Suicide/Toxification/Antiemetic regimen

An antiemetic regimen is used to prevent vomiting up one's suicide drug cocktail. Taking drugs in overdose often causes vomiting (i.e. emesis). To throw up a drug cocktail is obviously a bad thing and can render the cocktail inefficient. To prevent this from happening, you need to take antiemetics beforehand, which are pharmaceutical drugs that prevent vomiting. OTC drugs used to treat motion sickness, such as Dramamine and Gravol, are not suitable for preventing emesis that is caused by drug overdose. A dopamine blocker is ideal.

In‐depth discussion of antiemetics

Mechanisms that trigger vomiting and why motion sickness pills will not work

Our body has several distinct mechanisms that trigger vomiting. This means that there is no universal antiemetic, no drug that would prevent vomiting irrespective of the cause. Each antiemetic drug targets a specific vomiting mechanism and is only effective for some cause. For example, medicines used to prevent motion sickness will not work to stop nausea caused by general anaesthesia, and vice versa.

• Most over-the-counter (OTC) antiemetics are usually used for travel sickness. Examples of such a drug is dimenhydrinate (Dramamine, Gravol). They work through the histaminic receptors and the cholinergic receptors, thus they would not be suitable for drug-induced vomiting, which is triggered through other neurotransmitters.
• Another class of antiemetics that would only be slightly efficient for drug-induced vomiting are those which are used for post-surgery emesis and chemotherapy-induced emesis. Those are the class of drugs which inhibit the 5-HT receptors (serotonin blockers and drugs which work through the vagus nerve). To some extent, those drugs can lower the drug-induced vomiting, but it would not be the antiemetic of choice for this purpose, since serotonin is not the main neurotransmitter for triggering the brain's vomiting centre when a drug overdose is ingested. Dopamine is the main neurotransmitter for that.
• The third class of antiemetics is the one that would be suitable for our purpose. Those are the class of dopamine blockers, and therefore they would work best for inhibiting drug-induced vomiting.

Dopamine blockers: the antiemetics of choice for drug overdoses

There are three well known dopamine blockers that would serve our purpose well:

• Template:Interwiki (Compazine)
• Template:Interwiki (Reglan)
• Template:Interwiki (Motilium)

Comparison between prochlorperazine, metoclopramide and domperidone

If we sort these three widespread dopamine blockers by their potency, then it will look like this:

• 1. Prochlorperazine (Compazine) - this is the most potent dopamine blocker
• 2. Metoclopramide (Reglan)
• 3. Domperidone (Motilium) - this is the least potent dopamine blocker

So, on one hand, Compazine can be considered as the premier choice. However, it being the strongest dopamine blocker means that the likelihood to experience EPS would be extremely high (and EPS would cause you to abort your suicide attempt), thus the risks outweigh the protection that you get.

The same goes for metoclopramide, though it is considered a milder dopamine blocker than Compazine, plus also it possesses some prokinetic properties (which Compazine does not possess). The latter means that metoclopramide would also speed up the rate of gastric emptying, which ultimately means that even if you do vomit, your stomach will be empty (so there is nothing to vomit), since its contents will have passed to the intestine by the time you start to vomit. In any case, we believe that metoclopramide is preferred to Compazine.

The last dopamine blocker is domperidone (Motilium), which is the mildest dopamine blocker out of all three. Its advantage is that it does not readily cross the blood-brain barrier, therefore there are no case reports of people experiencing EPS when using this drug. Also, domperidone is considered to be a potent enough antiemetic for our purpose, and thus we believe that it is the best antiemetic choice for drug cocktails.

At least one study comparing the efficiency of metoclopramide (Reglan) and domperidone (Motilium) for chemotherapy-induced vomiting found domperidone to be as efficient as metoclopramide:

"In order to prevent vomiting induced by anti-cancer chemotherapy, the efficiency of domperidone has been compared to metoclopramide in a randomised trial. No difference has been observed between both emetic treatments."

Antiemetic options

General advice regarding antiemetics

Below we list several options for an antiemetic regimen. There is no right antiemetic; you may chose one based on availability of drugs or our analysis of risks.

No matter which option of the three mentioned below you decide to use, please apply a short and controlled test, just to confirm that you are not allergic to that specific antiemetic (e.g. Motilium, Reglan, etc.), and to avoid any unexpected side effects in your actual suicide attempt. The test should include no more than a 10 mg dose to see if you are somehow badly affected by this antiemetic. If so, you might want to test an alternative.

