amphetamine after having taken a high dose of over the counter energy pills with yohimbe in them earlier in the day he decided to research interactions, and toxic reactions to amphetamines in general. Swim found several sites that recomended benzodiazepams to sedate the patient if the patient was agitated which most patients overdosed on amphetamine would be. swim has already forgotten some of the details a little amphetamine helps memory a really large amount just makes you talk to much. Anyway there were some risks with giving someone on amphetamines benzodiazepams at least swim thinks he remembers reading about some minor risks. Overall though swim got the impression that using benzodiazepams in cases of amphetamine overdose was overall more helpfull than harmfull. This doesn't exactly answer your question about GHB I know but both drugs I beleive act on the GABA receptors in the brain

Ran out of typing room in last post for some reason. Anyway it's my understanding that ghb and benzodiazepams are similar in there effects and the neurotransmitters that they work on. Also Swim can tell you from personal experience if you overdose on say ephedrine which is a much more physical and dangerous stimulant than amphetamine they will give you sedatives as part of the treatment. Swim read muscle relaxants were used to keep the body cool as stimulants raise body temperature. Anyway swim knows from experience that they will give you strong muscle relaxants and sedatives when you overdose on stimulants, what type though and how long or short acting they are I don't know, and that would make a huge difference. I don't have any actually knowledge to back this up but I am pretty sure if Swim took stimulants then took a long acting sedative when the stimulant wore off the sedative effects would be intesified and could be dangerous. I don't know if this post has been helpfull or just the ramblings of swim. If any of the info in here was usefull I just want my account Drakzon unbanned it was 2 years ago, tonight I let swim post freely on here even though he was as high as he has ever been. I think that proves my friend Drakzon has changed and gained control with experience. Sure I can get on these forums using some computer trickery but I want to be able to log on as myself and show I can be a usefull member. Anyone who reads my posts tonight will find them plentiful but also I beleive decent quality posts that broke no rules. Anyway if I've proven myself tonight great, if i've managed to screw things up somehow then I won't try to get around the ban until at least another 2 years have passed

--Drakzon

[rxbandit]

It appears that GHB is not a typical depressant. It has two actions on the GABA-b receptor, which is responsible for its 'downer' effect, but it also acts on the GHB receptor which is apparently named after GHB. It's action on the GHB receptor causes stimulation and like Mr. G hinted its action on this receptor promotes alertness. This receptor also seems to inhibit the release glutamate and both the GHB recptor and the GABA-b receptor seem to promote dopamine release... however,

Interactions between sodium oxybate(aka GHB) and three drugs commonly used in patients with narcolepsy (zolpidem tartrate, protriptyline HCl, and modafinil) have been evaluated in formal studies. Sodium oxybate, in combination with these drugs, produced no significant pharmacokinetic changes for either drug (see Pharmacokinetics). However, pharmacodynamic interactions cannot be ruled out. Nonetheless, sodium oxybate should not be used in combination with sedative hypnotics or other CNS depressants. Alteration of gastric pH with omeprazole produced no significant change in the oxybate kinetics. http://www.rxlist.com/cgi/generic/xyrem_ad.htm

The drug modafinil is known to effect both dopamine and norepenephrine, the same neurotransmitters effected by most stimulants and according to the study above no significant interactions were noted.

It actually appears as if combination with a stimulant may counteract some of the CNS depressant effect. all warnings for GHB strongly indicate danger with combination of CNS depressants but do not list any interactions with stimulant based drugs. The page on Xyrem(pharmaceutical GHB) is a good indication that there is sufficient data since most pharmaceuticals are sure to have a list of medicines that should not be taken with that medication. Xyrem does not list any stimulant type drugs that are commonly prescribed to both people with ADHD or narcolepsy so the case is strong that no significantly negative interactions were found during the pharmaceutical proofing process.

It appears that GHB and stimulants would not be to detrimental to the body other then the harm an individual might cause to him/herself with the extra added energy of a stimulant and the disorientation and confusion of GHB.

[MrG]

Originally Posted by rxbandit

It appears that GHB and stimulants would not be to detrimental to the body other then the harm an individual might cause to him/herself with the extra added energy of a stimulant and the disorientation and confusion of GHB.

That has been SWIM's theory for a while now. He knows how Coke and Alcohol feel on the body (rough), but when he has partied with Coke and GHB he has never felt anything but comfortable both during and following.

This is why I started this thread because so many users give the usual knee-jerk warning about combining uppers and downers when, in fact, GHB works differently to most CNS suppressors. All negative aspects I have found in online research relate to OD which is nothing to do with the original question.

