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The '''Dextromethorphan''' (''DXM'') and '''Diphenhydramine''' (''DPH'') combination experience (also known as '''counterflipping''', in reference to both DXM and DPH being over the counter (OTC) in the US) is a combination that when taken produces uniquely [[hallucinogenic]], [[dissociative]] and powerful [[deliriant]] effects when [[Routes of Administration|administered]].
The '''Dextromethorphan''' (''DXM'') and '''Diphenhydramine''' (''DPH'') combination experience (also known as '''counterflipping''') is a substance combination, that when taken, produces an array of uniquely [[hallucinogenic]], [[dissociative]] and powerful [[deliriant]] effects when [[Routes of Administration|administered]].
This article is something that [[PsychonautWiki]] is documenting because although there are seemingly infinite amount of possible drug combinations, almost all of them simply induce the effects of the two separate drugs on top of each other in a very predictable manner. However, these two substances do just the opposite of that, producing a very unique synergy when taken together, potentiating the positive aspects of the other substance whilst simultaneously suppressing its ''percieved'' negative or uncomfortable side effects; with distinct visual and hallucinatory effects that are sometimes not found on neither of these substances when taken on their own. However, despite its unique and positive effects, this combination can readily produce significantly dangerous physical and psychological effects, already at common dosages.
This article is something that [[PsychonautWiki]] is documenting because although there are a huge variety of drug combinations, most of them simply induce the effects of the two separate drugs alongside each other in a very predictable manner. However, the combination of DXM and DPH does just the opposite of that, producing a very unique synergy when taken together, potentiating the positive aspects of the other substance whilst simultaneously suppressing its ''perceived'' negative or uncomfortable side effects; with distinct visual and hallucinatory effects that are sometimes not found in neither substance when taken on their own. Although, despite the unique and positive effects, this combination can readily also produce significantly dangerous physical and psychological effects, sometimes at relatively common dosages.
Typically, dosages for both [[DXM]] and [[DPH]] are both taken in equal amounts, for example 300 milligrams of DXM with 300 milligrams of DPH, although some users prefer higher or lower amounts of either substance. This makes the spectrum of the combination very broad and the effects and dangers can vary significantly. Generally, it is strongly advised that users without extensive experience do not go over a light to common dose of both DXM and DPH alone when combining the two in recreational doses.
Typically, dosages for both [[DXM]] and [[DPH]] are both taken in equal amounts, for example, 300 milligrams of DXM with 300 milligrams of DPH, although some users prefer higher or lower amounts of either substance. This makes the spectrum of the combination very broad and the effects and dangers can vary significantly. It is strongly advised that users without extensive experience do not go over a light to common dose of both DXM and DPH alone when combining the two in recreational doses.
Both substances strongly amplify each others effects; while DPH inhibits the metabolism of DXM and increasing its concentration,{{citation needed}} DXM in turn suppresses the dysphoric and anxiolytic effects of DPH whilst powerfully amplifying its hallucinations and deliriant properties.{{citation needed}} Even at common doses, few may be subject to extreme states of [[dissociation]] and [[delirium]], possibly not being able to communicate with the outside anymore. This is very heavily dependant on body chemistry, which is already a unique effect seen with DXM and one might respond completely differently from anoth person even with the same dosages.
Both substances strongly amplify each other's effects; while DPH inhibits the metabolism of DXM and increases its concentration,{{citation needed}} DXM in turn suppresses the perceived dysphoric and anxiogenic effects of DPH and powerfully amplifying its hallucinations and deliriant properties.{{citation needed}} Even at common doses, some may be subject to extreme states of [[dissociation]] and [[delirium]], possibly not being able to effectively perceive or respond to external events. This depends heavily on body chemistry, which is already a unique effect seen with DXM and one might respond completely differently from another person even with the same dosages.
This combination is especially extremely physically taxing, especially since the dangerous effects are suppressed and can become unnoticed. It is highly advised to go against the common or strong dosage range due to the risk of effects such as toxicity, [[increased heart rate]], [[increased blood pressure]], [[rhabdomyolysis]] and agitated mental states such as [[delirium]] or [[panic attack]]s. People with preexisting cardiovascular problems should avoid this combination and further substances should not be added to this mix. It is strongly advised to use [[harm reduction practices]] if using this combination and independent research should always be done prior.
This combination is very physically taxing, especially since the dangerous effects are suppressed and they can become unnoticed by the user. It is highly advised to use doses below the common range due to the risk of effects such as toxicity, [[tachycardia|increased heart rate]], [[hypertension|increased blood pressure]], [[rhabdomyolysis]] and agitated mental states such as [[delirium]] or [[panic attack]]s. People with preexisting cardiovascular problems should avoid this combination and further substances should not be taken during the experience. It is strongly advised to use [[harm reduction practices]] if using this combination.
==History and culture==
{{historystub}}
==Chemistry==
==Chemistry==
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''{{Main|Diphenhydramine#Pharmacology}}''
''{{Main|Diphenhydramine#Pharmacology}}''
When taken in combination, [[Diphenhydramine]] acts as a pharmologically significant CYP2D/CYP2D6 inhibitor<ref>https://www.erowid.org/chemicals/dxm/faq/dxm_refs.shtml#r151</ref> and thus inhibits the breakdown of [[DXM]] into [[DXO]].<ref name=":0">Cytochrome P450-dependent metabolism of dextromethorphan: fetal and adult studies. (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/1306804</ref>
When taken in combination, [[Diphenhydramine]] acts as a pharmologically significant CYP2D/CYP2D6 inhibitor<ref>{{cite journal | vauthors=((Hiroi, T.)), ((Ohishi, N.)), ((Imaoka, S.)), ((Yabusaki, Y.)), ((Fukui, H.)), ((Funae, Y.)) | journal=The Journal of Pharmacology and Experimental Therapeutics | title=Mepyramine, a histamine H1 receptor antagonist, inhibits the metabolic activity of rat and human P450 2D forms | volume=272 | issue=2 | pages=939–944 | date= February 1995 | issn=0022-3565}}</ref> and thus inhibits the breakdown of [[DXM]] into [[DXO]].<ref name=":0">{{cite journal | vauthors=((Jacqz-Aigrain, E.)), ((Cresteil, T.)) | journal=Developmental Pharmacology and Therapeutics | title=Cytochrome P450-dependent metabolism of dextromethorphan: fetal and adult studies | volume=18 | issue=3–4 | pages=161–168 | date= 1992 | issn=0379-8305}}</ref>
==Subjective effects==
==Subjective effects==
When taken in combination, [[DXM]] and [[DPH]] both lessen the percieved uncomfortable side effects of the other substance. For example, due to DPH’s nausea suppressing abilities, the nausea associated with DXM is almost entirely abscent. In return, DXM’s dissociating and anesthetic-like qualities have an extremely positive effect on the unbearably strong physical dysphoria found within DPH. This completely eliminates the muscle cramps, nausea, dizziness, drowsiness, restless leg syndrome, and extreme dehydration experienced when DPH is tried by itself. This allows the unique delirium, hallucinations and visual effects of the DPH experience to become much more accessible to your average person.
