[Solved] Psilocybin with insulin, Forxiga, Levemir, metformin, Mounjaro, Ascal, Brintellix, lorazepam, pantoprazole, methotrexate and rosuvastatin

Let’s look at the possible interactions for each medication:

Insulin with psilocybin: There are no known direct interactions. However, it is important to be alert to hypoglycaemia or hyperglycaemia during the session, as appetite, food intake and physical activity may change.

Forxiga (dapagliflozin) with psilocybin: No known direct interactions. Do ensure you drink enough fluids, as Forxiga increases the excretion of glucose in the urine and may therefore lead to dehydration.

Levemir (insulin detemir) with psilocybin: No known direct interactions. The same precautions apply as with other forms of insulin use, including monitoring blood glucose levels.

Metformin with psilocybin: No known direct interaction. Metformin does not usually cause hypoglycaemia on its own.

Mounjaro (tirzepatide) with psilocybin: No known direct interaction. Due to the delayed gastric emptying that Mounjaro may cause, the absorption of psilocybin may take place slightly later. Nausea and gastrointestinal symptoms may also be more pronounced.

Ascal (acetylsalicylic acid) with psilocybin: No known direct interaction. Psilocybin may temporarily raise blood pressure and heart rate during the session, but this is unrelated to the use of Ascal.

Brintellix (vortioxetine) with psilocybin: Brintellix may reduce the effects of psilocybin. The risk of serotonin syndrome is sometimes mentioned, but there are hardly any well-documented cases of this occurring with this combination. Any changes to medication should always be made in consultation with the treating doctor.

Lorazepam with psilocybin: Lorazepam can significantly reduce the effects of psilocybin. In some people, this effect is reduced if lorazepam is not taken for a few days prior to the session. However, medication should only be adjusted in consultation with the prescribing doctor.

Pantoprazole with psilocybin: No clinically relevant interactions are known.

Methotrexate with psilocybin: There is little research available on this combination. Based on current knowledge, no direct interactions are expected.

Rosuvastatin with psilocybin: No known direct interaction. This combination is generally considered safe.

Finally

There is usually a good reason for such a list of medications. Although no direct interactions with psilocybin are known for most of the drugs listed, the presence of multiple medications often indicates underlying health conditions that may well be relevant to a psychedelic session.

It is therefore advisable, when carrying out a comprehensive safety assessment, not only to consider the individual interactions, but also to discuss with your treating doctor – for example, a general practitioner or a diabetologist – whether a session is appropriate given your overall health situation.

In particular, discuss any cardiovascular conditions, diabetes management, kidney function and other relevant medical factors. Psilocybin usually causes a temporary rise in blood pressure and heart rate during the acute phase of the experience. In healthy individuals, this usually does not cause any problems, but in cases of existing cardiovascular conditions, an individual assessment may be advisable.

The current scientific literature provides no evidence that psilocybin, at typical doses, causes any significant damage to the liver or kidneys. Nevertheless, a medical assessment is still recommended if a person has multiple chronic conditions or is taking various medicines.

Marcel has summed it up well. What I’d like to add to that is this: taking so many medicines at the same time is, in itself, a reason to be extra careful, quite apart from any individual interactions. It’s the overall picture that counts.

With regard to Brintellix (vortioxetine) specifically, it is worth noting that this medicine acts on the serotonin system, just like psilocybin. The risk of serotonin syndrome with this combination appears to be low and there are few well-documented cases, but it is something you should discuss seriously with your doctor before making any decisions.

If you’re taking lorazepam, there’s a high chance that the session will be much less effective or may even have hardly any effect at all. Benzodiazepines significantly dampen the effects of psilocybin. That doesn’t mean it’s dangerous, but it does mean that the likelihood of having a meaningful experience is reduced.

Marcel’s point about the rise in blood pressure during the acute phase is also important. Given a list of medications that suggests diabetes and possible cardiovascular problems, this is definitely something you should discuss thoroughly in advance with a doctor who is familiar with your situation.