We still need to find an actual formal study report for reference though.

[trptamene]

Originally Posted by MrG

That has been SWIM's theory for a while now. He knows how Coke and Alcohol feel on the body (rough), but when he has partied with Coke and GHB he has never felt anything but comfortable both during and following.

MrG, have the lab rats reproduced this results or in general any other swimmer had exp w/ this? Perhaps should be in its own thread re: GHB + Cocaine combinations, but this is rather interesting.

[Swimster]

the only thing swim has heard about the theory with narcolepsy: narcoleptics can get more restorative sleep and be less sleepy during the day(with ghb).

[rxbandit]

also i stumbled upon this study that a french group did on benzos and amphetamines. benzos also heavily effect the same neurotransmitters as GHB, GABA.

This study was designed to uses the non-specific stimulant sedative D-amphetamine to dissociate and memory-impairing effects of the benzodiazepine triazolam. Across furnace sessions, 20 healthy adult volunteers received via oral examination capsule administration placebo, 0.25 mg/70 kg triazolam alone, 20 mg/70 kg D-amphetamine sulphates alone, and triazolam (0.25 Mg 70 kg) and D-amphetamine (20 mg/70 kg) conjointly, in A double-blind, staggered dosing, cross-country race-over design. D-amphetamine significantly reversed the effects of triazolam one all taking part rating and psychomotor sedative performance-based measures of effects, and selectively reversed the memory-impairing effects of triazolam one some measures

http://translate.google.com/translat...language_tools

If it were dangerous to mix these two drugs i doubt there would be a study testing their effect combined and if it did prove dangerous i think it would be indicated in the article.

This combination seems safe which further leads me to believe that GHB in combination with stimulants is fairly safe.


also, Mr G it looks like this may be the study your looking for http://www.mdma.net/misc/ecstasy-ghb.html it is a study of MDMA combined with GHB however you can not view more then the journal abstract. I do believe you could locate the journal article, however.

[rxbandit]

also,

Q:Is it dangerous to mix GHB with MDMA? One of my friends does no research whatsoever before he mixes 2 different substances.A:We're not aware of any reports of serious complications from mixing MDMA with GHB, although there is always the possibility of problems since this combination is not well explored.

GHB is a depressant and MDMA is a stimulant and users who combine the two report that GHB's depressant effects are reduced dramatically in combination with MDMA. An extreme example was one story we received of a gentleman who used 10-15grams of GHB every time he did MDMA (!) and then he did the same dose without MDMA and woke up in the hospital because he had gone into the unrousable "GHB Coma" state.

One thing to be concerned about mixing strong stimulants with strong depressants is that with other drugs this can cause increased stress on the heart and vascular system rather than decreas them. Many people have died mixing cocaine & heroin or amphetamines & alcohol because higher doses can be taken while still remaining conscious. Depressants can also reduce the perceived side effects of higher dose stimulants. This is generally considered a dangerous mix of classes, so tell your friend to be careful of increasing their dose.

Many people report enjoying this combination and find that the combination is physically very euphoric, while many others feel that the GHB dulls the emotional opening and psychedelic aspects of the MDMA.

it looks like this site has your answer http://www.informaworld.com/smpp/con...7163128~db=all but it also looks like they require a fee to view said information.

[MrG]

Oh I love that, 32 US Dollars plus VAT !

So firstly you have to take a hit on the US currency conversion, then the fuckers do you for EU Value Added Tax. Nice!

I am toying with the idea of purchasing the report though as it does appear to be remarkably close to the resource we are looking for.

Ok, let's see if anyone else can find anything over the next day or so. If not, I will buy that online report and, as long as the description holds true, our question will have been suitably answered and rxbandit will win the prize!

[rxbandit]

Originally Posted by MrG

rxbandit will win the prize!

what exactly was the prize... whatever it was I never got it lol.

Swirx has taken GHB on the comedown of various prescription amphetamines, never had any bad side effects but I suppose if any idiot takes a lot of two things something bad is going to happen...

[rxbandit]

well i found another legitimate looking source that does not cost any money. However this source seems to counter me and Mr. G's theory; but here it is http://www.ualberta.ca/~csps/JPPS4(2)/M.Okun/GHB.htm

This resource however does not cite dosage and lacks a pharmacological reason for its toxicological findings but it is something to consider.