When taken in combination, [[DXM]] and [[DPH]] both lessen the perceived uncomfortable side effects of the other substance. For example, due to DPH’s nausea suppressing abilities, the nausea associated with DXM is almost entirely absent. In return, DXM’s dissociating and anesthetic-like qualities have an extremely positive effect on the physical dysphoria found within DPH. This completely eliminates the muscle cramps, nausea, dizziness, drowsiness, restless leg syndrome, and extreme dehydration experienced when DPH is used by itself. This allows the unique delirium, hallucinations and visual effects of the DPH experience to become much more accessible to your average person.
{{Preamble/SubjectiveEffects}}
{{Preamble/SubjectiveEffects}}
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|{{effects/physical|
|{{effects/physical|
*'''[[Effect::Stimulation]]'''<ref name="Reissig">Reissig, C. J., Carter, L. P., Johnson, M. W., Mintzer, M. Z., Klinedinst, M. A., & Griffiths, R. R. (2012). High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens. Psychopharmacology, 223(1), 1-15. https://doi.org/10.1007/s00213-012-2680-6</ref> & '''[[Effect::Sedation]]''' - At lower, recreational doses, this combination is predominantly stimulating. However, it can produce waves of tiredness, or the desire to lay down with the eyes closed in a sleep-like state. As higher dosages are approached, the experience generally turns very chaotic, sometimes with states of agitated delirium resulting in stimulation or moments of sedation where the user does not move at all.
*'''[[Effect::Stimulation]]'''<ref name="Reissig">{{cite journal | vauthors=((Reissig, C. J.)), ((Carter, L. P.)), ((Johnson, M. W.)), ((Mintzer, M. Z.)), ((Klinedinst, M. A.)), ((Griffiths, R. R.)) | journal=Psychopharmacology | title=High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens | volume=223 | issue=1 | pages=1–15 | date= September 2012 | url=http://link.springer.com/10.1007/s00213-012-2680-6 | issn=0033-3158 | doi=10.1007/s00213-012-2680-6}}</ref> & '''[[Effect::Sedation]]''' - At lower, recreational doses, this combination is predominantly stimulating. However, it can produce waves of tiredness, or the desire to lay down with the eyes closed in a sleep-like state. As higher dosages are approached, the experience generally turns very chaotic, sometimes with states of agitated delirium resulting in stimulation or moments of sedation where the user does not move at all.
*'''[[Effect::Abnormal heartbeat]]''' - Diphenhydramine is able to prolong the QT interval, potentially leading to torsades de pointes, an abnormal heart rhythm that can cause sudden cardiac death.<ref>QT interval prolongation in diphenhydramine toxicity | https://www.sciencedirect.com/science/article/abs/pii/S0167527304000786</ref> This risk if greatly amplified by both DPH and DXM by increasing heart rate to dangerously high levels.
*'''[[Effect::Abnormal heartbeat]]''' - Diphenhydramine is able to prolong the QT interval, potentially leading to torsades de pointes, an abnormal heart rhythm that can cause sudden cardiac death.<ref>{{cite journal | vauthors=((Thakur, A. C.)), ((Aslam, A. K.)), ((Aslam, A. F.)), ((Vasavada, B. C.)), ((Sacchi, T. J.)), ((Khan, I. A.)) | journal=International Journal of Cardiology | title=QT interval prolongation in diphenhydramine toxicity | volume=98 | issue=2 | pages=341–343 | date=15 February 2005 | url=https://www.sciencedirect.com/science/article/pii/S0167527304000786 | issn=0167-5273 | doi=10.1016/j.ijcard.2003.10.051}}</ref> This risk is greatly amplified by both DPH and DXM by increasing heart rate to dangerously high levels.
*'''[[Effect::Physical autonomy]]''' - At very high dosages some find to awake in strange locations, sometimes while standing or performing actions with no recollection of events or how they got there. When approaching delirium, the experience generally turns stimulating and as a result, one may start to walk long distances.
*'''[[Effect::Perception of bodily lightness]]''' & '''[[Effect::Perception of bodily heaviness]]''' - This creates the sensation that the body is floating and has become entirely weightless. This effect is stimulating and encourages physical activities by making the body feel light and effortless to move. This effects is amplified when compared with DXM alone. DPH however can also produce bodily heaviness and increase in percieved gravity, especially at the beginning of the experience or if higher dosages of DPH are used than DXM.
*'''[[Effect::Perception of bodily lightness]]''' & '''[[Effect::Perception of bodily heaviness]]''' - This creates the sensation that the body is floating and has become entirely weightless. This effect is stimulating and encourages physical activities by making the body feel light and effortless to move. This effects is amplified when compared with DXM alone. DPH however can also produce bodily heaviness and increase in percieved gravity, especially at the beginning of the experience or if higher dosages of DPH are used than DXM.
*'''[[Effect::Spontaneous bodily sensations]]''' - The body high is a sharp, pleasurable tingling sensation which is location specific to the hands, feet and head. The second is a warm euphoric glow which emanates outwards from the centre of the body's torso. At lower dosages, it can produce an empowering stimulated sensation, at higher dosages a slight body load or none at all. It should be noted that it can also spontaneously transform into intense physical dysphoria.
