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Taking both these drugs should not be harmful. The effects of both drugs are likely to be reduced.

We strongly recommend you avoid taking these drugs together, reactions are highly unpredictable and can be fatal. You will likely come to some degree of harm even if you take strong precautions.

Taking both of these drugs together is not usually any more harmful than taking them individually. The drugs are not known to interact with each other, each positively or negatively.

Be careful when mixing amphetamines and GHB. 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.

There is no evidence to date showing interactions between allergy medicines and LSD. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

There is no evidence to date showing interactions between ibuprofen and 2C-B. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

Taking both these drugs together is likely to cause an effect stronger than taking them individually. If used with care they are unlikely to cause an adverse or undesirable reaction.

_Users report that the two herbs go well with each other, however, moderation is important when combining them. Keeping both doses low helps ensuring that you derive the highest possible positive effects without crossing the line to negative side-effects. You should go particularly light on cannabis dosage. Although rarely, some users report mild effects, such as feeling nauseous, sick and uncomfortable. Stronger side effects include anxiety and dizziness._

Taking both these drugs together may produce unpleasant effects such as physical discomfort or overstimulation. High doses put you at risk. If you mix, start low and go slow

Amphetamines and DMT is not usually a harmful combination but stimulants generally increase anxiety levels and the risk of thought loops which can lead to negative experiences.

Tricyclics (Amitriptyline, Anafranil, Asendin, Aventyl, Elavil, Endep, Norfranil, Norpramin, Pamelor, Sinequan, Surmontil, Tipramine, Tofranil, and Vivactil) is consistently reported as being very bad in combination with LSD. People attempting this combination are unable to communicate with others, they go into a fugue state where they wander away from home and don't know how they got there, and they are generally in a terrible state psychologically. Life-threatening seizures and at least one death have been reported to be triggered by the combination of LSD and tricyclics. If you are prescribed tricyclics for mental health problems, it is not a good idea to try LSD outside of a supervised medical setting, as it might worsen the symptoms.

Using these drugs together can cause an effect stronger than desired though they aren't likely to cause a serious adverse reaction if used carefully. Additional research should always be done before mixing drugs.

Cannabis and mushrooms is not usually a harmful combination, but cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics so beware when mixing these drugs.

The combination is unlikely to cause any adverse or undesirable reactions beyond those that might ordinarily be expected from taking these drugs individually. Users have reported diminished experiences thus care should be taken with dosage.

This combination carries a low risk. Ibuprofen and cannabis are unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

There is a low risk when drinking a moderate amount of alcohol when using the recommended dose of aspirin.

Avoid alcohol if you are taking aspirin for a headache. Alcohol is likely to make a headache worse as it causes dehydration.

_Reactions and side effects are rare, but using these drugs together can cause an effect stronger than taking them individually, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Kratom’s effects are due primarily to its interaction with mu-receptors in the brain, while SSRIs produce their effects by interacting with the serotonin receptors. It is hypothesized that, since both act on receptors that can sometimes be involved with each other in certain processes, an interaction may or may not occur. Interactions include risks such as_ [_serotonin syndrome_](https://www.mdedge.com/ccjm/article/120386/neurology/serotonin-syndrome-preventing-recognizing-and-treating-it)_. Additional research should always be done before mixing drugs._

There is no evidence to date showing interactions between ibuprofen and ketamine. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

Caffeine and GHB have low risk and decreased synergy. Caffeine will mildly hide the depressant effects of GHB leading to a slightly increased risk of overdose.

These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Be careful when mixing these drugs.

Effects will compound with each other, however, the effects of DMT will probably overpower that of 2C-B since it is a much more powerful hallucinogen.

