Lysergic acid diethylamide, commonly known as LSD (from German Lysergsäurediethylamid) and by the nicknames acid and Lucy, is a semisynthetic psychedelic drug derived from ergot, known for its potent psychological effects. LSD taken orally has an onset of action of 0.4 to 1.0 hours and a duration of 7 to 12 hours. In recreational settings it is commonly administered via tabs of blotter paper. LSD is extremely potent, with noticeable effects at doses as low as 20 micrograms and is sometimes taken in even smaller amounts for microdosing. Despite widespread use, no fatal human overdoses have been documented. LSD is mainly used recreationally or for spiritual purposes. LSD can cause mystical experiences. LSD exerts its effects primarily through high-affinity binding to several serotonin receptors, especially the serotonin 5-HT2A receptor, and to a lesser extent dopamine and adrenergic receptors. Neuroimaging studies indicate that LSD reduces the efficacy of thalamo-cortical information filtering (producing sensory overload), decreases oscillatory power within the default mode network, and flattens hierarchical organization of large-brain activity. At higher doses, it can induce visual and auditory hallucinations, ego dissolution, and anxiety. LSD use can cause hallucinogen-induced psychotic disorder where paranoia and delusions persist beyond the initial effects of the drug. LSD may lead to persistent visual disturbances known as hallucinogen persisting perception disorder (HPPD). Swiss chemist Albert Hofmann first synthesized LSD in 1938 and discovered its potent psychedelic effects in 1943 after accidental ingestion. It became widely studied in the 1950s and 1960s. The drug was initially explored for psychiatric use due to its structural similarity to serotonin and safety profile. It was used experimentally in psychiatry for treating alcoholism and schizophrenia. By the mid-1960s, LSD became central to the youth counterculture in places like San Francisco and London, influencing art, music, and social movements through events like Acid Tests and figures such as Timothy Leary, Owsley Stanley and Michael Hollingshead. Its psychedelic effects inspired distinct visual art styles and musical innovations, and caused a lasting cultural impact. However, its association with the counterculture movement of the 1960s led to its classification as a Schedule I drug in the United States in 1970. It was also listed as a Schedule I controlled substance by the United Nations in 1971 and remains without approved medical uses. Despite its legal restrictions, LSD remains influential in scientific and cultural contexts. Research on LSD declined due to cultural controversies by the 1960s, but has resurged since 2009. In 2024, the United States Food and Drug Administration designated LSD (code name MM120 or DT120) as a breakthrough therapy for generalized anxiety disorder. As of 2017, about 10% of people in the United States had used LSD at some point, with 0.7% having used it in the past year. Usage rates have risen, with a 56.4% increase in adult use in the United States from 2015 to 2018.
Uses
Recreational LSD is commonly used as a recreational drug for its psychedelic effects.
Spiritual LSD can catalyze intense spiritual experiences and is thus considered an entheogen. Some users have reported out of body experiences. In 1966, Timothy Leary established the League for Spiritual Discovery with LSD as its sacrament. Stanislav Grof has written that religious and mystical experiences observed during LSD sessions appear similar to descriptions in sacred scriptures of great religions of the world and the texts of ancient civilizations.
Medical
LSD currently has no formally approved medical use anywhere in the world. In Switzerland, a special authorization program allows limited medical use of substances like LSD for patients with serious, treatment-resistant conditions, with patients treated under physician supervision.
Dosing
LSD is an extraordinarily potent substance, and is one of the most potent psychoactive drugs known. This means that it produces its pharmacological effects at very small doses, with its dose range measured in micrograms (μg); that is, millionths of a gram. Noticeable effects can occur with doses of LSD as low as 20 μg, which is around 1/200th the mass of a grain of sand. LSD is approximately 200 times as potent as psilocybin and 5,000 times as potent as mescaline, meaning that it produces effects of similar magnitude at 1/200 and 1/5,000 times the respective doses. The usual dose range of LSD for psychedelic effects is 20 to 200 μg. The typical intermediate and "good effect" dose for a psychedelic experience is 100 μg (range 75–150 μg, while 20 to 50 μg is a low or "minidose" and 200 μg is a high or ego-dissolution dose.) A dose range as wide as 10 to 450 μg has been reported. LSD may also be used in microdosing. In this context, it may be used at subthreshold or microdoses of less than 10 μg. The extremely high potency of LSD played an essential role in its emergence and popularity during the counterculture of the 1960s due to the economic feasibility of its manufacture, in contrast to the case of mescaline, which had been known for many decades previously but remained relatively little-known. The doses of LSD present in illicit LSD samples have decreased over time. In the mid-1960s, Owsley Stanley, the most important black market LSD manufacturer in the United States, distributed LSD at a standard concentration of 270 μg, while street samples of the 1970s contained 30 to 300 μg. By the 1980s, the amount had reduced to between 100 and 125 μg, dropping more in the 1990s to the 20 to 80 μg range, and even further in the 2000s.