*'''[[Effect::Spontaneous bodily sensations]]''' - The body high is a sharp, pleasurable tingling sensation which is location specific to the hands, feet and head. The second is a warm euphoric glow which emanates outwards from the centre of the body's torso. At lower dosages, it can produce an empowering stimulated sensation, at higher dosages a slight body load or none at all. It should be noted that it can also spontaneously transform into intense physical dysphoria.
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*'''[[Effect::Gustatory hallucination]]'''
*'''[[Effect::Gustatory hallucination]]'''
*'''[[Effect::Olfactory hallucination]]'''
*'''[[Effect::Olfactory hallucination]]'''
*'''[[Effect::Physical autonomy]]''' - At very high dosages some find to awake in strange locations, sometimes while standing or performing actions with no recollection of events or how they got there.
*'''[[Effect::Tactile suppression]]''' - This partially to entirely suppresses one's sense of touch, creating feelings of numbness within the extremities.
*'''[[Effect::Tactile suppression]]''' - This partially to entirely suppresses one's sense of touch, creating feelings of numbness within the extremities.
*'''[[Effect::Pupil dilation]]'''- Pupil dilation is very noticeable at moderate to high doses.
*'''[[Effect::Pupil dilation]]'''- Pupil dilation is very noticeable at moderate to high doses.
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*'''[[Effect::Physical fatigue]]''' - This effect can become very strong during the comedown.
*'''[[Effect::Physical fatigue]]''' - This effect can become very strong during the comedown.
*'''[[Effect::Tactile enhancement]]''' - This results in increased feelings of touch, pain, warmth and orgasms. It is usually only present at very low dosages.
*'''[[Effect::Tactile enhancement]]''' - This results in increased feelings of touch, pain, warmth and orgasms. It is usually only present at very low dosages.
*'''[[Effect::Tactile suppression]]''' - This produces feelings of numbness throughout the body. This is attributed to DPH's ability to block sodium channels within the nerves<ref>Block of sodium currents in rat dorsal root ganglion neurons by diphenhydramine | http://www.sciencedirect.com/science/article/pii/S0006899300028602?via%3Dihub</ref> and DXM's NMDA antagonism. At higher dosages, this can lead to massive amounts of pain relief comparable to anesthesia.
*'''[[Effect::Tactile suppression]]''' - This produces feelings of numbness throughout the body. This is attributed to DPH's ability to block sodium channels within the nerves<ref>{{cite journal | vauthors=((Kim, Y. S.)), ((Shin, Y. K.)), ((Lee, C.-S.)), ((Song, J.-H.)) | journal=Brain Research | title=Block of sodium currents in rat dorsal root ganglion neurons by diphenhydramine | volume=881 | issue=2 | pages=190–198 | date=27 October 2000 | url=https://www.sciencedirect.com/science/article/pii/S0006899300028602 | issn=0006-8993 | doi=10.1016/S0006-8993(00)02860-2}}</ref> and DXM's NMDA antagonism. At higher dosages, this can lead to massive amounts of pain relief comparable to anesthesia.
*'''[[Effect::Tactile hallucination]]''' - This is often a direct result of visual [[external hallucinations|hallucinations]] and they commonly feel and look extremely realistic.
*'''[[Effect::Tactile hallucination]]''' - This is often a direct result of visual [[external hallucinations|hallucinations]] and they commonly feel and look extremely realistic.
*'''[[Effect::Skin flushing]]''' - Flushed skin occurs mostly around the eyes, but can also be seen all over the body.
*'''[[Effect::Skin flushing]]''' - Flushed skin occurs mostly around the eyes, but can also be seen all over the body.
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====Distortions====
====Distortions====
As for visual distortions and alterations, effects experienced are detailed below:
*'''[[Effect::Drifting]]''' ''([[Visual drifting#Melting|melting]], [[Visual drifting#Breathing|breathing]], [[Visual drifting#Morphing|morphing]] and [[Visual drifting#Flowing|flowing]])'' - In comparison to other hallucinogens, this effect can be described as intricate in complexity, jittery, slow and rigid in motion, static in their permanence, blurry in detail, realistic in believability, and interactive in plasticity.
*'''[[Effect::Drifting]]''' ''([[Visual drifting#Melting|melting]], [[Visual drifting#Breathing|breathing]], [[Visual drifting#Morphing|morphing]] and [[Visual drifting#Flowing|flowing]])'' - In comparison to other hallucinogens, this effect can be described as intricate in complexity, jittery, slow and rigid in motion, static in their permanence, blurry in detail, realistic in believability, and interactive in plasticity.
*'''[[Effect::After images]]'''
*'''[[Effect::After images]]'''
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The effects of this combination are extremely efficient at inducing delirious hallucinations which can be broken into the two categories described below:
The effects of this combination are extremely efficient at inducing delirious hallucinations which can be broken into the two categories described below:
*'''[[Effect::External hallucination]]''' (''[[effect::autonomous entities]]''; ''[[effect::settings, sceneries, and landscapes]]''; ''[[effect::perspective hallucinations]]'' and ''[[effect::scenarios and plots]]'') - In comparison to other classes of [[hallucinogens]], this effect occurs more frequently than that of any other at moderate to heavy dosages and is the defining feature of the experience. It can be comprehensively described through its variations as delirious in believability, autonomous in controllability and solid in style. The most common themes for these hallucinations include those of both everyday occurrences such as smoking phantom cigarettes, talking to people who are not there, insects and sinister or nightmarish experiences.
*'''[[Effect::External hallucination]]''' (''[[effect::autonomous entities]]''; ''[[effect::settings, sceneries, and landscapes]]''; ''[[effect::perspective hallucinations]]'' and ''[[effect::scenarios and plots]]'') - In comparison to other classes of [[hallucinogens]], this effect occurs more frequently than that of any other at moderate to heavy dosages and is the defining feature of the experience. It can be comprehensively described through its variations as delirious in believability, autonomous in controllability and solid in style. The most common themes for these hallucinations include those of both everyday occurrences such as smoking phantom cigarettes, talking to people who are not there, insects and sinister or nightmarish experiences. The person may experience sceneries of people which they know, have frequently been in contact with or play a significant role in one's head. Events may unfold similar to dream-like states where hallucinations are mixed into reality in despiclable or even realistic scenarios. A whole theather of possible imaginations can be experienced/hallucinated all while the user in unaware of what is happening.
