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bubble_chart Synergistic tendency



The effects of these substances are multiplied or greatly modified by their combination.
Reliability: inferred.
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error_outline Estimated risk



The combination of these substances presents major physical or mental risks.
Reliability: hypothetical.
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flare About effects

Although testimonials are rare, most agree on the strong potentiation: for example, here, symptoms suggestive of serotonin syndrome appear more than 10 hours after MDMA ingestion. Moreover, this combo doesn't seem very pleasant, with the expression "I thought I was going to die" recurring regularly.

Several factors may explain this:

  • MDMA is an inhibitor of the enzymes that metabolize DXM (CYP2D6 and CYP3A4). As highlighted by this study, its elimination is therefore slowed down; consequently, its concentration and that of its active metabolite (DXO) are altered. This is the explanation given by DanceSafe.
  • As MDMA is a serotonin releaser and DXM a serotonin reuptake inhibitor, serotonin overdose may be suspected: such is the point made by PsychonautWiki in classifying this combo as dangerous.

Some research is looking at this combination from a therapeutic point of view: this study, for example, tests the neuroprotective effect of DXM on the serotonergic toxicity of MDMA. Nothing is ever simple with the brain.

menu_book About risks

According to this study, DXM increases heart rate and blood pressure. As is also the case with MDMA (see this meta-study), the risk of cardiovascular complications probably increases in combination.

The risk of serotonin syndrome is difficult to assess: on the one hand, meta-studies such as this one rate it as low; but they seem to extrapolate from SSRI antidepressants rather than from DXM-specific data (or perhaps they refer to therapeutic doses, which are lower than recreational doses). On the other hand, the few feedback reports alert us to worrying effects suggestive of serotonin syndrome. For the latter reason, secondary sources such as PsychonautWiki indicate that this combo is dangerous.

Finally, Erowid reports that body temperature dysregulation is a common side effect of DXM. As is also the case with MDMA, DanceSafe indicates a risk of hyperthermia ("heat stroke"), which is toxic to the organs.