Effects LSD produces a variety of physical, psychological, and sensory effects.
Psychological The primary immediate psychological effects of LSD are visual pseudo-hallucinations and altered thought, often referred to as "trips". These sensory alterations are considered pseudohallucinations because the subject does not perceive the patterns seen as being located in three-dimensional space outside the body. LSD is not considered addictive. An "afterglow" effect, characterized by an improved mood or perceived mental state, may persist for days or weeks following ingestion. Positive experiences, or "good trips", are described as intensely pleasurable and can include feelings of joy, euphoria, an increased appreciation for life, decreased anxiety, a sense of spiritual enlightenment, and a feeling of interconnectedness with the universe. Negative experiences, commonly known as "bad trips", can induce feelings of fear, agitation, anxiety, panic, and paranoia. While the occurrence of a bad trip is unpredictable, factors such as mood, surroundings, sleep, hydration, and social setting, collectively referred to as "set and setting", can influence the risk and are considered important in minimizing the likelihood of a negative experience. Uniquely among psychedelics, LSD appears to have two temporally and qualitatively distinct phases of psychoactive effects. These include an initial psychedelic phase associated with serotonin 5-HT2A receptor agonism and a subsequent paranoia- and psychosis-like phase associated with dopamine D2-like receptor agonism. Subsequent research has found that the delayed dopaminergic phase is associated with the highly potent dopamine D4 receptor agonism of LSD's metabolite 13-hydroxy-LSD. The first phase is described as a "psychedelic experience", with "meaningfulness and portentousness" as the primary effects, while the latter phase is "clearly a paranoid state", including feeling "at the least self-centered, and usually suspicious, with ideas of reference or even paranoid convictions". The second phase typically develops about 4 to 6 hours after administration but at times up to 10 hours after administration. Parallels have been drawn between this phase and amphetamine psychosis. There is no indication that similar effects occur with other psychedelics like phenethylamines and simple tryptamines, which lack dopamine receptor agonism. The preceding findings have been described by researchers like Daniel X. Freedman and David E. Nichols.
Sensory LSD induces an animated sensory experience affecting senses, emotions, memories, time, and awareness. The effects range from subtle perceptual changes to profound cognitive shifts. Alterations in auditory and visual perception are common. Users may experience enhanced visual phenomena, such as vibrant colors, objects appearing to morph, ripple, or move, and geometric patterns on various surfaces. Changes in the perception of food's texture and taste are also noted, sometimes leading to aversion towards certain foods. There are reports of inanimate objects appearing animated, with static objects seeming to move in additional spatial dimensions. The auditory effects of LSD may include echo-like distortions of sounds, and an intensified experience of music. Basic visual effects often resemble phosphenes and can be influenced by concentration, thoughts, emotions, or music. Higher doses can lead to more intense sensory perception alterations, including synesthesia, perception of additional dimensions, and temporary dissociation.
Physical
LSD can induce physical effects such as pupil dilation, decreased appetite, increased sweating, and wakefulness. The physical reactions to LSD vary greatly, and some may be a result of its psychological effects. Commonly observed symptoms include increased body temperature, blood sugar, and heart rate, as well as goose bumps, jaw clenching, dry mouth, and hyperreflexia. In cases of adverse reactions, users may experience numbness, weakness, nausea, and tremors.
Onset and duration The psychoactive effects of LSD last on average between 7 and 11 hours, with a possible range of 4 to 22 hours. Higher doses tend to lead to a longer duration of action. The onset of action when administered orally is 0.4 to 1.0 hours on average, with a possible range of 0.1 to 1.8 hours. The time to peak effects given orally is 2.2 to 2.8 hours on average, with a range of 1.3 to 6.5 hours. The duration of LSD can be shortened through the use of trip killers or shorteners like ketanserin. In a clinical trial, ketanserin given 1 hour after LSD shortened its duration from 8.5 hours to 3.5 hours or by about 60%.