Both drugs potentiate the sedation and impairment of coordinate caused by the other. High doses can lead to unexpected loss of consciousness

There is no evidence to date showing interactions between ibuprofen and modafinil. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

There is no evidence to date showing interactions between aspirin and LSD. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

There is no evidence to date showing interactions between contraceptive pills and cannabis and generally this combination carries a low risk. However, cannabis will often intensify and alter your mood. If your contraception is causing significant changes in your mood, it is advisable to avoid cannabis as it may intensify mood swings.

Avoid cannabis if you are taking allergy medicines. Benadryl, Piriton and Piriteze are known to have adverse effects when combined with cannabis.

Cannabis intensifies the drowsiness caused by the antihistamines in allergy medicines. Dizziness, confusion and difficulty concentrating may also occur as well as a reduction in judgements and motor coordination.

DMT and mushrooms are both psychedelics and will thus have additive effects when taken together. Be careful as the doses will quickly become overwhelming.

GHB and LSD is not usually a harmful combination, but it will tend to decrease the effects of both drugs.

Be careful when taking amphetamines (e.g. Adderall) and cocaine together. Both are stimulants, which increases the strain on your heart and places you at higher risk of overdosing. Cocaine will also mildly block the effects of the amphetamines4,21.

This combination carries a low risk. Paracetamol and cannabis are unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

There is a low risk when drinking a moderate amount of alcohol when using the recommended dose of paracetamol.

Avoid alcohol if you are taking paracetamol for a headache. Alcohol is likely to make a headache worse as it causes dehydration.

DMT and opioids is an unsafe combination. Low doses seem to counter the effects of hallucinogens, whereas higher doses potentiate them. Be careful with tramadol as it is known to lower the seizure threshold and psychedelics can sometimes cause seizures. Read more [here](http://www.ncbi.nlm.nih.gov/pubmed/3006089).

Be careful when taking allergy meds and cocaine together. There is some evidence that certain allergy medications combined with cocaine can increase reinforcement (i.e. how strongly you feel the need to take more of the drug). Both have similar effects which puts at increased risk of overstimulation. If you mix, start low and go slow53-56.

Aspirin and MDMA taken together may cause a greater increase in body temperature and sweating than is normal. This poses the greatest risk when dancing in crowded conditions. Take a break periodically to cool down.

These combinations are considered extremely harmful and should always be avoided. Reactions to combining these drugs are highly unpredictable and can potentially cause death.

Tramadol lowers the seizure threshold and thus should not be combined with any psychedelics, MAOIs, amphetamines and substituted amphetamines, or other opioids.

Be careful when taking mushrooms and cocaine together. You may experience anxiety. Some of their physiological effects oppose each other which puts strain on your body and makes it easier for you to overdose, especially during the comedown. If you mix, start low and go slow41,42.

Cannabis and DMT is not usually a harmful combination, but cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics so beware when mixing these drugs.

Taking the combined oral contraceptive pill and cocaine together is not usually any more harmful than taking them individually. The drugs are not known to interact with each other, each positively or negatively46,47.

Alcohol and GHB is an unsafe combination. Even in very low doses this rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

Avoid benzos if you are taking allergy medicines. benzos and allergy medicines such as Benadryl, Piriton and Clarityn are depressants and both slow down your central nervous system. This can produce heightened side effects such as drowsiness, sedation and poor concentration. In extreme cases, loss of consciousness and may occur.

Using these drugs together can cause an effect stronger than taking them individually, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before mixing drugs.

Effects will be stronger than taking either drug alone, however, it’s unlikely that there will be any adverse health reactions to this combination.

There is no evidence to date showing interactions between ibuprofen and benzos. This combination is unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

Be careful when taking paracetamol and cocaine. Paracetamol may increase the harmful effects of cocaine on the liver4.

_Kratom leaves produce complex opioid-like analgesic effects, which could be potentiated with the use of ibuprofen._

Stimulants should not be combined with kratom, as they further increase the level of stimulation provided by the kratom. This results in the development of potentially severe side effects: anxiety, heart palpitations, excessive sweating, and general agitation. More life-threatening side effects that may result include: increased blood pressure. The lowering of the seizure threshold may also be observed.

