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Medicines > classes : Classic Psychedelic or Dissociative or [[:Category:Barbiturates|Barbiturate (parent compound)]]

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generic:
brand:
None (86) · Delysid (historical, Sandoz, withdrawn 1965) (1) · DXM (1) · DXO (1) · Mysoline (1) · Spravato (1)
classes: (Click arrow to add another value)
mechanism:
5-HT2A agonist (26) · Potent 5-HT2A agonist (5) · LSD analogue; 5-HT2A agonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · NMDA antagonist (3) · Contains LSA (2) · Contains mescaline (2) · NMDA antagonist; sigma receptor agonist (2)
uses:
None (89) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-00000015-QINU`"', '"`UNIQ--vote-00000016-QINU`"' (1)
starting dose:
None (89) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · Seizures: 100-125 mg PO at bedtime x 3 days, then BID, then TID, escalating to 750-1500 mg/day. Essential tremor: 25-50 mg PO at bedtime, titrate slowly to 250-750 mg/day (1)
preparations:
None (89) · 28 mg/device (each dose uses 2 devices) (1) · Tablets 50, 250 mg (1)
fda max:
None (89) · 2 g/day (seizures); typically much lower for essential tremor (1) · 84 mg per session (1)
routes:
None (88) · Intranasal (under direct medical supervision) (1) · Oral (2)
onset:
None (88) · 30–60 minutes (1) · Anticonvulsant effect emerges with slow titration over weeks; tremor effect over weeks (1) · Within hours of first administration (1)
duration:
None (88) · 8–12 hours (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1) · BID-TID dosing (1)
halflife:
None (88) · 3–5 hours (1) · Primidone 5-15 hours; '''phenobarbital active metabolite 50-150 hours'''; PEMA (phenylethylmalonamide) active metabolite 16 hours'"`UNIQ--ref-00000017-QINU`"' (1) · ~7-12 hours (1)
bioavailability:
None (88) · 70–90% (oral) (1) · ~48% intranasal (1) · ~90% (oral)'"`UNIQ--ref-00000018-QINU`"' (1)
pregnancy:
None (88) · Avoid; may cause fetal harm (1) · Not established (1) · Substantial teratogenic signal (barbiturate class effects including neonatal withdrawal and hemorrhagic disease of newborn).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (88) · Rx, Schedule III (US). REMS program required. (1) · Schedule I (United States) (1) · [[USLegal:Prescription only|Rx-only]] in US. '''Federally non-controlled despite being a barbiturate''', a paradoxical situation given that its primary active metabolite phenobarbital is Schedule IV'"`UNIQ--ref-00000019-QINU`"' (1)

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