Contraindications
Adverse effects
LSD, a classical psychedelic, is deemed physiologically safe at standard doses (50–200 μg), and its primary risks lie in psychological effects rather than physiological harm. A 2010 study by David Nutt ranked LSD as significantly less harmful than alcohol, placing it near the bottom of a list assessing the harm of 20 drugs.
Psychological effects LSD can induce panic attacks or extreme anxiety, colloquially termed a "bad trip". Despite lower rates of depression and substance abuse found in psychedelic drug users compared to controls, LSD presents a heightened a risk of hallucinogen-induced psychotic disorder for individuals with mental illnesses such as bipolar disorder or schizophrenia or who have a family history of those illnesses. It is common for people with pre-existing mental illness to be hospitalized for hallucinogen-induced psychotic disorder caused by LSD. LSD is also the main cause of hallucinogen persisting perception disorder (HPPD), where visual distortions persist beyond the initial effects of the drug.
Suggestibility While research from the 1960s indicated increased suggestibility under the influence of LSD among both mentally ill and healthy individuals, the CIA and US Department of Defense conducted secret mind control experiments in which LSD was administered to unwitting human subjects as part of secret operations MKUltra and Operation Midnight Climax.
Flashbacks
Flashbacks are psychological episodes where individuals re-experience some of LSD's subjective effects after the drug has worn off, persisting for days or months post-hallucinogen use. These experiences are associated with hallucinogen persisting perception disorder (HPPD), where flashbacks occur intermittently or chronically, causing distress or functional impairment. The etiology of flashbacks is varied. Some cases are attributed to somatic symptom disorder, where individuals fixate on normal somatic experiences previously unnoticed before drug consumption. Other instances are linked to associative reactions to contextual cues, similar to responses observed in individuals with past trauma or emotional experiences. The risk factors for flashbacks remain unclear, but pre-existing psychopathologies may be significant contributors. Estimating the prevalence of HPPD is challenging. It is considered rare, with occurrences ranging from 1 in 20 users experiencing the transient and less severe type 1 HPPD, to 1 in 50,000 for the more concerning type 2 HPPD. Contrary to internet rumors, LSD is not stored long-term in the spinal cord or other parts of the body. Pharmacological evidence indicates LSD has a half-life of 175 minutes and is metabolized into water-soluble compounds like 2-oxo-3-hydroxy-LSD, eliminated through urine without evidence of long-term storage. Clinical evidence also suggests that chronic use of SSRIs can potentiate LSD-induced flashbacks, even months after stopping LSD use.
Hallucinogen-induced psychotic disorder
LSD can rarely cause hallucinogen-induced psychotic disorder (HIPD), where after the drug has run its course, paranoia, delusions, hallucinations, or a reduced ability to communicate occur. A common presentation of hallucinogen-induced psychotic disorder is paranoia or severe anxiety days or weeks after LSD use. Hallucinogen-induced psychotic disorder is a medical emergency. It is also known under the more general term, substance-induced psychosis. The treatment for hallucinogen-induced psychotic disorder is atypical antipsychotics such as aripiprazole, quetiapine, or olanzapine, or risperidone. The condition occurs in fewer than 1% of people with psychedelics.
Suicide LSD has led to suicide weeks or months after ingestion. LSD was originally categorized as a schedule I controlled substance because of the suicide of Diane Linkletter 6 months after she took LSD. There are several case reports of suicidal reactions to LSD.
Tolerance LSD shows significant tachyphylaxis, with tolerance developing 24 hours after administration. The progression of tolerance at intervals shorter than 24 hours remains largely unknown. Tolerance typically resets to baseline after 3–4 days of abstinence. Significant cross-tolerance occurs between LSD, mescaline and psilocybin. A slight cross-tolerance to DMT is observed in humans highly tolerant to LSD. Tolerance to LSD also builds up with consistent use, and is believed to result from serotonin 5-HT2A receptor downregulation. Researchers believe that tolerance returns to baseline after two weeks of not using psychedelics.
Addiction and dependence liability LSD is widely considered to be non-addictive, despite its potential for abuse. Attempts to train laboratory animals to self-administer LSD have been largely unsuccessful. Although tolerance to LSD builds up rapidly, a withdrawal syndrome does not appear, suggesting that a potential syndrome does not necessarily relate to the possibility of acquiring rapid tolerance to a substance. A report examining substance use disorder for DSM-IV noted that almost no hallucinogens produced dependence, unlike psychoactive drugs of other classes such as stimulants and depressants.