*'''[[Effect::Internal hallucination]]''' (''[[effect::autonomous entities]]''; ''[[effect::settings, sceneries, and landscapes]]''; ''[[effect::perspective hallucinations]]'' and ''[[effect::scenarios and plots]]'') - In comparison to other classes of hallucinogen, this effect occurs briefly and spontaneously at moderate dosages but becomes progressively extended in its occurrence and duration proportional to dosage before eventually becoming all encompassing. It can be comprehensively described through its variations as delirious in believability, interactive in style, equal in new experiences and memory replays in content, autonomous in controllability and solid in style.
*'''[[Effect::Internal hallucination]]''' (''[[effect::autonomous entities]]''; ''[[effect::settings, sceneries, and landscapes]]''; ''[[effect::perspective hallucinations]]'' and ''[[effect::scenarios and plots]]'') - In comparison to other classes of hallucinogen, this effect occurs briefly and spontaneously at moderate dosages but becomes progressively extended in its occurrence and duration proportional to dosage before eventually becoming all encompassing. It can be comprehensively described through its variations as delirious in believability, interactive in style, equal in new experiences and memory replays in content, autonomous in controllability and solid in style.
*'''[[Effect::Unspeakable horrors]]'''
*'''[[Effect::Unspeakable horrors]]'''
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}}
}}
|{{effects/cognitive|
|{{effects/cognitive|
The emotional dysphoria, paranoia, anxiety, depression and feelings of impending doom usually found within DPH do not seem to present when taken in combination with DXM. This could be attributed to DXM's euphoric and calming effects. In total the subjective cognitive effects of DXM and DPH can be broken down into several components all of which progressively intensify proportional to dosage. These components generally include:
*'''[[Effect::Analysis suppression]]''' - At higher dosages, a person could experience a complete halt of external information processing, which can make the user unable to perform simple tasks or make decisions.
*'''[[Effect::Analysis suppression]]''' - At higher dosages, a person could experience a complete halt of external information processing, which can make the user unable to perform simple tasks or make decisions.
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*'''[[Effect::Decreased libido]]'''
*'''[[Effect::Decreased libido]]'''
*'''[[Effect::Déjà vu]]'''
*'''[[Effect::Déjà vu]]'''
*'''[[Effect::Delirium]]''' - Delirium may be experienced already with common doses which may necessitate hospitalization as this state can be extremely dangerous for an individual, especially if they are not accompanied by a [[trip sitter]], as they can injure themselves or others.
*'''[[Effect::Delirium]]''' - The threshold dose for full-blown delirium may be experienced already with common doses, which may necessitate hospitalization as this state can be extremely dangerous for an individual, especially if they are not accompanied by a [[trip sitter]], as they can injure themselves or others. The user may not be able to differentiate percieved visual hallucinations from reality at all, in addition to mental delirium making the user's thoughts delirious and believeable which further contributes to the hallucinations.
*'''[[Effect::Delusion]]''' - This effect can occur pretty reliably.
*'''[[Effect::Delusion]]''' - This effect can occur very reliably.
The auditory effects of this combination are extremely consistent in occurrence in comparison to that of LSD and psilocin and exhibit a range of effects which commonly includes:
*'''[[Effect::Auditory enhancement]]'''
*'''[[Effect::Auditory suppression]]'''
*'''[[Effect::Auditory suppression]]'''
*'''[[Effect::Auditory distortion]]'''
*'''[[Effect::Auditory distortion]]'''
*'''[[Effect::Auditory hallucination]]'''
*'''[[Effect::Auditory hallucination]]'''
*'''[[Effect::Glossolalia]]'''
}}
}}
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*'''[[Effect::Physical disconnection]]'''
*'''[[Effect::Physical disconnection]]'''
*'''[[Effect::Visual disconnection]]'''
*'''[[Effect::Visual disconnection]]'''
}}
{{effects/multisensory|
*'''[[Effect::Synaesthesia]]''' - In its fullest manifestation, this is a very rare and non-reproducible effect. Increasing the dosage can increase the likelihood of this occurring, but seems only to be a prominent part of the experience among those who are already predisposed to synaesthetic states.
The afterglow is a feeling that can occur in the following day or weeks after the experience. It can be described regarding its physical sensation as one of [[euphoria]], [[rejuvenation]], relaxation and a light bounciness. <p>Cognitive manifestations include a loss of anxiety, feelings of content, [[increased music appreciation]] and other sensory stimuli that are sometimes accompanied with mild [[derealization]] or [[depersonalization]].
The afterglow is a feeling that can occur in the following day or weeks after the experience. At lower dosages, it can be described regarding its physical sensation as one of [[euphoria]], [[rejuvenation]], relaxation and a light bounciness. <p>Cognitive manifestations include a loss of anxiety, feelings of content, [[increased music appreciation]] and other sensory stimuli that are sometimes accompanied with mild [[derealization]] or [[depersonalization]]. As higher dosages are used, after effects typically consist of strong fatigue and [[sleepiness]].
}}
}}
}}
}}
==Toxicity and harm potential==
''{{Main|Dextromethorphan#Toxicity}}''
''{{Main|Diphenhydramine#Toxicity}}''
When taken in combination, it should be noted that enormous amounts of strain can be put on the circulatory system, as both substances increase one's heart rate and blood pressure. This can become dangerous in high dosages. The toxicity of both substances is also present. States of agitated delirium can pose a significant risk to the person as they are subject to confusion and a general inability to properly assess visual and audio stimuli.