[**Tramadol**](https://www.drugs.com/tramadol.html) can result in seizures when taken with LSD, as Tromadol lowers the seizure threshold.

These two drugs potentiate each other strongly and unpredictably which might lead to memory loss, blackout and respiratory depression.

Be careful when taking GHB with cocaine. 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 behind30,31.

Taking LSD and cocaine together is likely to cause overstimulation and anxiety. This combination will put strain on your heart and circulatory system and increase your risk of seizure. High doses will put you at risk. If you mix, start low and go slow37.

Cannabis and LSD is not usually a harmful combination, but cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics so beware when mixing these drugs.

2C-X and GHB is not usually a harmful combination, it will tend to decrease the effects of both drugs. Be careful as 2C-X has mild stimulant effects which can cover the depressant effects of GHB.

Be careful when taking these drugs together, there is a considerable risk of a bad experience or overdose. If you mix, start low and go slow.

We strongly recommend you avoid taking DXM and cocaine together. Your blood pressure and heart rate are likely to increase to dangerous levels. You are at increased risk of experiencing blackouts. You may also experience anxiety and panic attacks28,29.

There is no evidence to date showing interactions between paracetamol and MDMA. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

Here are the most common effects, not everyone necessarily experiences all of them every time they consume the drug and other effects not listed might be felt. **The likelihood of experiencing negative effects is far greater at high doses.**

The effects are (from positive to negative):

>>> effects 
++   Increase in energy
++   Euphoria
++   Sense of calm and serenity
++   Meaningful spiritual experiences
++   Enhanced sense of connection with the world (beings or objects)
==   Distortion or loss of sensory perceptions
==   Closed and open eyes visuals
==   Dissociation of mind from body- in large doses users may experience a “k-hole” which is an intense out-of-body or near-death like experience with very realistic visuals.
==   Changes in how you perceive time
==   Pain relief/numbness
==   Shifts in perception of reality
==   Slurred speech
--   Some short term memory loss may occur and this is worse for regular users!
--   Nasal discomfort when snorting
--   Discomfort, pain or numbness at injection site (only when injected)
--   Severe confusion, disorganised thinking
--   Paranoia (with regular use)
--   Nausea and vomiting
--   Frightening or untimely distortion
--   Loss of control of body movements and balance. Becoming uncoordinated, finding it difficult to move around
--   Sever dissociation, depersonalisation
--   Loss of consciousness(may be dangerous in certain situations)
--   Depression of heart rate and respiration
<<<

**Source:** [erowid.org](http://www.erowid.org/)

### How? How much? When? For how long?

As with any drug, the correct dose for you depends on factors such as weight, gender, metabolism, whether you have taken the drug recently or not, amongst many others.

**Read our section on** [**dosing**](/me/dosing) **and** [**tolerance**](/me/tolerance) **for more information.**

### How you take ketamine matters...

#### Snorting

**Snorting** is the most common way of using it. People usually divide the powder out into lines with a card and snort it with a straw or a piece of paper. Snorting through one nostril over a long time can lead to nasal ulcers or damage the septum.

#### Oral

**Ingesting** ketamine results in slightly different effects to snorting or injecting. If taken as a ‘bomb” (wrapping a dose in a cigarette paper) the effects take longer to feel and the experience will last longer. Taking ketamine orally usually results in a less intense experience.

**Drinking** is another way of doing it. You can dissolve the crystals/powder in a small amount of water and acidic juice (e.g. citrus or apple).

**Gumming** is another less common way of doing it. A small amount is applied on the inside of the lips or gum. This can damage your gums and lips. Gumming is not a common way of taking ketamine as most users find the taste very unpleasant.

#### Intramuscular injection

**Injection** is the most harmful way to take it. Like all other substances mentioned on our website- it’s recommended that you do not inject ketamine. Injecting also increases the likelihood of becoming addicted to a substance.

