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Drilldown: Medicines

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Medicines > classes : Dissociative or Research material or [[:Category:NSAIDs|NSAID (aspirin)]]

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generic:
brand:
None (137) · (none, never marketed) (1) · DXM (1) · DXO (1) · Fiorinal; with codeine as Fiorinal with Codeine (Schedule III) (1) · O-DSMT (1) · Percodan (1) · Spravato (1)
classes: (Click arrow to add another value)
mechanism:
5-HT2A agonist (26) · Monoamine releasing agent (9) · GABAA positive allosteric modulator (8) · CB1/CB2 agonist (7) · Dopamine/norepinephrine reuptake inhibitor (5) · Potent 5-HT2A agonist (5) · LSD analogue; 5-HT2A agonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · NMDA antagonist (3) · Serotonin/norepinephrine/dopamine releasing agent (3) · None (2) · Cathinone analogue; monoamine reuptake inhibitor (2) · Dopamine and norepinephrine reuptake inhibitor (2) · NMDA antagonist; sigma receptor agonist (2) · Prodrug of GHB (2)
uses:
None (140) · No approved medical problem. Encountered as a designer/research benzodiazepine and, increasingly, as an adulterant in illicit opioid supplies. (1) · 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-000014F9-QINU`"' (1) · '"`UNIQ--vote-000015B6-QINU`"' (1)
starting dose:
None (140) · 1 tablet (4.8355 mg oxycodone / 325 mg aspirin) PO every 6 hours as needed (1) · 1-2 capsules (50 mg butalbital / 325 mg aspirin / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d (1) · 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) · No medical dose. Active recreational doses reported in the 0.5–1.5 mg range (similar potency to alprazolam). (1)
preparations:
None (140) · 28 mg/device (each dose uses 2 devices) (1) · 4.8355 mg oxycodone / 325 mg aspirin tablets (1) · 50/325/40 mg capsules (1) · Illicit tablets ("bars"), powders, blotter, occasionally solutions. No pharmaceutical product exists. (1)
fda max:
None (140) · 6 capsules/d (300 mg butalbital, 1950 mg aspirin, 240 mg caffeine) (1) · 84 mg per session (1) · Aspirin GI/bleeding-limited; oxycodone titrated to effect (1) · N/A (never approved) (1)
routes:
None (140) · Intranasal (under direct medical supervision) (1) · intranasal; rectal and IV reported. (1) · Oral (3) · sublingual (1)
onset:
None (140) · 15-30 minutes (1) · 30-60 minutes (1) · Within hours of first administration (1) · ~20–40 min PO; faster sublingual/intranasal. (1)
duration:
None (140) · 4-6 hours (2) · 6–10 h subjective; full pharmacologic effect considerably longer. (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1)
halflife:
None (140) · Butalbital ~35 hours; aspirin (acetyl group) ~15 minutes, salicylate 2-3 hours; caffeine 3-7 hours'"`UNIQ--ref-000015B7-QINU`"' (1) · Estimated ~12–17 h (some sources cite up to ~21 h); active metabolites prolong effect. (1) · Oxycodone 3-5 hours; aspirin (acetyl group) 15-20 minutes, salicylate 2-3 hours at therapeutic doses'"`UNIQ--ref-000014FA-QINU`"' (1) · ~7-12 hours (1)
bioavailability:
None (140) · Butalbital well-absorbed; aspirin 50-75%; caffeine ~100%'"`UNIQ--ref-000015B8-QINU`"' (1) · Not formally characterized in humans. (1) · Oxycodone 60-87%; aspirin 50-75%'"`UNIQ--ref-000014FB-QINU`"' (1) · ~48% intranasal (1)
pregnancy:
None (140) · Avoid. Benzodiazepines are associated with neonatal sedation, floppy-infant syndrome, and withdrawal; teratogenic signal weak but non-zero. Designer benzo with no safety data, assume worst-case. (1) · Avoid; aspirin teratogenicity concerns plus opioid neonatal withdrawal.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Avoid; may cause fetal harm (1) · Avoided; barbiturate + aspirin teratogenicity and bleeding concerns.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (141) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Schedule III|Schedule III controlled substance]] in US (Fiorinal is scheduled federally; Fioricet with acetaminophen is unscheduled federally despite identical butalbital content, a regulatory quirk) (1) · [[USLegal:Schedule II|Schedule II controlled substance]] in US (1)

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