==Legal issues==
''{{Main|Dextromethorphan#Legality}}''
''{{Main|Diphenhydramine#Legality}}''
==See also==
*[[Responsible use]]
*[[Harm reduction]]
*[[DXM]]
*[[DPH]]
Cognitive effects
The emotional dysphoria, paranoia, anxiety, depression and feelings of impending doom usually found within DPH do not seem to present when taken in combination with DXM. This could be attributed to DXM's euphoric and calming effects. In total the subjective cognitive effects of DXM and DPH can be broken down into several components all of which progressively intensify proportional to dosage. These components generally include:
Consciousness disconnection
Memory suppression
Thought deceleration
Emotion suppression
Information processing suppression
Language suppression
Amnesia
Simultaneous emotions
Visual effects
Suppression
This combination does not enhance visual stimuli in the way that psychedelics do; instead they tend to degrade and decrease visual aptitude both increasing hallucination and degrading vision. These are described below and generally include:
Acuity suppression
Double vision
Pattern recognition suppression
Visual disconnection
Distortions
As for visual distortions and alterations, effects experienced are detailed below:
Drifting (melting, breathing, morphing and flowing) - In comparison to other hallucinogens, this effect can be described as intricate in complexity, jittery, slow and rigid in motion, static in their permanence, blurry in detail, realistic in believability, and interactive in plasticity
3-Dimensional textures - Another distinct visual distortion which is seemingly unique to this very specific combination is a distortion which exclusively effects rough and detailed textures. This causes textures to become 3-Dimensional, rising up out of the surface which they reside upon in a strangely intricate and static fashion that looks similar in appearance to condensed, mostly opaque and coloured smoke.
Geometry
In terms of the specific style of geometry present within this combination, they can be described as intricate in complexity, slow in movement, dark in colour scheme and ominous in emotional vibe. They manifest themselves in a traditional psychedelic manner when the eyes are closed but appear as static, unmoving shapes and geometry which the external environment morphs into when the eyes are open and looking at any single point, always resetting once the person double takes. This is an unusual visual effect because both dissociative and psychedelic visuals do not do this, instead preferring to manifest themselves as a fast moving and flat translucent veil across the visual field which cannot be interacted with.
Hallucinatory states
The effects of this combination are extremely efficient at inducing delirious hallucinations which can be broken into the two categories described below:
External hallucinations ([Effect::Autonomous entities]], Settings, sceneries, and landscapes, Alterations in perspective and Scenarios and plots) - In comparison to other classes of hallucinogen, this effect occurs more frequently than that of any other at moderate to heavy dosages and is the defining feature of the experience. It can be comprehensively described through its variations as delirious in believability, autonomous in controllability and solid in style. The most common themes for these hallucinations include those of both everyday occurrences such as smoking phantom cigarettes, talking to people who are not there, insects and sinister, nightmarish experiences.
Internal hallucinations (Autonomous entities, Settings, sceneries, and landscapes, Alterations in perspective and Scenarios and plots) - In comparison to other classes of hallucinogen, this effect occurs briefly and spontaneously at moderate dosages but becomes progressively extended in its occurrence and duration proportional to dosage before eventually becoming all encompassing. It can be comprehensively described through its variations as delirious in believability, interactive in style, equal in new experiences and memory replays in content, autonomous in controllability and solid in style.
Unspeakable horrors
Shadow people
Auditory effects
The auditory effects of this combination are extremely consistent in occurrence in comparison to that of LSD and psilocin and exhibit a range of effects which commonly includes:
↑ Dextromethorphan attenuates trimethyltin-induced neurotoxicity via sigma1 receptor activation in rats | http://linkinghub.elsevier.com/retrieve/pii/S0197-0186(07)00038-1
↑ Dextromethorphan attenuates trimethyltin-induced neurotoxicity via σ1 receptor activation in rats | http://www.sciencedirect.com/science/article/pii/S0197018607000381
↑ Psychotropic Effects of Dextromethorphan Are Altered by the CYP2D6 Polymorphism: A Pilot Study | http://journals.lww.com/psychopharmacology/pages/articleviewer.aspx?year=1998&issue=08000&article=00014&type=abstract
↑ Comparison of the Effects of Dextromethorphan, Dextrorphan, and Levorphanol on the Hypothalamo-Pituitary-Adrenal Axis | http://jpet.aspetjournals.org/content/309/2/515
- I find the title DXM & DPH to be the most alluring title for this article, tho we could use DXM + DPH as well (or both)
==My notes (heavily disorganized)==
The combination of Dextromethorphan (DXM) and Diphenhydramine (DPH, avoid DMH), also called "Over-The-Counter Flipping" synergizes verz well and can become extremely powerful, profound and detaching from reality.
When using both DXM and DPH in high doses, effects can become extremely bizarre in nature, have profound experiences, overwhelming confusion
Most importantly for harm reduction, i can easily become very dangerous, both physically and psychologically (and somewhat socially).
This short guide will summarize the important rules and harm reduction practises you absolutely should use, else you might, without prior knowledge, get in a **real** bad mess, accident or pay a sum of money, if you don't respect the dosages and the very powerful synergy.
It's very easy to fall into a full-blown delirium, akin to Datura?, and you may wake up somewhere you don't want to be or don't know where you are.
The combination is presumably also very straining on your heart and circulation. People with cardiovascular problems shoud not try this!
Introduction
DXM and DPH, in recreational doses, synergize unusually favorable with each other. Most negative effects of one drug is masked by the other, especially the dysphoric headspace of DPH, or the nausea and body load from DXM. They produce a sort of entirely new experience with features of both drugs in addition to synergestic effects that form, which can become quite strong.
Psychological Effects
The dissociation from DXM is amplified with DPH's deliriant and short-term + long-term amnesia, which can quickly turn into delirium. Approaching delirium the trip suddenly can become stimulating/energetic and one might end up moving or walking for some (or very long) distance without being coherent.
DXM lowers the delirium theshold of DPH significantly. Dosages with this combination should be greatly respected and anyone should have a sober person by his/her side at all times. In some people a dose of 300mg/300mg could already be sufficient for full-blown delirium (not being able to differentiate reality). __This is extremely dangerous when one finds themselves alone__.
DPH can reduce nausea from DXM and it masks the body load that some users percieve differently DPH also adds to memory blackouts
The synergestic effects are very diverse for each type. Perception itself includes a kind of stimulated, strongly dissociating and also from delusions to full-blown delirium, which can completely renders the user unable to differentiate hallucinations from reality, not even capable of using logic.