### How much ketamine?

#### Snorting

- **Light dose:** 15-30 mg
- **Common dose:** 30-75 mg
- **Strong dose:** 75-150 mg
- **Heavy ("K-hole"):** 150+ mg

#### Oral

- **Light dose:** 50-100 mg
- **Medium dose:** 100-300 mg
- **Strong dose:** 200-450 mg
- **Heavy ("K-hole"):** 500+ mg

#### Intramuscular injection

- **Light dose:** 15-30mg
- **Medium dose:** 25-50mg
- **Strong dose:** 40-100mg
- **Heavy ("K-hole"):** 60-125mg

**Source:** [Erowid](https://erowid.org/chemicals/ketamine/ketamine_dose.shtml)

### When do the effects of ketamine kick in and for how long?

The **START** time below is when you will usually begin to feel the effects of ketamine from the time when you first take it. The **DURATION** is roughly the length of time you will experience the effects, after which the effects will start to wind off and you might start to feel the calm-down/comedown down effects.

#### Snorted ketamine timeline

- **START:** 5-15 minutes
- **DURATION:** 45-60 minutes

#### Oral ketamine timeline

- **START:** 15-25 minutes
- **DURATION:** 1-2 hours

#### Injected ketamine timeline

- **START:** 1-5 minutes
- **DURATION:** 1-2 hours

You will feel after-effects for 1-3 hours after taking it.

Ketamine may have an anti-depressive effect in low doses (20-30mg), and there are currently a number of ongoing research trials looking into this.

**Sources:** [erowid.org](https://erowid.org/chemicals/ketamine/ketamine_dose.shtml); [tripsit.me](http://drugs.tripsit.me/Ketamine)

### How often can I take ketamine?

If you know of any good source containing this information please email us to contact@drugsand.me . We'll credit you in our Team section! Thanks :)

There are certain precautions you should take before doing ketamine. The advice below helps you to be physically and mentally prepared before doing it. Furthermore, we want you to be safe, and just in case you have a bad experience or some of the unwanted side effects associated with ketamine, we have also provided information on how to take care of yourself when you are in full swing. Finally, there are those uncomfortable or undesirable effects after the high have worn out, we will provide you with some practical tips on how to have a better calm down and help you to reduce the harm done to your body and brain.

**Head over to our** [**ME**](/me) **section if you would like to know more about harm reduction.**

>>> tabs 

# Before 

### Testing
What is ketamine usually cut with?
- Ketamine is sometimes mixed with other substances to increase the volume or change the way it feels. The cutting agents can vary widely depending on factors like the source and region. It has been found mixed with things such as creatine, caffeine, or MSG, but it could be almost anything. Because of this variation, it’s not possible to know for sure what is in a sample just by looking at it. Only lab testing across multiple samples can help map out what people in a particular area might be using.
- We recommend to [**test your drugs to ensure you are getting what**](https://www.reagent-tests.uk/) you expect. There have been some cases where people have been sold other substances as ketamine, such as [**methoxetamine**](http://knowthescore.info/drugs-a-z/methoxetamine#accordian-1), which can have much stronger effects.

### Hygiene

- Good hygiene can also reduce harm. If you are snorting ketamine, ensure you use a clean surface and an unused straw. Sharing straws or using notes can put you at risk of infections.
- Regularly snorting any drug can damage your nose. If you are going to snort ketamine, make sure it is crushed finely. Afterwards, clean your nose with water.

### Green tea

- There is some [evidence that drinking green tea](https://www.sciencedirect.com/science/article/pii/S1879522615004157) before consuming ketamine may have protective effects but this was performed in rats.

### No food

- You should avoid food for at least 1.5 hours before taking ketamine. Nausea and vomiting can occur when coming up. Staying still can help with this feeling.

