Chemsex
Fact sheet 10 – Frequent interactions in a chemsex context: safety guidelines
Reading time: 2 minutes
Reading time: 2 minutes
Dr Edouard Bougueret
•
Chemsex Fact Sheet
Dr Edouard Bougueret
•
Chemsex Fact Sheet
PDE5-i, poppers, GHB, stimulants: this summary sheet helps structure a harm reduction discourse during consultations, without dramatization, using concrete references and warning signals.
1) General principles (to be communicated to patients)
In chemsex, the risk often comes from mixtures + duration (fatigue, dehydration, redosing).
Avoid stacking depressants (GHB/GBL + alcohol/benzodiazepines/opioids/ketamine): this is where loss of consciousness and respiratory distress occur.
Buddy system : if possible, do not consume alone; do "check-ins" with each other.
In case of ARV/PrEP/psychiatric treatments: think about interactions (CYP, sedation, QT, etc.) and check a dedicated resource.
2) Frequent interactions: reference table (HR)
Combination (frequent) | Why it is a problem | Main risks | HR reference (useful phrases) |
|---|---|---|---|
PDE5-i (sildenafil/tadalafil) + poppers (nitrites) | Addition of vasodilatory effects → | faintness, syncope, palpitations, chest pain | “One or the other, never both.” Delay without poppers: sildenafil 24 h, tadalafil 48 h. |
GHB/GBL + alcohol | Increased respiratory depression and sedation | loss of consciousness, vomiting + inhalation, respiratory arrest | “GHB = zero alcohol.” |
GHB/GBL + benzodiazepines / opioids | Summation of CNS depressants | coma, respiratory distress | “No benzos/opioids with G.” |
GHB/GBL + ketamine | Sedation + coordination disorders + confusion | falls, amnesia, coma | “Avoid the G + K duo.” |
Stimulants (meth/cocaine/cathinones) | Cardiovascular load + hyperthermia + agitation | tachycardia, hypertension, chest pain, anxiety attack, overheating | “Avoid stacking stimulants.” |
Stimulants + GHB/GBL | Alternating “up/down” → redoses and loss of bearings | GHB overdose, confusion, risky behaviors | “G to 'come down' is a redosing trap.” |
Cathinones/MDMA + serotonergic antidepressants (SSRIs/SNRIs) / MAOIs | Risk of serotonin syndrome | agitation, tremors, hyperthermia, confusion | “If symptoms (fever, stiffness, confusion) = emergency.” |
Boosted ARVs (ritonavir/cobicistat) | Enzymatic inhibition | exaggerated effects, hypotension, faintness, overdose | Check systematically. Example: with ritonavir, sildenafil must be strongly reduced (Liverpool guidelines). |
Practical note (consultation) :
if the patient does not know the exact molecules (e.g., “poppers”, “3-MMC”, “crystal”), start from the effects (stimulant vs. depressant) and mixtures.
3) Warning signals: when it is URGENT (15 / 112)
Drowsiness impossible to wake from, slow/irregular breathing, bluish lips
Convulsions
Chest pain, severe faintness, palpitations + faintness
Hyperthermia, confusion, extreme agitation (risk of heat stroke / serotonin syndrome)
Suicidal thoughts, delirium, threatening hallucinations
4) Mini-script: “interaction” questions
“What is planned this weekend: stimulants, G, poppers, others?”
“Are you taking medication? (ARV/PrEP, anxiolytics, antidepressants, ADHD, beta-blockers…)”
“Is there any G + alcohol or G + benzos involved?”
“Poppers + erection pills?”
“Have you ever had a blackout / fainted?”
“Will you be with someone who can check / call if needed?”
5) “Reflex” resource (professionals)
ARV ↔ substance / PDE5-i interaction: Liverpool HIV Drug Interactions (to check) Liverpool HIV Interactions
Prevention messages for the general public on ARVs and recreational drugs (useful for psychoeducation) aidsmap.com
PDE5-i, poppers, GHB, stimulants: this summary sheet helps structure a harm reduction discourse during consultations, without dramatization, using concrete references and warning signals.
1) General principles (to be communicated to patients)
In chemsex, the risk often comes from mixtures + duration (fatigue, dehydration, redosing).
Avoid stacking depressants (GHB/GBL + alcohol/benzodiazepines/opioids/ketamine): this is where loss of consciousness and respiratory distress occur.
Buddy system : if possible, do not consume alone; do "check-ins" with each other.
In case of ARV/PrEP/psychiatric treatments: think about interactions (CYP, sedation, QT, etc.) and check a dedicated resource.
2) Frequent interactions: reference table (HR)
Combination (frequent) | Why it is a problem | Main risks | HR reference (useful phrases) |
|---|---|---|---|
PDE5-i (sildenafil/tadalafil) + poppers (nitrites) | Addition of vasodilatory effects → | faintness, syncope, palpitations, chest pain | “One or the other, never both.” Delay without poppers: sildenafil 24 h, tadalafil 48 h. |
GHB/GBL + alcohol | Increased respiratory depression and sedation | loss of consciousness, vomiting + inhalation, respiratory arrest | “GHB = zero alcohol.” |
GHB/GBL + benzodiazepines / opioids | Summation of CNS depressants | coma, respiratory distress | “No benzos/opioids with G.” |
GHB/GBL + ketamine | Sedation + coordination disorders + confusion | falls, amnesia, coma | “Avoid the G + K duo.” |
Stimulants (meth/cocaine/cathinones) | Cardiovascular load + hyperthermia + agitation | tachycardia, hypertension, chest pain, anxiety attack, overheating | “Avoid stacking stimulants.” |
Stimulants + GHB/GBL | Alternating “up/down” → redoses and loss of bearings | GHB overdose, confusion, risky behaviors | “G to 'come down' is a redosing trap.” |
Cathinones/MDMA + serotonergic antidepressants (SSRIs/SNRIs) / MAOIs | Risk of serotonin syndrome | agitation, tremors, hyperthermia, confusion | “If symptoms (fever, stiffness, confusion) = emergency.” |
Boosted ARVs (ritonavir/cobicistat) | Enzymatic inhibition | exaggerated effects, hypotension, faintness, overdose | Check systematically. Example: with ritonavir, sildenafil must be strongly reduced (Liverpool guidelines). |
Practical note (consultation) :
if the patient does not know the exact molecules (e.g., “poppers”, “3-MMC”, “crystal”), start from the effects (stimulant vs. depressant) and mixtures.
3) Warning signals: when it is URGENT (15 / 112)
Drowsiness impossible to wake from, slow/irregular breathing, bluish lips
Convulsions
Chest pain, severe faintness, palpitations + faintness
Hyperthermia, confusion, extreme agitation (risk of heat stroke / serotonin syndrome)
Suicidal thoughts, delirium, threatening hallucinations
4) Mini-script: “interaction” questions
“What is planned this weekend: stimulants, G, poppers, others?”
“Are you taking medication? (ARV/PrEP, anxiolytics, antidepressants, ADHD, beta-blockers…)”
“Is there any G + alcohol or G + benzos involved?”
“Poppers + erection pills?”
“Have you ever had a blackout / fainted?”
“Will you be with someone who can check / call if needed?”
5) “Reflex” resource (professionals)
ARV ↔ substance / PDE5-i interaction: Liverpool HIV Drug Interactions (to check) Liverpool HIV Interactions
Prevention messages for the general public on ARVs and recreational drugs (useful for psychoeducation) aidsmap.com
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