Cancer and pregnancy The mutagenic potential of LSD is unclear. Overall, the evidence points to limited or no effect at commonly used doses. Studies showed no evidence of teratogenic or mutagenic effects.
Long-term effects
A potential risk of frequent repeated long-term use of LSD and other serotonergic psychedelics is cardiac fibrosis and valvulopathy due to serotonin 5-HT2B receptor agonism. This may also be the case with microdosing. However, the risks are theoretical, and more research is needed to see if these complications can actually occur with psychedelics. A preliminary animal study found that chronic microdosing of LSD did not result in heart structure changes or valvulopathy in rodents. Research appears to be mixed on whether LSD is a potent serotonin 5-HT2B receptor agonist or not, with some studies finding it to be essentially inactive.
Interactions
Some psychedelics, including LSD, are metabolized by the cytochrome P450 enzyme CYP2D6. Concurrent use of selective serotonin reuptake inhibitors (SSRIs), some of which are potent inhibitors of CYP2D6, with LSD might heighten the risk of serotonin syndrome. However, according to other researchers, there is no risk of serotonin syndrome combining psychedelics like LSD and psilocybin with SSRIs. Chronic usage of SSRIs, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) is believed to diminish the subjective effects of psychedelics, likely due to 5-HT2A receptor downregulation or desensitization induced by elevated serotonin levels. However, a clinical study found that administration of LSD to people taking paroxetine, an SSRI and strong CYP2D6 inhibitor, increased LSD exposure by about 1.5-fold, was well-tolerated, and did not modify the pleasant subjective effects or physiological effects of LSD, whereas negative effects of LSD, including "bad drug effect", anxiety, and nausea, were reduced. Similarly, a clinical study with LSD found that LSD levels were 75% higher in people with non-functional CYP2D6 (poor metabolizers) compared to those with functional CYP2D6. In contrast to certain other psychedelics, MAOIs do not inhibit the metabolism of or potentiate the effects of LSD and instead reduce its effects. Interactions between psychedelics and antipsychotics or anticonvulsants are not well-documented; however, co-use with mood stabilizers like lithium may induce seizures and dissociative effects, particularly in individuals with bipolar disorder. Lithium notably intensifies LSD reactions, potentially leading to acute comatose states when combined.
Overdose LSD at typical recreational doses (~50–250 μg) is considered to be very safe in terms of toxicity, with not a single toxicity-related death having been reported at such doses despite many millions of exposures. In addition, LSD is considered to be a relatively non-toxic drug in overdose. The highest dose of LSD evaluated in clinical trials in humans has been 800 μg (0.8 mg), or 8 times the typical recreational dose of 100 μg. However, other studies reported use of doses of up to 2,000 μg intramuscularly in some individuals, or more than 20 times the typical dose. It is estimated, based on animal studies and human case reports, that the lethal dose of LSD in humans is approximately 100 mg, or 1,000 times the typical dose. There have been a handful of reported cases of fatal overdose with LSD as of 2024. However, critical review of the literature by David E. Nichols found that of five identified cases, one was not consistent with the effects of LSD but instead may have been another drug like 25I-NBOMe; two involved normal doses of LSD in individuals who were placed in maximal physical restraint (hogtied) by police followed by presumed positional asphyxia and fatal cardiovascular collapse (hogtying being a practice that is associated with accidental death generally); and two were associated with massive LSD overdose involving doses of possibly more than 300 mg. Besides death due to toxicity, LSD is rarely associated with death via suicide, accidents, or violent encounters due to induction of abnormal behavior. In one well-known 1974 case series, 8 people accidentally insufflated two "lines" of nearly pure LSD powder that they thought were cocaine. The exact doses of LSD were unknown, but were considered to be massive. For context, a typical "line" of cocaine for insufflation is 50 to 100 mg. The individuals reported to the hospital within 10 to 15 minutes, with five of them comatose, three requiring intubation and mechanical