### Injecting

- Injecting ketamine causes damage to the skin and veins, leading to sores. Sharing injecting equipment risks infections such as HIV, Hepatitis B and Hepatitis C. Injecting street ketamine carries further risks as it is likely to contain other substances which may increase harm. If you are going to inject ketamine, use only medical grade ketamine liquid and always use new injecting equipment. [**Free needle and syringe exchange services**](http://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes) are available around the UK. They provide sterile injecting equipment as well as advice to users.

# During 

### Setting

- It’s very important to think about where you take ketamine. On high doses or in a K-hole, it is very difficult to move around, which puts you in a vulnerable position. It’s best to ensure you are in a safe and familiar place if you are going to take it. It is a good idea to be with someone who is familiar with the drug. You might become quite confused and also be injured if you try to move around when taking the drug.

### Friends

- If you are feeling unwell after taking ketamine in a party, look for your friends. They will help you feeling better. Tell them how you feel and ask them for anything that might make you feel better such as water.

### Driving

- It is very important to avoid driving while on ketamine. Not only is this very dangerous, it is also illegal. [**The drug driving limit for ketamine**](https://www.gov.uk/government/collections/drug-driving#table-of-drugs-and-limits) is 20 micrograms per litre of blood.

### Signs of overdose

Whilst death from ketamine poisoning is quite uncommon, it is still possible to overdose. Signs of a ketamine overdose include:

- Feeling sick and/or vomiting
- Feeling very confused
- Chest pain and irregular heart rate
- Being unable to move
- Violence or becoming very frightened (this may be due to hallucinations)
- Loss of consciousness or coma
- In severe cases, ketamine can cause you to have a fit. In some cases, people have choked on their vomit when unable to move or unconscious.
- Raised blood pressure

If you think you or a friend has taken an overdose of ketamine, it is very important to seek help immediately. Call an ambulance and tell them what has been taken so that medical staff can help. You won’t get into trouble for this and you may minimise or prevent any serious long-term damage.

# After 

### Hangover

Although the major effects of ketamine only last about 1-2 hours before users feel normal, some people have longer lasting subtle effects that might last for a couple of days. Maintaining a healthy lifestyle is important to your physical and mental wellbeing, so try to make sure that you eat well, get enough sleep, and try to get some exercise.

Some people take ketamine to forget about problems in their everyday life. While this might work for a short time, it can encourage people to take ketamine more and more often which can cause a range of physical and psychological effects.

Check and compare anonymously your drug use [**with the Drugsmeter ketamine app**](https://drugsmeter.com/ketamine/).
<<<

### IN THE LONG TERM

Ketamine can have long term effects, both physically and mentally when consumed regularly.

#### Urinary problems

Long term use of ketamine can lead to urinary problems. In the most serious of cases, this may result in the removal of the bladder. If you use ketamine and experiencing any pain or difficulties in urinating, stop use immediately and seek advice from your GP. Some people take more ketamine to help with this pain, however this may cause further, more serious damage. Learn more about [bladder damage from ketamine use](https://dancesafe.org/ketamine-bladder-damage-what-you-need-to-know/).

There is some [evidence that drinking green tea](https://www.sciencedirect.com/science/article/pii/S1879522615004157) before consuming ketamine may have protective effects but this was performed in rats.

#### Long term memory problems

Ketamine has been shown to interfere with memory, learning and attention. Some users have also described [**having flashbacks**](http://thecanyonmalibu.com/ketamine/) after taking the drug.

#### Addiction

Ketamine has a high potential for abuse and while it is not physically addictive, it can cause psychological dependence in some users. Tolerance to the effects of ketamine develops quite quickly, so user need to use more and more of the drug to get the same effects as when they started using.

Read more about dependence [**here**](https://drugsand.me/en/me/addiction/).

#### When you want to quit

If you decide to stop using ketamine, you may experience some unwanted withdrawal effects. If you do, it is a good idea to speak to a health professional who will be able to support you and signpost you to helpful services.