Extremely realistic and diverse external hallucinations occur, ranging from well-defined, mostly known people, insects, imaginary passages or groups of obstacles (branches, trees..), unrealistic objects of any absurd kind, usually with some correlation to a delusional thought. Even entire sceneries can form, e.g. social gatherings, implementing many of the previously mentioned hallucinations. Just like DPH Delirium, hallucinations appear 99% realistic and even after the trip is gone you still don't know what has been real or not in your trip. Hallucinations mostly feel casual, as if they were normal, despite a terrorizing nature, but can also feel very stressful or terrorizing nonetheless. This is most likely due to the DXM. The dysphoria from DPH is practically gone.
Internal hallucinations can develop occasinally and are typicakly sinister or bizzare sceneries, more detailed than DPH and less harmless/fun/strange visions of DXM. They are more common on low to moderate doses.
Closed-eye geometry is defined, they resemble DXM although they transform very slow, jittery and occasionally freeze up entirely, then spontaneously transform into internal hallucinations or geometry again.
Thought process can range from intoxixation to delusions+blackouts and finally full-blown delirium. Of couse, basic physical movements are still there although muscle coordination can be very bad, hideous and clumsy at times.
The experience can be perceived in many different but extreme feelings of euphoria, profoundness, confusion, casuality, fear, terror, dissociation, frustration, disinhibition and more. The trip will play out what experience or scenery you have.
Physical Effects
There is a pleasant numb/warm feeling across the body.
DXM and DPH both increase heart rate, possibly to very strenuous levels that can turn dangerous. Very high doses should be avoided because of this.
Duration
Depending on dose, peak effects last between 6 - 12 hours and the total duration approximately 12- 20 hours. Please note these estimates are purely from my own experience.
Dosage
Be sure that DXM and DPH are the ONLY active ingredients, some can get dangerous when also added.
Also avoid ANY other drug combination, including ALL safe ones for DXM and DPH, Nicotine, Caffeine, Grapefruit juice, medication and preferably cannabis.
If you don't decide to dose lower on either DPH or DXM in the combination, you can follow this starting recommendation for the full effects from both drugs:
Light: 120mg/120mg
Common: 200mg/200mg
Strong: 280mg/280mg (possible to fall into delirium)
Heavy: 350mg/350mg (slowly work up before trying)
Maximum: 400mg/400mg (possibly unsafe physicaly. Do not exceed, even experienced users)
Guide & Preparation to enjoy DXM + DPH as safely as possible.
There is quite a few key points that are absolutely neccesary to follow, or else bad things might happen. The Combo is also only recommended for experienced people, with both DXM and DPH both alone!
• Have one or more sober tripsitters that you have good relationships with. They should always be watching you at all times. Might be the most important requirement to prevent any trainwrecks or some Hangover Movie thing.
Even for experienced users, never take this combo alone, notably high doses. You could wake up somewhere far away, get in a fight or loose all your belongings.
You should be aware that you'll appear very inappropriate in front of other people so avoid public spaces and people you dont trust.
• No exceptions: Start low! The combination can be very powerful and incapacitating. Starting at 200mg/200mg is recommended.
• A good setting and enough time. I'd recommend first time to only stay at home and have 24 hours to spare.
• Water, little food, nutrients, vitamins.
1. Drink enough water!
2. Magnesium, Potassium, little Sodium should be taken to replenish what the DXM takes away.
3. DMAE, Alpha-GPC or another choline source will counteract some of the anticholinergic effects.
• Preferably a heart-rate monitor and/or blood pressure monitor to check if your circulation is OK.
• Avoid any significant exercise. Avoid driving or machinery. (Depending on your state you'd never be able to come up with such an idea anyway)
personal xp vo PC
add from notes
yes absolutely they generally synergize reeealy well
but out of all things I've done the most crazy shit and endangering myself with these 2 combined. way to easy to fall into COMPLETE delirium at 300/300. You could end up anywhere, I hallucinated an entire party at night and traveled several miles back and forth my town. but the trip itself is like ephoric dph on steroids I remember it being awesome nevertheless
also I should note this combo is probably dangerous for your heart, but more so to yourself and others as well, take caution
I have a comment describing in detail what i experienced from 400/400
DXM negates all dysphoric aspects of dph, but it is very easy to fall into complete delirium and do REALLY stupid stuff.
300/300 was sufficient to just so cross the border of full-blown delirium
also very straining on your heart
waay to easy to fall into delirium IME. 300/300 is already sufficient. Actually it's not bad because dxm negates all the uncomfortable effects of dph and somewhat vice versa too, while they potentiatie each other favorably
I've seen crazy shit I didn't know the brain was even capable of imagining such scenarios, at ~400/400. I've ventured across my whole city two times at night and I would've been put in an asylum if someone would have seen me, it's a wonder that no one did and I was high for at least 24 hours and in full-on delirium for at least 10 hours. Not scary at all, but it's like you're used to live in hell and dxm takes the edge off the anxiety, that's it lol
==References==
also, i can't confirm, but this might be very bad for your circulatory system
{{reflist|1}}
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Latest revision as of 17:16, 6 July 2023
The combination of DXM and DPH is reported to produce potentially dangerous experiences both physiologically and mentally, especially at higher doses.
The deliriant and dissociative effects associated with recreational doses of this combination are highly unpredictable and may result in erratic behaviors, self-injury, physical side effects such as dangerously elevated heart rate or blood pressure, hospitalization, or (in extreme cases) death.
Please use harm reduction practices if using this combination (e.g. starting with low dosages and always having a trip sitter). Refer to this section for more details.
WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section.
DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.
The Dextromethorphan (DXM) and Diphenhydramine (DPH) combination experience (also known as counterflipping) is a substance combination, that when taken, produces an array of uniquely hallucinogenic, dissociative and powerful deliriant effects when administered.