ventilation, and the conscious individuals experiencing severe hallucinogenic effects, among other toxic symptoms. All of them completely recovered within 12 hours and there were no deaths. A subsequent 2020 case similarly involved accidental insufflation of a confirmed 55 mg dose of LSD instead of cocaine, which was without adverse health consequences. In other reports, a 5 mg overdose of LSD produced severe nausea and vomiting along with severe behavioral disturbances, while a 10 mg overdose was also non-fatal. Despite acting as non-selective serotonin receptor agonists, major psychedelics like LSD and psilocybin do not cause serotonin syndrome even with extreme overdose. This is thought to be because they act as partial agonists of serotonin receptors like the serotonin 5-HT2A receptor relative to serotonin itself. Conversely, NBOMe psychedelics like 25I-NBOMe are more efficacious and have been uniquely associated with serotonin syndrome-like toxicity. A 2018 retrospective analysis of 3,554 LSD-only exposures reported to poison control centers in the United States between 2000 and 2016 found that serious toxicity was infrequent. Common adverse effects (2.4–42%) included agitation or irritability, tachycardia, hallucinations or delusions, confusion, pupil dilation, hypertension, drowsiness or lethargy, elevated creatine phosphokinase (CPK), nausea and vomiting, and others. Selected serious adverse effects included fever or hyperthermia in 3.8%, single seizure in 2.4%, coma in 1.4%, elevated creatinine in 1.4%, multiple seizures in 1.2%, rhabdomyolysis in 1.1%, respiratory depression in 0.9%, cardiac conduction disorder in 0.5%, and status epilepticus in 0.4%. There is a case report of severe neurological sequelae following a single typical recreational dose of LSD involving seizure and cardiorespiratory arrest. In general, psychedelics like LSD may rarely cause seizures in some individuals. The median lethal dose (LD50) of LSD in animals varies and is 50 to 60 mg/kg in mice, 16.5 mg/kg in rats, and 0.3 mg/kg in rabbits all given by injection. A well-known 1962 instance of an elephant named Tusko given 297 mg (~0.1 mg/kg) LSD by intramuscular injection proved fatal. These findings suggest that elephants may be much more sensitive to LSD in overdose than humans and other species. However, this instance has been mired in criticism and controversy due to miscalculation of LSD dose and concomitant post-LSD administration of promazine and pentobarbital. The experiment was repeated in two elephants with similar doses of LSD in 1984 without incident. Massive doses of LSD are largely managed by symptomatic treatments, and agitation can be addressed with benzodiazepines. Reassurance in a calm, safe environment is beneficial. Antipsychotics such as haloperidol are not recommended as they may have adverse effects. Gastrointestinal decontamination with activated charcoal is of little use due to the rapid absorption of LSD, unless performed within 30 to 60 minutes of ingesting exceedingly huge amounts. Administration of anticoagulants, vasodilators, and sympatholytics may be useful for treating ergotism.
LSD substitute overdose Although LSD is relatively safe in overdose, 25-NB (NBOMe) psychedelics like 25I-NBOMe and 25B-NBOMe are often sold as "LSD" and are highly toxic in overdose, with many reported severe intoxications and deaths. Owing to their high potency analogous to LSD, these drugs are also regularly sold as "LSD" in blotter papers. Fatalities involved in NBOMe intoxication suggest that a significant number of individuals ingested the substance which they believed was LSD, and researchers report that "users familiar with LSD may have a false sense of security when ingesting NBOMe inadvertently". Researchers state that the alleged physiological toxicity of LSD is likely due to psychoactive substances other than LSD. NBOMe compounds are reported to have a bitter taste, are not active orally, and are usually taken sublingually. When NBOMes are administered sublingually, numbness of the tongue and mouth followed by a metallic chemical taste was observed, and researchers describe this physical side effect as one of the main discriminants between NBOMe compounds and LSD. Despite its high potency, recreational doses of LSD have only produced low incidents of acute toxicity, but NBOMe compounds have extremely different safety profiles. Testing with Ehrlich's reagent gives a positive result for LSD and a negative result for NBOMe compounds.