[~lostgurl~]

Lehendakari's article Sudden leg paralysis induced by GBL and stimulant use seems very inconsistant with what SWIM has observed in her friends on GHB whether mixed with amphetamines or not, it is usually the top half of the body that falls asleep first, while the legs keep dancing to the tunes like in this video clip: http://www.drugs-forum.com/forum/loc...id=122&lpage=6

[MrG]

I am really torn about getting that article http://www.informaworld.com/smpp/con...7163128~db=all, not so much about the price but about the electronic trail. Call it paranoia but I can't help thinking how easy it would be for a bunch of Fediots in the US to set up notifications on particular online information sources. Someone who isn't based in a scientific research capacity who is willing to pay for a document about GHB and stimulants might be worth getting a gold star for by tipping off his local rozzers to conduct an "enquiry".

As for http://www.ualberta.ca/~csps/JPPS4(2)/M.Okun/GHB.htm it falls pretty far short of anything other than Emergency Room panic treatment and conflicting theories on what GHB and GABA actually do.

It is proving quite difficult to locate because of this fact, that there are disagreements in the scientific community on the way GHB and GABA affect the CNS. Until we can locate some research that specifically states the modalities (had to get that word in sometime!) of GHB in conjunction with stimlulants of some sort, we are unlikely to be able to have definitive proof.

Keep digging.

[trptamene]

Originally Posted by MrG

I am really torn about getting that article http://www.informaworld.com/smpp/con...7163128~db=all

This has been uploaded to the archive. http://www.drugs-forum.com/forum/showthread.php?t=55458

Maybe Rx will get his prize after all...

Reputation Comments on this post:

Great work there Tryp. Thanks.

[CircuitBoy]

SWIM loves the coke and GHB combination. SWIM says it's both highly euphoric and energetic when properly balanced, and makes a passable substitute for MDMA. Problem with this combo, though, is if you overdo the GHB, no amount of coke will keep you awake, you WILL G out. SWIM says the coke tends to make you feel confident about your G, making it easier to make mistakes or overdo it. SWIM also needs somewhat more G to reach the same ehphoria level, so you are playing closer to the danger zone. Coke + G seems to be a great combination, but one must be aware of the risks and not take any chances with the G part of the formula. The GHB should be accurately premeasured and a reliable timing regimen followed if there are repeated doses.

Reputation Comments on this post:

thanks for the info and harm reduction stance

[jim1965]

Mr G, not sure if this adds anything to the thread, but SWIM has been using GBL for a long time now and SWIM knows his volumes very well.

@ sleep inducing volume, SWIM take 0.2g M1 and nowhere near sleep (in fact, an extremely good buzz for many hours)...duplicated this many times - same vol of GBL alone knocks SWIM out every time.

never any problems or side affects

[MrG]

Originally Posted by jim1965

@ sleep inducing volume, SWIM take 0.2g M1 and nowhere near sleep (in fact, an extremely good buzz for many hours)...duplicated this many times - same vol of GBL alone knocks SWIM out every time.

never any problems or side affects

Hi Jim, haven't seen you around for ages, welcome back.

Well this was one of the reasons for the thread to be honest, SWIM has a *lot* of experience with G and stimulant use and, even though he has never felt anything other than completely fine physiologically, he has always borne in mind that it would be worthwhile to be able to get hold of some solid research to explain exactly what the situation is with the combination.

Too many times people have simply regurgitated the whole "not mixing uppers and downers" mantra and it just doesn't fit in this case. As mentioned early in this thread, the reams of Xyrem data for patients who are also usually on stimulants of one sort or another daily, only ever raises the issue of the stimulants possibly affecting the efficacy of their Xyrem dose (read: it stops them falling asleep properly!).

Oh and RX, you came close to winning the Rep prize, but I couldn't bring myself to get that report due to the electronic paper trail so your find stays locked away for the time being!

As for the many ER reports that mention G overdose connected to stimulant use, that is usually as a result of one of two things:
1) The stimulant wears off and catches the user out because the G then knocks them out sparko thus panicking their well meaning friends/family who then rush them to hospital where they end up with a load of tubes coming out of them and a nicely inflating medical charge for lots of unnecessary procedures when they are more than likely going to simply wake up a couple of hourse later anway.
2) The same scenario as above but the user happens to be an idiot and has consumed stimulants, G and also other CNS suppressors such as alcohol. The stimulant wears off and the combined effect of the G and alchohol kills them because their central nervous system grinds to a halt.

Neither of the above scenario's are any use for the purpose of this thread though as we are simply trying to source some decent research that explains the actual physiological processes concerned with combining G with stimulants.

[jim1965]

Hi Mr G, yeah just been lurking never really away