This article is something that PsychonautWiki is documenting because although there are a huge variety of drug combinations, most of them simply induce the effects of the two separate drugs alongside each other in a very predictable manner. However, the combination of DXM and DPH does just the opposite of that, producing a very unique synergy when taken together, potentiating the positive aspects of the other substance whilst simultaneously suppressing its perceived negative or uncomfortable side effects; with distinct visual and hallucinatory effects that are sometimes not found in neither substance when taken on their own. Although, despite the unique and positive effects, this combination can readily also produce significantly dangerous physical and psychological effects, sometimes at relatively common dosages.
Typically, dosages for both DXM and DPH are both taken in equal amounts, for example, 300 milligrams of DXM with 300 milligrams of DPH, although some users prefer higher or lower amounts of either substance. This makes the spectrum of the combination very broad and the effects and dangers can vary significantly. It is strongly advised that users without extensive experience do not go over a light to common dose of both DXM and DPH alone when combining the two in recreational doses.
Both substances strongly amplify each other's effects; while DPH inhibits the metabolism of DXM and increases its concentration,[citation needed] DXM in turn suppresses the perceived dysphoric and anxiogenic effects of DPH and powerfully amplifying its hallucinations and deliriant properties.[citation needed] Even at common doses, some may be subject to extreme states of dissociation and delirium, possibly not being able to effectively perceive or respond to external events. This depends heavily on body chemistry, which is already a unique effect seen with DXM and one might respond completely differently from another person even with the same dosages.
This combination is very physically taxing, especially since the dangerous effects are suppressed and they can become unnoticed by the user. It is highly advised to use doses below the common range due to the risk of effects such as toxicity, increased heart rate, increased blood pressure, rhabdomyolysis and agitated mental states such as delirium or panic attacks. People with preexisting cardiovascular problems should avoid this combination and further substances should not be taken during the experience. It is strongly advised to use harm reduction practices if using this combination.
When taken in combination, Diphenhydramine acts as a pharmologically significant CYP2D/CYP2D6 inhibitor[1] and thus inhibits the breakdown of DXM into DXO.[2]
Subjective effects
When taken in combination, DXM and DPH both lessen the perceived uncomfortable side effects of the other substance. For example, due to DPH’s nausea suppressing abilities, the nausea associated with DXM is almost entirely absent. In return, DXM’s dissociating and anesthetic-like qualities have an extremely positive effect on the physical dysphoria found within DPH. This completely eliminates the muscle cramps, nausea, dizziness, drowsiness, restless leg syndrome, and extreme dehydration experienced when DPH is used by itself. This allows the unique delirium, hallucinations and visual effects of the DPH experience to become much more accessible to your average person.
Disclaimer: The effects listed below cite the Subjective Effect Index (SEI), an open research literature based on anecdotal user reports and the personal analyses of PsychonautWikicontributors. As a result, they should be viewed with a healthy degree of skepticism.
It is also worth noting that these effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects. Likewise, adverse effects become increasingly likely with higher doses and may include addiction, severe injury, or death ☠.
Physical effects
Stimulation[3] & Sedation - At lower, recreational doses, this combination is predominantly stimulating. However, it can produce waves of tiredness, or the desire to lay down with the eyes closed in a sleep-like state. As higher dosages are approached, the experience generally turns very chaotic, sometimes with states of agitated delirium resulting in stimulation or moments of sedation where the user does not move at all.
Abnormal heartbeat - Diphenhydramine is able to prolong the QT interval, potentially leading to torsades de pointes, an abnormal heart rhythm that can cause sudden cardiac death.[4] This risk is greatly amplified by both DPH and DXM by increasing heart rate to dangerously high levels.
Physical autonomy - At very high dosages some find to awake in strange locations, sometimes while standing or performing actions with no recollection of events or how they got there. When approaching delirium, the experience generally turns stimulating and as a result, one may start to walk long distances.
Perception of bodily lightness & Perception of bodily heaviness - This creates the sensation that the body is floating and has become entirely weightless. This effect is stimulating and encourages physical activities by making the body feel light and effortless to move. This effects is amplified when compared with DXM alone. DPH however can also produce bodily heaviness and increase in percieved gravity, especially at the beginning of the experience or if higher dosages of DPH are used than DXM.
Spontaneous bodily sensations - The body high is a sharp, pleasurable tingling sensation which is location specific to the hands, feet and head. The second is a warm euphoric glow which emanates outwards from the centre of the body's torso. At lower dosages, it can produce an empowering stimulated sensation, at higher dosages a slight body load or none at all. It should be noted that it can also spontaneously transform into intense physical dysphoria.
Physical euphoria - This inconsistently results in feelings of physical euphoria which range between mild pleasure to powerful, all-encompassing bliss.
Motor control loss[3] - A loss of gross and fine motor control alongside balance and coordination is prominent and becomes especially strong at higher dosages. One should be sitting down before the onset to prevent falling over and becoming injured and have a trip sitter be watching over them.
Increased perspiration - This is the result of a combination of increased bodily temperature and temperature regulation suppression.[citation needed] Users should be monitored that they do not overheat.
Dehydration[citation needed] - Both substances can be extremely dehydrating. Users should drink plenty of water before and after an experience to avoid dangerous complications such as seizures.
Physical fatigue - This effect can become very strong during the comedown.
Tactile enhancement - This results in increased feelings of touch, pain, warmth and orgasms. It is usually only present at very low dosages.
Tactile suppression - This produces feelings of numbness throughout the body. This is attributed to DPH's ability to block sodium channels within the nerves[5] and DXM's NMDA antagonism. At higher dosages, this can lead to massive amounts of pain relief comparable to anesthesia.
Seizure - Both substances are known to significantly lower the seizure theshold and this may be dangerously amplified when taken in combination.
Visual effects
This combination does not enhance visual stimuli in the way that psychedelics do; instead they tend to degrade and decrease visual aptitude both increasing hallucination and degrading vision.
Double vision - This component is prevalent at moderate to heavy dosages and makes reading impossible unless one closes an eye.
Pattern recognition suppression - This effect generally occurs at higher dosages and makes one unable to recognize and interpret perceivable visual data. Examples can include an inability to recognize faces or motion.