Pharmacology
Pharmacodynamics
LSD is a serotonergic psychedelic and acts as a non-selective serotonin receptor modulator. It binds with high affinity to most of the serotonin receptors. The psychedelic effects of LSD are thought to be mediated specifically by activation of the serotonin 5-HT2A receptor. However, the role of other serotonin receptors and targets in the effects of LSD cannot be ruled out and may be considered likely. Uniquely among serotonergic psychedelics, LSD also shows potentially significant affinity for the dopamine receptors, albeit much lower than for most of the serotonin receptors. LSD binds to most serotonin receptor subtypes except for the serotonin 5-HT3 and 5-HT4 receptors. However, some of these serotonin receptors may not be affected at typical brain concentrations of LSD. In humans, recreational doses of LSD may affect serotonin 5-HT1A, 5-HT2A, 5-HT2B, 5-HT2C, 5-HT5A, and 5-HT6 receptors. Although not present in humans, serotonin 5-HT5B receptors found in rodents also have high affinity for LSD. The psychedelic effects of LSD are attributed to activation of 5-HT2A receptors. Many but not all serotonin 5-HT2A receptor agonists are psychedelics, and serotonin 5-HT2A receptor antagonists block the psychedelic effects of LSD. The drug exhibits pronounced functional selectivity or biased agonism at the serotonin 5-HT2A and 5-HT2C receptors in that it activates the signal transduction enzyme phospholipase A2 (PLA2) instead of activating the enzyme phospholipase C (PLC) as the endogenous ligand serotonin does, among other differences. Exactly how LSD produces its effects is unknown, but it is thought that it may work in part by increasing glutamate release in the cerebral cortex and therefore excitation in this area, specifically in layer V. LSD, like many other drugs of recreational use, has been shown to activate DARPP-32-related pathways. The drug enhances dopamine D2 receptor protomer recognition and signaling of D2–5-HT2A heteromeric receptor complexes, which may contribute to its psychotropic effects. LSD has been shown to have low affinity for histamine H1 receptors, displaying antihistamine effects, although the significance of this at doses used in humans is unknown. David E. Nichols has suggested that there may be a pharmacological basis for some bad trips with LSD, with this thought to be related to LSD's metabolite 13-hydroxy-LSD, a highly potent dopamine D4 receptor agonist. LSD is a biased agonist that induces a conformation in serotonin 5-HT2 receptors that preferentially recruits β-arrestin over activating G proteins. It also has an exceptionally long residence time when bound to serotonin receptors lasting hours, consistent with the long-lasting effects of LSD despite its relatively rapid clearance. In rodents, LSD levels are undetectable by 8 hours post-dosing, yet LSD continues to produce partial interoceptive effects (54% responding) at this time point. A crystal structure of the serotonin 5-HT2B receptor bound to LSD reveals an extracellular loop that forms a "lid" over the diethylamide end of the binding cavity and "traps" LSD in the binding pocket, which explains the slow rate of LSD unbinding from serotonin receptors. The related lysergamide lysergic acid amide (LSA) that lacks the diethylamide moiety is far less potent in comparison. Moreover, a specific residue in the binding pocket is partially responsible for the prolonged action of LSD, and this residue is found in the human protein but not in the receptors of rodents. LSD is an extraordinarily potent psychoactive drug and is among the most potent psychedelics known in humans. The very high potency of LSD in producing psychedelic-like effects is also the case in animals, including rodents and monkeys. It is unclear why LSD is so potent. The affinity and activational potency of LSD at the human serotonin 5-HT2A receptor in vitro is unremarkable compared to other psychedelics such as DOI and DOB. There is no evidence for its greater potency being related to pharmacokinetics or metabolism. It appears that the N,N-diethylamide moiety of LSD fits into a sterically constrained region of the serotonin 5-HT2A receptor that specifically accommodates this moiety. LSD, like other psychedelics, has been found to increase the expression of genes related to synaptic plasticity and hence to have psychoplastogenic effects. This appears to be mediated by serotonin 5-HT2A receptor agonism. LSD has also been reported to act as a highly potent positive allosteric modulator of the tropomyosin receptor kinase B (TrkB), one of the receptors of brain-derived neurotrophic factor (BDNF). However, subsequent studies failed to reproduce these findings and instead found no interaction of LSD with TrkB. There appears to be no significant acute tolerance to the subjective effects of LSD. Hence, its duration appears to be dictated by pharmacokinetics rather than by pharmacodynamics. This is in contrast to MDMA, which shows marked acute tolerance and a duration of effects that is shorter than its elimination half-life. The cryo-EM structures of the serotonin 5-HT2A receptor with LSD, as well as with various other psychedelics and serotonin 5-HT2A receptor agonists, have been solved and published by Bryan L. Roth and colleagues.
Mechanisms of action
Neuroimaging studies using resting state fMRI recently suggested that LSD changes the cortical functional architecture. These modifications spatially overlap with the distribution of serotonergic receptors. In particular, increased connectivity and activity were observed in regions with high expression of 5-HT2A receptor, while a decrease in activity and connectivity was observed in cortical areas that are dense with 5-HT1A receptor. Experimental data suggest that subcortical structures, particularly the thalamus, play a synergistic role with the cerebral cortex in mediating the psychedelic experience. LSD, through its binding to cortical 5-HT2A receptors, may enhance excitatory neurotransmission along frontostriatal projections and, consequently, reduce thalamic filtering of sensory stimuli towards the cortex. This phenomenon appears to involve ventral, intralaminar, and pulvinar nuclei selectively.
