Disclaimer

If you are experiencing a medical emergency, please call 911.
The information and recommendations provided on this website should be regarded only as anecdotal, and do not constitute medical advice. It has been noted that there is a deficiency in research and useful treatment recommendations concerning N2O and its effects on health. This information is provided with the intent of harm reduction only.

Heavy and prolonged nitrous oxide use does significant damage to the nervous system and circulatory system. It can cause psychosis, addiction, permanent nerve damage and paralysis, and blood clots that can lead to strokes, deep vein thrombosis, and pulonary embolisms.

Supplements can help delay damage and accelerate the body and brain's healing from damage. Critically, it's likely that no amount of supplementation will keep a heavy and frequent nitrous user healthy forever. These supplements can reduce the pace of damage and accelerate healing, but it's essential that nitrous use be limited to once every few weeks at maximum to maintain long term health. If that isn't possible, you should consider the possibility that you're addicted and seek help.

Always consult a qualified healthcare professional for accurate information and guidance.

The Fundamental Three Supplements:
Reducing Harm While Using

Nitrous oxide oxidizes B12, making it unusable in the body. B12 levels may appear fully normal in blood tests, but this is meaningless, as those tests don't differentiate between usable B12 and the corrupted form of B12 that nitrous leaves behind. Without B12, the body can't make or restore myelin, which surrounds the long nerves in the body and helps nerve signals travel back and forth. This leads to tingling, numbness, clumsiness, weakness, and eventually paralysis.

As part of the corruption of B12, heavy nitrous oxide use also leads to a buildup of a molecule called homocysteine. A buildup of this substance increases the risk of blood clots that can break off and travel to the heart or brain, causing strokes or even death.

To reduce the risk of these outcomes, there are three essential supplements to take every day before, during, and after nitrous use until all symptoms subside. The links point to Amazon, but these can be purchased from most drug stores.

Supplement	Why	Dosage
B12 as methylcobalamin	Preserves nervous system function. The body's B12 is corrupted by nitrous use.	~5,000 mcg / day
Methylfolate	A form of folic acid. Breaks down homocysteine, reducing the risk of blood clots and stroke.	~1,000 mcg / day
L-Methionine	Essential for making DNA. The body can’t make it without healthy B12. In animals, L-methionine slows or prevents nerve damage from nitrous.	~2 grams / day

How long should these supplements be taken?
These should definitely be taken daily during active nitrous use and for days or weeks after. After a protracted period of heavy nitrous use that leads to any symptoms such as brain fog or numbness or tingling, the essential supplements above should be continued until all symptoms have subsided. The amount of all of them can be reduced over time as symptoms improve. B12 can be (but doesn't have to be) dropped to 1,000 mcg / day when symptoms are substantially better, even before they've disappeared entirely. Methylfolate or folic acid can be stopped if a homocysteine test shows homocysteine levels are normal, so long as nitrous use has ended.

Note: There is a persistent myth that B12 cannot be absorbed by the body during nitrous use. This is incorrect. Use of these supplements is a good idea at any time in the cycle of nitrous use. These compounds are also difficult to overdose from. If in doubt, take some both immediately before and immediately after a session using nitrous.

Secondary Supplements to Protect the Brain and Accelerate Healing

Some additional supplements listed below can possibly help in protecting the brain from inflammation and oxidative stress that's caused by nitrous oxide, and in accelerating the restoration of the myelin layer that sheaths neurons. The evidence is more speculative and indirect for the supplements below, but they may help, and are very unlikely to hurt.

Supplement	Why	Dosage
NAC	A potent antioxidant with antipsychotic properties. It may help buffer the brain against the inflammation and oxidization that nitrous causes. It also mildly reduces cravings to multiple drugs.	Up to 3,600 mg / day. Divided into three doses.
ALA (Alpha Lipoic Acid)	One of the most powerful antioxidants known, it may protect the brain from the oxidation and inflammation caused by nitrous use.	1,200 mg / day
Omega 3 Fatty Acids	These substances found in fish oil, particularly EPA, help with multiple mental health conditions, have an anti-inflammatory effect, and seem to help in rebuilding the myelin sheath around nerves.	Up to 3 grams / day
Choline (as Alpha GPC)	Choline is an essential nutrient that is used in making cell membranes, including the myelin around nerve cells. It may help accelerate the healing from nitrous's damage to myelin sheaths. Alpha GPC is a very bio-available form of choline.	~2 grams / day
B-Complex	Other B vitamins, especially biotin (B7) may play a role in protecting or repairing the myelin sheath. NOTE: The linked B-complex contains enough folate that taking methylfolate with it is not required.	1ml of linked product or equivalent.

Supplements to Help with Nitrous Psychosis and Anhedonia

Heavy and/or prolonged use of nitrous oxide causes psychosis, delusions, paranoia, persecutory delusions, and full on breaks from reality. Lack of sleep during a nitrous binge often exacerbates this. These symptoms generally go away quickly after nitrous use is ceased and normal sleep is resumed. Symptoms often mostly subside within hours, though sometimes they may linger for days or even weeks.

People recovering from heavy nitrous use also frequently report anhedonia - the inability to feel joy or pleasure. This anhedonia can last for days or weeks after the end of a heavy period of nitrous use.

Long term psychosis or anhedonia that lasts more than days or a few weeks should be evaluated by a psychiatrist. It's possible that heavy nitrous use can trigger lasting psychotic or schizophrenic symptoms that can only be treated by a medical professional.

Nonetheless, there are some supplements that have some promise in reducing psychotic or schizophrenic symptoms that may be worth trying. These supplements generally have more evidence of effectiveness on negative symptoms (isolation, withdrawal from others, anhedonia) than on positive symptoms (hallucinations, voices in the head). That said, they have some, but inconsistent, evidence of effect on positive symptoms. These same supplements show more promise in reducing anhedonia. These supplements work in part by affecting the NMDA receptor. Nitrous oxide blocks this receptor, preventing important signals that help the brain differentiate reality from fantasy from getting through. The supplements below stabilize or boost NMDA signaling in the brain, potentially helping to reverse what nitrous oxide has done in the short term, and helping restore the brain to its pre-nitrous state if taken over a longer term.

Supplement	Why	Dosage
Sarcosine	Sarcosine is an NMDA "co-agonist". It also increases the levels of glycine in the brain, another NMDA co-agonist. It increases the amount of signaling that happens at NMDA receptors, acting in the opposite direction as nitrous. People who supplement with it report increased mental clarity and emotional depth. It's been found to be mildly effective at reducing symptoms of schizophrenia and anhedonia. NOTE: This supplement is likely completely ineffective while nitrous is in the body.	1 - 2 grams / day Start low (500mg/day) and increase over time.
D-Serine	D-Serine is another NMDA co-agonist that increases NMDA receptor function, acting opposite to how nitrous oxide works. NOTE: Also likely ineffective while nitrous is in the body.	1 - 3 grams / day Start low (500mg-1g) and increase over time.
NAC	NAC, mentioned above, is a potent antioxidant that's used in the treatment of multiple mental health disorders, including psychosis. It helps stabilize NMDA receptor function.	Up to 3,600 mg / day, split into 3x 1,200 mg doses.