LSD (Acid)
LSD is a psychedelic that alters perception and consciousness for 8 to 12 hours. Relevant pharmacological interactions with modern antiretrovirals are not expected, although emotional and environmental context strongly shape the experience.
What is it?
LSD (lysergic acid diethylamide) is a psychedelic substance that changes perception, mood, thoughts, and sensations. Its effects usually last 8 to 12 hours. It should never be injected.
How is it used?
- Orally in very small doses
- Usually on blotter paper, tabs, or sugar cubes
- Also in liquid form (less common)
The dose on blotter paper varies a lot depending on the source, which makes it hard to know exactly how much has been taken.
How does it work?
LSD mainly acts on serotonin receptors (5-HT2A) in the brain, deeply changing sensory perception and consciousness. It may produce:
- Changes in visual, auditory, and tactile perception (synesthesia, hallucinations)
- Changes in thinking: intensified ideas, unusual connections
- Deep euphoria or well-being in positive experiences
- Intense introspection and emotional connection
- Distortion of time (hours may feel like minutes or the other way around)
- Effects lasting 8 to 12 hours
The experience is strongly shaped by set (mood and expectations) and setting (physical and social environment).
Interactions with antiretrovirals
LSD has a particular pharmacological profile: it is used in very small doses (micrograms) and its metabolism does not share the main enzyme pathways used by modern antiretrovirals.
No clinically relevant pharmacological interactions are expected between LSD and most current antiretrovirals.
No relevant known interactions with:
| Medicine | Interaction |
|---|---|
| Dolutegravir | No relevant interaction |
| Bictegravir | No relevant interaction |
| Cabotegravir | No relevant interaction |
| Raltegravir | No relevant interaction |
| Tenofovir | No relevant interaction |
| Emtricitabine | No relevant interaction |
| Lamivudine | No relevant interaction |
| Efavirenz | No relevant pharmacological interaction |
| Nevirapine | No relevant pharmacological interaction |
| Lenacapavir | No relevant interaction |
What may still be affected
It may INCREASE:
- Anxiety or paranoia in susceptible people: risk is shaped more by context, environment, and emotional state than by antiretroviral interactions
- Intense sensory effects when combined with other substances (stimulants, CNS depressants)
Efavirenz in particular may have nervous system effects (vivid dreams, anxiety, dizziness) that can intensify the anxious side of an LSD experience for some people.
Harm reduction
- Learn about the substance before using it
- Choose a safe and comfortable environment (setting strongly shapes the experience)
- Avoid combining with stimulants or CNS depressants
- Have a trusted sober companion who knows what to do if help is needed
- If it is your first time, start with low doses
- If discomfort or anxiety appears: breathe deeply, change environment, reduce stimulation, and ask a trusted person for support
- Do not make important decisions while under the effects
- Wait until you are in a stable emotional state before using
Warning signs
- Intense anxiety or panic attacks that do not improve
- Severe confusion or persistent disorientation
- Chest pain or palpitations
- Loss of contact with reality (not recognising people or surroundings)
- Dangerous behaviours toward yourself or others
When should you seek medical care?
- Anxiety or panic that does not improve with support and a change of setting
- Severe confusion or loss of consciousness
- Chest pain, trouble breathing, or seizures
- Risk to your life or someone else’s
At parties or events, seek the harm reduction teams if present.
What does the evidence say?
Current scientific literature does not document clinically significant pharmacological interactions between LSD and commonly used antiretrovirals. LSD doses are extremely small (25-200 micrograms), and its metabolism does not appear to compete with the main ART enzyme systems. The main risk with LSD is not related to HIV or ART, but to the psychological and environmental context of the experience. People with a history of psychotic episodes, bipolar disorder, or schizophrenia should be especially cautious.