Neurotoxicity
Chronic administration of LSD has been associated with long-lasting schizophrenia-like behavioral changes in rodents, which were not blocked by serotonin 5-HT2A receptor antagonism but may instead be related to LSD's dopamine D2-like receptor agonism. Single macrodoses of LSD do not produce such changes in rodents, but the preceding findings may have implications for continuous psychedelic microdosing with LSD. LSD, via activation of serotonin 5-HT2 receptors, has been found to potentiate MDMA-induced serotonergic neurotoxicity in rodents.
Pharmacokinetics
Absorption The oral bioavailability of LSD was crudely estimated as approximately 71% using previous data on intravenous administration of LSD. The sample was equally divided between male and female subjects. There were no significant sex differences observed in the pharmacokinetics of LSD. In a subsequent higher-quality 2025 study, the oral bioavailability of LSD was about 80%. The pharmacokinetics of LSD were not properly determined until 2015, which is not surprising for a drug with the kind of low-μg potency that LSD possesses. In a sample of 16 healthy subjects, a single mid-range 200 μg oral dose of LSD was found to produce mean maximal concentrations of 4.5 ng/mL at a median of 1.5 hours (range 0.5–4 hours) post-administration. A large meal before taking LSD has been found to result in circulating levels that were 50% lower than on an empty stomach.
Distribution In terms of distribution, it is estimated that only about 1 to 1.5% of the drug reaches the brain both in animals and humans. Following a typical 100 μg dose in humans, this would be about 1 μg that is distributed into the brain. LSD levels in different brain areas have been found to vary in monkeys. Levels were equal in blood, cerebral cortex, cerebellum, and brainstem, whereas levels were 1.5 times higher in the thalamus and extrapyramidal system, 2 to 3 times higher in the hypothalamus and limbic system, 2 to 5 times higher in the auditory and visual cortex, 5 to 7 times higher in the posterior pituitary and pineal gland, and 10 times higher in the anterior pituitary gland. These varying concentrations in different brain areas may explain the specific profile or balance of psychedelic effects of LSD. Bodily distribution of LSD has also been studied. It has been said that there is a peculiar 40-minute lag before onset of the psychedelic effects of LSD when it is administered intravenously. This has been said to be related to time-dependent interactions of LSD with the serotonin 5-HT2A receptor. However, contradicting the preceding claims, other sources have stated that intravenous injection of LSD results in onset of effects within a few minutes. In a 2025 pharmacokinetic study comparing oral and intravenous LSD, the onset orally was about 45 minutes and the onset by intravenous injection was about 2.5 minutes. In addition, intrathecal injection (intraspinal injection) is reported to have a virtually instantaneous onset of action. However, in the 2025 study, time to maximal effects was about 2.5 hours orally and about 1.2 hours intravenously. In an earlier 2016 study, intravenous LSD effects similarly peaked after about 1.7 hours. For comparison, intravenous dimethyltryptamine (DMT) given as a bolus has been found to produce maximal effects after about 2 minutes and intravenous psilocybin given over 60 seconds produces peak effects after about 4 minutes. Doses of LSD are said to be similar by oral and injectable routes, with the exception of intrathecal injection, in which the dose is reduced to about one-third of usual. The plasma protein binding of LSD in humans is unknown, but it is 65 to 90% bound to plasma proteins in guinea pigs.
Metabolism
The metabolites of LSD include 2-oxo-3-hydroxy-LSD (O-H-LSD), 2-oxo-LSD, lysergic acid ethylamide (LAE), lysergic acid ethyl-2-hydroxyethylamide (LEO), nor-LSD, 13-hydroxy-LSD, 14-hydroxy-LSD, and the glucuronide conjugates of the 13- and 14-hydroxylated metabolites, among other possible metabolites. The major metabolite of LSD is O-H-LSD. Levels of O-H-LSD in urine have been found to be 4 to 40 times higher than those of LSD, indicating extensive metabolism of LSD into this compound. It is formed by cytochrome P450 enzymes, although the specific enzymes involved are unknown, and O-H-LSD's potential pharmacology is little-studied. However, it was found to have profoundly reduced activity at the serotonin 5-HT2 receptors relative to LSD in vitro. Little is known about the specific enzymes responsible for the formation of LSD metabolites. LSD is not metabolized by monoamine oxidase (MAO) enzymes.