Option #1: Domperidone

This antiemetic regimen is taken from Dr. Admiraal's book Guide to a Humane Self-Chosen Death.

Starting at least 36 hours before ingestion of the drug cocktail, one should take:

Drug	Dosage
Template:Interwiki (Motilium)	10 mg every 7-8 hours, starting at least 36 hours before the cocktail.

The last 10 mg dose should be taken 45 minutes before the final ingestion. Do not exceed the suggested amount and do not cut down the suggested interval under any circumstances. Doing so would put you at risk for EPS (short for extrapyramidal symptoms).

In his book, Dr. Admiraal suggested this regimen as the second-best option. His drug of choice was metoclopramide. However, domperidone rates well for the following reasons:

• Domperidone has minimal side effects. Unlike other antiemetics from this category, domperidone does not cross the blood-brain barrier and has low risk of EPS.
• In studies, domperidone was proven to be as efficient as metoclopramide, at least for vomiting caused by chemotherapy.
• In Europe, domperidone is sold without prescription under the name Motilium. Its advertised use is to relieve symptoms of a bloated stomach.

Option #2: Metoclopramide

This antiemetic regimen is the preferred regimen from from Dr. Admiraal's book Guide to a Humane Self-Chosen Death.

Starting at least 36 hours before ingestion of the drug cocktail, one should take:

Drug	Dosage
Template:Interwiki (Degan, Maxeran, Maxolon, Primperan, Pylo, Reglan)	10 mg every 7-8 hours, starting at least 36 hours before the cocktail.

The last 10 mg dose should be taken 45 minutes before the final ingestion. Do not exceed the suggested amount and do not cut down the suggested interval under any circumstances. Doing so would put you at risk for EPS (short for extrapyramidal symptoms).

Note: The Swiss euthanasia organisation Dignitas uses one-time metoclopramide before Nembutal ingestion.

Option #3: Prochlorperazine and domperidone

Take the following only once, 45 minutes before ingestion of the drug cocktail:

Drug	Dosage
Template:Interwiki (Buccastem, Compazine, Phenotil, Stemetil)	10 mg
Template:Interwiki (Motilium, Motillium)	10 mg

Do not exceed the suggested amount and do not cut down the suggested interval under any circumstances. Doing so would put you at risk for EPS (short for extrapyramidal symptoms).

Vomiting and related matters

Effect of sedatives on vomiting

In all the drug cocktails described on this wiki, the sedatives should take effect in less than 10 minutes, which means that we need the protection of the antiemetics for merely the first minutes or so. This is because later, the sedatives depress the central nervous system, thus ultimately also depressing the vomiting centre in the brain, therefore preventing any chance for emesis to occur.

What to do if vomiting occurs, despite the antiemetic regimen?

See this quotation from The Peaceful Pill Handbook by Dr. Nitschke:

"If vomiting does occur, the individual should bring up (vomit up) as much of the drug from their stomach as they can and the attempt to end their life should be abandoned. Ipacec Syrup can be used to encourage vomiting. It may be advisable to have some on hand. Ipacec can be readily obtained from the local pharmacy."

EPS: risks, symptoms and dealing with it

All of the antiemetic drugs efficient for our purposes carry a risk for extrapyramidal symptoms (EPS). Because of the way these drugs work, they affect a part of the brain involved in the coordination of movement. EPS includes number of symptoms, including involuntary movements, tremors and rigidity, body restlessness, muscle contractions and changes in breathing and heart rate. If you wish, you can go to YouTube and see some videos that show what Template:Interwiki and Template:Interwiki (which are symptoms associated with EPS) look like; the disorders seen on the videos were not caused by the antiemetic drugs that we have discussed, but drug-induced EPS may take a similar form.

What to do if EPS happens to you:
Standard treatment for EPS is to take 50 mg of diphenhydramine (Benadryl, Dimedrol).

You are at higher risk for EPS if one of the following applies to you:

• Previous episodes of EPS in life or other motoric disorders;
• The prolonged use of neuroleptic drugs before, such as haloperidol;
• You are under 30 years old: people under that age tend to be more prone to EPS;
• You are a woman above the age of 50.