If my proposed modified version doesn't seem reliable because of lack of information or evidence or perhaps if it turns out to be a bit too painful how about something similar. By similar I mean as try to work with the heart or cardiac, here we try to use a modified version of
DDMP without the morphine (which is the hard to acquire drug for most) and add-in some other drugs.
According to
DDMP wiki:
- Diazepam 1G
- Digoxin 50mg
- Morphine 15G
- Propranolol 2G
As with all cocktails, it should be used with an antiemetic regimen.
My idea is to remove Morphine altogether unless someone can suggest an easy-to-acquire alternative. Replace Diazepam with Midazolam simply because it is my understanding that Midazolam is more potent. Add increase the amount of Midazolam to 1.5g+ to 2g or higher (simply because more is better?) and again if anyone knows of a reason why Midazolam be used or increased amount I'm suggesting, please do share.
Now add-in
- Digoxin 50mg (should be increased I think)
- Propranolol 2G (same)
Not sure but perhaps the Propranolol & Digoxin dosage can be increased a little bit in proper proportion too to increase success chance maybe. Why? If you research Propranolol OD, there are reports of people surviving at a higher dose, even at dosage of 5g+ or even 10g, not sure how that happens how well, some people survives. And while I do think that those who survive higher dosage of Propranolol , there is more to the story than just the higher dose but for all I know is that it didn't work and I don't have the medical expertise required to even remotely understand why or what exactly happened there.
Which is why I'm going with the cave man way ... more = better (unless someone suggests otherwise). However I'm still unsure what the increased dosage of Propranolol & Digoxin would be.
Also in ppeh, in terms of anti-emetics ... a stat dose of 20mg Meto and 2mg Haloperidol is suggested to be ingested 1hour prior to the actual DDMP/4-drug protocol mixture ingestion.
See here, the OP of the post shares their own thoughts and research regarding DDMP (original non-modified version).
Another couple of good reads:
https://sanctioned-suicide.net/thre...iac-arrest-or-heart-attack.16304/#post-310451
However, in this post an user suggested the following:
Dunno if this will work..LD50 of propranolol is 660 mg per kilo, so pretty large. And the DDMP cocktail works mostly because of morphine and only on those with no tolerance.
I tried to look for evidence that proves the suggested claim. I was unable to find any such evidence, even anecdotal ones. I tried looking more into how the 4 drug lethal protocol works and nothing.
Looked into the LD50 of propol and came up with the following:
Unfortunately no human LD50 data.
Another:
https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@rn+318-98-9
/HUMAN EXPOSURE STUDIES/ Limited information is available on the acute toxicity of propranolol. In adults who intentionally ingested the drug, estimates of the ingested doses have ranged from 0.8-6 g. The principal manifestations of overdosage were bradycardia and severe hypotension (which may result in peripheral cyanosis); loss of consciousness and seizures have also occurred. Cardiac failure and bronchospasm may also occur. In most cases of acute propranolol overdosage, the patient recovered; however, in a few cases, toxicity was severe enough to result in death.
I personally feel like this specific one be taken as rather incomplete because it doesn't state the actual numbers or any specifics as to what amount of drug was taken, their age and/or physical condition and/or other relevant facts which may play a role in this, if they took any other drugs, how long before they were found, in what state etc and more.
More:
individual variations which may be due to an
underlying cardiac disease, to the ingestion
of other cardiotoxic drugs and to variations
in first-pass metabolism.
The toxic dose is about 1 g. In 104 cases
reported in literature the mean toxic (but
non lethal) dose was 1.75 g (Gross 1991)
although survival has been reported after
ingestion of 5 to 8 g (Lagerfeldt & Matell,
1982; Tynan et al., 1981). Khan & Miller
(1985) reported survival of a 28-year-old man
following ingestion of 3 g.
The minimal lethal dose reported was 1.6 g in
a 57-year-old man (Auzepy et al., 1983). The
mean lethal dose in 17 cases reported in the
literature was 5.85 g although there is wide
interindividual variation (Gross,
1991).
Here:
https://www.ncbi.nlm.nih.gov/pubmed/28691951
Suicidal intoxication from massive propranolol ingestion is rare. Surprisingly, no reported cases have involved physicians. The author herein reports a case of self-poisoning death due to ingestion of propranolol by a young male physician. A 31-year-old man with major depressive disorder was found dead in his dormitory room. Fifteen empty packages, each having contained ten 40-mg propranolol tablets, were found without any tablets leftover in his room. A suicide note was also found in his room. He was thus alleged to have ingested 6 g of propranolol for self-poisoning. Autopsy findings revealed approximately 150 mL of pink fluid with some partially dissolved pink tablets in the stomach. No anatomic cause of death was found, except for mild dilatation of cerebral ventricles. Toxicologic analysis revealed propranolol in his blood and gastric contents. The cause of death was attributed to acute cardiac arrest due to severe acute propranolol intoxication from self-poisoning caused by major depressive disorder possibly secondary to organic brain syndrome.
The person took 15 strips of 10 40mg tablets, which is 6g and they managed to ctb.
Also found a number of case reports where the person managed to CTB with Propranolol OD but non of them mentions important details such as how much they took, how long it took from ingestion to time of ctb.
This thread discusses the Propranolol OD.
In the thread here, an user suggests the following:
For a life-threatening drop in blood pressure: Propranolol+Verapamil or maybe Viagra+Nitroglycerin.
Later on a different post made by another user sort of verifies the previous suggestion of "Propranolol+Verapamil" being a potent combination.
From what I've read so far, personally I think if going with the Propranolol as the drug of choice, then going for rather high dose of 8g+ Would be optimal(could be over the top, yes but might just result in a success and provided there has been reports of failiure at 6g doase, I chose 8g). And yes probably an increased dose of anti-emetic to along with it..
https://www.jems.com/articles/2006/02/calcium-channel-blocker-overdo.html
Finally, much later the same day at 1530, the patient arrested again and could not be resuscitated. She expired nearly two full days after her ingestion.
Please read the report above. From what I understand, the reason it took 2 days is quite likely because obviously she wasn't alone but more importantly because the SR or Slow release drug. Oh and how many Propranolol did she take? I couldn't find it or maybe I'm just tired.
https://journals.sagepub.com/doi/abs/10.1177/0885066607307528?journalCode=jica&
A 15-year-old girl presented in cardiogenic shock after alcohol consumption and a propranolol and verapamil overdose; plasma concentrations: propranolol, 0.53 m/mL; verapamil, 1.06 mg/mL. She was successfully resuscitated with extracorporeal life support.
How much(in mg or number of pills) is "
propranolol, 0.53 m/mL; verapamil, 1.06 mg/mL " ?
Wondering if I were to choose a combination of Propranolol+Verapamil, what would be considered an ideal amount with a possiblity of high success rate with this drug combo?
On a different note: the
wiki page suggests that bioavailability of Propranolol is 26% , does it means 74% of the ingested amount doesn't exactly come in play? Asking specifically about Propranolol bioavailability.