Elimination Only 1% of the drug was eliminated in urine unchanged, whereas 13% was eliminated as O-H-LSD within 24 hours. Aghajanian and Bing (1964) found LSD had an elimination half-life of only 175 minutes (about 3 hours); however, using more accurate techniques, Papac and Foltz (1990) reported that 1 μg/kg oral LSD given to a single male volunteer had an apparent plasma half-life of 5.1 hours, with a peak plasma concentration of 5 ng/mL at 3 hours post-dose. In a more modern 2015 study, concentrations of LSD decreased following first-order kinetics with a half-life of 3.6 ± 0.9 hours and a terminal half-life of 8.9 ± 5.9 hours. A 2026 review found half-lives ranging from 3.0 to 4.3 hours in different studies. LSD has a longer half-life of on average 8 hours in CYP2D6 poor metabolizers or people taking CYP2D6 inhibitors due to slower metabolism.
Miscellaneous The acute effects of LSD normally last between 6 and 12 hours depending on dose, tolerance, and age. In a modern study, the effects of the dose of LSD given lasted for up to 12 hours and were closely correlated with the concentrations of LSD present in circulation over time, with no acute tolerance observed.
Chemistry
LSD is a chiral compound with two stereocenters at the carbon atoms C-5 and C-8, so that theoretically four different optical isomers of LSD could exist. LSD, also called d-LSD or (+)-LSD, has the absolute configuration (5R,8R). The other stereoisomers are iso-LSD (d-iso-LSD), l-LSD, and l-iso-LSD. The 5S- or levo- stereoisomers of lysergamides do not exist in nature and are not formed during the synthesis from d-lysergic acid. Retrosynthetically, the C-5 stereocenter could be analysed as having the same configuration as the alpha carbon of the naturally occurring amino acid L-tryptophan, the precursor to all biosynthetic ergoline compounds. However, LSD and iso-LSD, the two C-8 isomers, rapidly interconvert in the presence of bases, as the alpha proton is acidic and can be deprotonated and reprotonated. Non-psychoactive iso-LSD, which has formed during the synthesis, can be separated by chromatography and can be isomerized to LSD. Pure salts of LSD are triboluminescent, emitting small flashes of white light when shaken in the dark. LSD is strongly fluorescent and will glow bluish-white under UV light.
Synthesis The chemical synthesis of LSD has been described. It is commonly synthesized by reacting diethylamine with an activated form of lysergic acid. Activating reagents include phosphoryl chloride and peptide coupling reagents. Lysergic acid is made by alkaline hydrolysis of lysergamides like ergotamine, a substance usually derived from the ergot fungus on agar plate. Lysergic acid can also be produced synthetically, although these processes are not used in clandestine manufacture due to their low yields and high complexity. Albert Hofmann synthesized LSD in the following manner: (1) hydrazinolysis of ergotamine into D- and L-isolysergic acid hydrazide, (2) separation of the enantiomers with di-(p-toluyl)-D-tartaric acid to get D-isolysergic acid hydrazide, (3) enantiomerization into D-lysergic acid hydrazide, (4) substitution with HNO2 to D-lysergic acid azide and (5) finally substitution with diethylamine to form D-lysergic acid diethylamide. The precursor for LSD, lysergic acid, has been produced by GMO baker's yeast.
Stability "LSD," writes the chemist Alexander Shulgin, "is an unusually fragile molecule ... As a salt, in water, cold, and free from air and light exposure, it is stable indefinitely." LSD has two labile protons at the tertiary stereogenic C5 and C8 positions, rendering these centers prone to epimerisation. The C8 proton is more labile due to the electron-withdrawing carboxamide attachment, but the removal of the chiral proton at the C5 position (which was once also an alpha proton of the parent molecule tryptophan) is assisted by the inductively withdrawing nitrogen and pi electron delocalisation with the indole ring. LSD also has enamine-type reactivity because of the electron-donating effects of the indole ring. Because of this, chlorine destroys LSD molecules on contact; even though chlorinated tap water contains only a slight amount of chlorine, the small quantity of compound typical to an LSD solution will likely be eliminated when dissolved in tap water. The double bond between the 8-position and the aromatic ring, being conjugated