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lysergic acid diethylamide (LSD, Lysergide, Lysergamid)

Indications: - a recreational drug (no approved medical use) Dosage: - doses as low as 20-25 ug can produce effects - dose of 0.5-2 ug/kg can result in adverse effect [4] Clinical manifestations: 1) effects vary with both the user & the environment 2) euphoria 3) hallucinations 4) synesthesias Pharmacokinetics: - onset of psychological effects occurs 30-60 minutes after ingestion - peak effects in ~5 hours - effects last ~12 hours Adverse effects: 1) mydriasis 2) tachycardia 3) tremor 4) weakness 5) paresthesias 6) labile mood 7) hypothermia 8) hypoglycemia [4] 7) recurrent (flashback) hallucinations 8) delayed occurrence of: a) hysterical behavior b) hyperactivity c) hyperthermia d) psychotic reactions Laboratory: 1) specimen: a) plasma b) urine (random); store at 8 degrees C 2) methods: a) plasma: RIA b) urine: GC-MS -> 1-50 ng/mL in urine after hallucinogenic dose 3) labs with Loincs - lysergate diethylamide in specimen - lysergate diethylamide in gastric fluid - lysergate diethylamide in hair - lysergate diethylamide in meconium - lysergate diethylamide in serum/plasma - lysergate diethylamide in urine Drug interactions: - LSD in combination with serotonin precursors or serotonin agonists, serotonin-release stimulators, SSRIs, nonselective serotonin-reuptake inhibitors, or nonspecific inhibitors of 5-HT metabolism may result in serotonin syndrome - patients taking SSRIs or lithium carbonate have greater risk for seizures & flashbacks [4] Mechanism of action: - action at multiple sites within CNS via 5-HT2A receptor [3] Management: - management of intoxication - supportive therapy: IV fluids, benzodiazepine [6]

Interactions

drug interactions

Related

hallucination synesthesia

General

ergot alkaloid

Properties

MISC-INFO: 1/2life 3.5-4 HOURS therapeutic-range 5-9 NG/ML protein-binding 90%

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill pg 941
  2. Clinical Guide to Laboratory Tests, NW Tietz (ed) 3rd ed, WB Saunders, Philadelpha 1995
  3. Preller KH, Herdener M, Pokorny T et al The Fabric of Meaning and Subjective Effects in LSD-Induced States Depend on Serotonin 2A Receptor Activation. Current Biology Jan 2017 PMID: 28132813 http://www.cell.com/current-biology/fulltext/S0960-9822(16)31510-X
  4. Sinert RO Fast Five Quiz: Psilocybin and Other Hallucinogenic Drugs. Medscape. September 07, 2021 https://reference.medscape.com/viewarticle/957547
  5. Rega PP, Thornton SL LSD Toxicity Medscape. Jan 4, 2019 https://emedicine.medscape.com/article/1011615-overview#showall
  6. NEJM Knowledge+ Psychiatry