Some of the withdrawal effects of ketamine may include:

- Cravings
- Anxiety
- Shaking
- Sweating
- Fast heart beat

Don't hesitate to look for medical help, you won't get in trouble. Talk to your GP, who will be able to refer you on to your local addiction service.

There are other several advice services available online and over the phone including:

- [**Dan 24/7**](http://dan247.org.uk/ContactUs.asp) (For those based in Wales)
- [**Know the Score**](http://knowthescore.info/help-and-support/drugs-helpline) (For those based in Scotland)
- [**Minding Your Head**](http://www.mindingyourhead.info/topics/drugs) (for those based in Northern Ireland)

### Europe

- **Belgium:** It is legal for medical and veterinary use and illegal when sold or possessed without a prescription.
- **Czech Republic:** It is legal for medical and veterinary use and illegal when sold or possessed without a prescription.
- **Denmark:** It is legal for medical and veterinary use and illegal when sold or possessed without a prescription.
- **France:** Ketamine is a Schedule IV drug.
- **Germany:** It is legal for medical and veterinary use and illegal when sold or possessed without a prescription.
- **Norway:** Ketamine is a Class A drug.
- **Slovakia:** Ketamine is a Schedule II drug.
- **Sweden:** Ketamine is a Schedule IV drug.
- **UK:** Ketamine is a Class B drug. Ketamine was [**reclassified to a Class B drug**](https://www.unodc.org/LSS/Announcement/Details/ed9bba09-90bd-479c-8f57-aaa4130e6d5f) in the UK in 2014. The UK Advisory Council on the Misuse of Drugs made this recommendation based on the chronic harms associated with ketamine use.

### America

- **Brazil:** The drug is legal for veterinary use and illegal when sold or possessed for human use.
- **Canada:** Ketamine is a Schedule I drug.
- **Mexico:** Ketamine is a Category 3 drug.
- **USA:** Ketamine is a Schedule III drug.

### Asia and Oceania

- **Australia:** Ketamine is a Schedule IV drug.
- **China:** Ketamine is a Schedule II drug.
- **Hong Kong:** Ketamine is a Schedule I drug.
- **Malaysia:** The possession and sale is illegal.
- **New Zealand:** Ketamine is a Class C drug.
- **Singapore:** Ketamine is a Class A drug.
- **South Korea:** The possession and sale is illegal.
- **Taiwan:** Ketamine is a Schedule III drug.

### FAQs

#### Is ketamine a horse tranquiliser?

Ketamine is used as a safe anaesthetic in humans and also in many animals- not just horses. When first developed, it was for humans and used in certain situations where it might not be practical to use other anaesthetics that depress breathing. It is widely used in medical emergencies as a painkiller or as an anaesthetic in developing countries.

#### If ketamine is used for medicine, then will it be safe for me?

Ketamine is used in medical settings as a safe anaesthetic and painkiller. However, recreational use may not always be safe. Medical ketamine will be pure, whereas street ketamine may contain dangerous adulterants. In a recreational setting, ketamine can make you feel detached from your surroundings. You may find it difficult to move, which may put you in a vulnerable position or lead to injury. Long term use can also have serious effects, including damage to the bladder and urinary tract.

### Useful links

-   Ketamine podcast episode: [**Say Why To Drugs Podcast by Dr Suzanne Gage**](https://www.acast.com/saywhytodrugs/ketamine)

### Bibliography

-   Jansen, K. L. R 1993. _Non-medical use of ketamine._ British Medical Journal, 306, 601-602.

Don’t mix ketamine with alcohol; this can have dangerous sedating effects.

No alcohol

Make sure you are with someone who is sober.

In company

Ketamine can make you incoordinated and confused, putting you at risk of injury. You should avoid driving or being in a public place when you take the drug.

Ketamine

{K, Ket, Special K, Kit-Kat}

Effects