Frame rate suppression - This is the so-called "flanging" effect, which at appropriately high doses can affect sight, sound and at higher levels phrases, faces and thinking.
Nystagmus - At very high dosages one may be incapable of recognizing things such as movement of objects or human faces.
Visual acuity suppression - Vision is reported to be very dream-like, frequently with a hazy or "static-like" overlay affecting the visual field. This effect can also result in blurry vision to the point of blindness. It sometimes can last for days after the experience itself.
Distortions
As for visual distortions and alterations, effects experienced are detailed below:
Drifting(melting, breathing, morphing and flowing) - In comparison to other hallucinogens, this effect can be described as intricate in complexity, jittery, slow and rigid in motion, static in their permanence, blurry in detail, realistic in believability, and interactive in plasticity.
Object alteration - The textures seen are described as transparent whirling lines and swirls which move at changing speeds and jitter uncontrollably. They only appear slightly above surfaces, walls and ceilings and can not be felt.
In terms of the specific style of geometry present within this combination, they can be described as intricate in complexity, slow in movement, dark in colour scheme and ominous in emotional vibe. They manifest themselves in a traditional psychedelic manner when the eyes are closed but appear as static, unmoving shapes and geometry which the external environment morphs into when the eyes are open and looking at any single point, always resetting once the person double takes. This is an unusual visual effect because both dissociative and psychedelic visuals do not do this, instead preferring to manifest themselves as a fast moving and flat translucent veil across the visual field which cannot be interacted with.
Hallucinatory states
The effects of this combination are extremely efficient at inducing delirious hallucinations which can be broken into the two categories described below:
External hallucination (autonomous entities; settings, sceneries, and landscapes; perspective hallucinations and scenarios and plots) - In comparison to other classes of hallucinogens, this effect occurs more frequently than that of any other at moderate to heavy dosages and is the defining feature of the experience. It can be comprehensively described through its variations as delirious in believability, autonomous in controllability and solid in style. The most common themes for these hallucinations include those of both everyday occurrences such as smoking phantom cigarettes, talking to people who are not there, insects and sinister or nightmarish experiences. The person may experience sceneries of people which they know, have frequently been in contact with or play a significant role in one's head. Events may unfold similar to dream-like states where hallucinations are mixed into reality in despiclable or even realistic scenarios. A whole theather of possible imaginations can be experienced/hallucinated all while the user in unaware of what is happening.
Internal hallucination (autonomous entities; settings, sceneries, and landscapes; perspective hallucinations and scenarios and plots) - In comparison to other classes of hallucinogen, this effect occurs briefly and spontaneously at moderate dosages but becomes progressively extended in its occurrence and duration proportional to dosage before eventually becoming all encompassing. It can be comprehensively described through its variations as delirious in believability, interactive in style, equal in new experiences and memory replays in content, autonomous in controllability and solid in style.
The emotional dysphoria, paranoia, anxiety, depression and feelings of impending doom usually found within DPH do not seem to present when taken in combination with DXM. This could be attributed to DXM's euphoric and calming effects. In total the subjective cognitive effects of DXM and DPH can be broken down into several components all of which progressively intensify proportional to dosage. These components generally include:
Analysis suppression - At higher dosages, a person could experience a complete halt of external information processing, which can make the user unable to perform simple tasks or make decisions.
Anxiety suppression,Anxiety&Paranoia - Although this combination typically suppresses anxiety, it is also able to produce it in certain conditions. Extreme anxiety, paranoia or panic attacks may occur at heavy dosages.
Confusion[3] - States of delirium can become extremely confusing and uncomfortable. This can result in a complete inability to understand others' intentions, emotions, humor and even simple sentences.
Cognitive euphoria - While states of cognitive euphoria are commonly reported, this effect can unpredictably manifest itself as cognitive dysphoria for no apparent reason, particularly at higher doses.
Delirium - The threshold dose for full-blown delirium may be experienced already with common doses, which may necessitate hospitalization as this state can be extremely dangerous for an individual, especially if they are not accompanied by a trip sitter, as they can injure themselves or others. The user may not be able to differentiate percieved visual hallucinations from reality at all, in addition to mental delirium making the user's thoughts delirious and believeable which further contributes to the hallucinations.
Increased music appreciation - This effect can be very intense but steadily decreases as higher dosages are approached where sounds may be to chaotic or faint to be enjoyable.
Memory suppression - Short-term memory can be severely disrupted and one may not be able to hold on to thoughts for more than a few seconds.
Amnesia - This effect is present with higher dosages. It can range from partial to complete memory loss of the experience. Generally, more dull parts of the experience tend to not be remembered at all. Frequent use can also sometimes contribute to this, even for days after the experience.
The auditory effects of this combination are extremely consistent in occurrence in comparison to that of LSD and psilocin and exhibit a range of effects which commonly includes:
The afterglow is a feeling that can occur in the following day or weeks after the experience. At lower dosages, it can be described regarding its physical sensation as one of euphoria, rejuvenation, relaxation and a light bounciness.
Cognitive manifestations include a loss of anxiety, feelings of content, increased music appreciation and other sensory stimuli that are sometimes accompanied with mild derealization or depersonalization. As higher dosages are used, after effects typically consist of strong fatigue and sleepiness.
When taken in combination, it should be noted that enormous amounts of strain can be put on the circulatory system, as both substances increase one's heart rate and blood pressure. This can become dangerous in high dosages. The toxicity of both substances is also present. States of agitated delirium can pose a significant risk to the person as they are subject to confusion and a general inability to properly assess visual and audio stimuli.
↑Hiroi, T., Ohishi, N., Imaoka, S., Yabusaki, Y., Fukui, H., Funae, Y. (February 1995). "Mepyramine, a histamine H1 receptor antagonist, inhibits the metabolic activity of rat and human P450 2D forms". The Journal of Pharmacology and Experimental Therapeutics. 272 (2): 939–944. ISSN0022-3565.
↑Jacqz-Aigrain, E., Cresteil, T. (1992). "Cytochrome P450-dependent metabolism of dextromethorphan: fetal and adult studies". Developmental Pharmacology and Therapeutics. 18 (3–4): 161–168. ISSN0379-8305.
