Medical Contraindications - Who Should Not Drink Ayahuasca

This Page Might Save Your Life

Ayahuasca is not safe for everyone.

There are legitimate medical, psychiatric, and medication contraindications that can result in serious harm or death.

This is not fear-mongering. This is medical reality.

Responsible facilitators screen thoroughly and turn people away who shouldn’t drink. Irresponsible ones serve anyone who pays.

Know the contraindications. Be honest about your health. Your life may depend on it.

This page covers complete contraindications, why they matter, how to assess your risk, and alternatives if you can’t drink safely.

How Ayahuasca Works in the Body (The Basics)

The Chemistry

Ayahuasca contains:

• DMT (N,N-Dimethyltryptamine): The primary psychoactive compound
• MAOIs (Monoamine Oxidase Inhibitors): From the Banisteriopsis caapi vine, allow DMT to be orally active

How it works:

• Normally, MAO enzymes in your gut break down DMT before it reaches your brain
• MAOIs temporarily disable these enzymes
• This allows DMT to enter your bloodstream and cross the blood-brain barrier
• DMT then activates serotonin receptors, creating the psychedelic experience

Why this matters for contraindications:

• MAOIs interact dangerously with many medications and substances
• DMT significantly affects serotonin, cardiovascular, and neurological systems
• The combination creates unique risks

Physiological Effects

Ayahuasca causes:

• Cardiovascular: Increased heart rate and blood pressure (especially during peak)
• Neurological: Altered consciousness, sensory changes, potential seizure risk
• Gastrointestinal: Nausea, vomiting, diarrhea
• Psychological: Intense emotional states, ego dissolution, potential psychosis activation
• Metabolic: Liver metabolism, kidney filtration

If you have conditions affecting these systems, ayahuasca may be dangerous.

Absolute Contraindications (DO NOT DRINK)

🚨 Cardiovascular Conditions

Conditions that make ayahuasca extremely dangerous:

Heart disease:

• Coronary artery disease
• History of heart attack (myocardial infarction)
• Angina (chest pain from heart disease)
• Congestive heart failure
• Cardiomyopathy (weakened heart muscle)
• Significant heart valve problems
• Congenital heart defects (depending on severity)

Why it’s dangerous:

• Ayahuasca increases heart rate and blood pressure significantly
• Can trigger heart attack, arrhythmia, or heart failure
• May be fatal in people with compromised cardiac function

Arrhythmias and electrical problems:

• Atrial fibrillation or flutter
• Ventricular tachycardia
• Long QT syndrome
• History of sudden cardiac arrest
• Pacemaker or defibrillator (ICD)

Why it’s dangerous:

• DMT can affect heart rhythm
• Risk of dangerous arrhythmias
• Potentially fatal cardiac events

Severe hypertension (high blood pressure):

• Uncontrolled hypertension (above 140/90, especially above 160/100)
• Hypertensive crisis history
• Malignant hypertension

Why it’s dangerous:

• Ayahuasca raises blood pressure further
• Risk of stroke, heart attack, hypertensive emergency
• MAOI + tyramine (from diet violations) = hypertensive crisis

Stroke or TIA (transient ischemic attack) history:

• Any history of stroke
• TIA (“mini-stroke”)
• Cerebrovascular disease
• Brain aneurysm or AVM (arteriovenous malformation)

Why it’s dangerous:

• Blood pressure spikes risk another stroke
• Potential hemorrhage if aneurysm/AVM present
• Can be fatal

What to do if you have cardiovascular conditions:

• Do not drink ayahuasca without explicit clearance from cardiologist
• Get cardiac workup (EKG, stress test, etc.)
• Consider other healing modalities
• If mild/well-controlled and doctor approves: Proceed with extreme caution, medical monitoring

🚨 Psychiatric Contraindications

Conditions where ayahuasca is extremely high-risk:

Psychotic disorders:

• Schizophrenia
• Schizoaffective disorder
• Delusional disorder
• Any psychotic disorder
• First-degree relative with schizophrenia (genetic risk)

Why it’s dangerous:

• Ayahuasca can trigger or worsen psychosis
• May precipitate first psychotic break
• Can cause persistent psychosis
• Genetic predisposition significantly increases risk

Bipolar disorder:

• Bipolar I (especially with psychotic features)
• Bipolar II (with caution)
• Cyclothymia (milder, but still caution)

Why it’s dangerous:

• Can trigger manic or psychotic episodes
• May destabilize mood severely
• Interactions with mood stabilizers
• High risk of psychiatric emergency

Severe personality disorders:

• Borderline personality disorder (high risk of destabilization)
• Dissociative identity disorder (DID)
• Severe PTSD with dissociative features

Why it’s dangerous:

• Risk of severe dissociation
• Potential for destabilization
• May worsen symptoms
• Requires specialized therapeutic support if attempted at all

Active suicidal ideation:

• Current suicidal thoughts with plan/intent
• Recent suicide attempt
• Severe self-harm behaviors
• Active crisis

Why it’s dangerous:

• Ceremony can intensify suicidal thoughts
• Vulnerable state with reduced impulse control
• Need psychiatric stabilization first

What to do if you have psychiatric conditions:

• Schizophrenia/psychosis: Do not drink (strong recommendation)
• Bipolar: Only with psychiatrist approval, medication taper plan, strong support
• Borderline/PTSD: Only with experienced trauma-therapist support, small doses, therapeutic container
• Active suicidal crisis: Stabilize first, then reconsider

🚨 Medication Interactions (Potentially Fatal)

Medications you MUST discontinue before ayahuasca (with doctor supervision):

SSRIs (Selective Serotonin Reuptake Inhibitors):

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)

Other antidepressants:

• Tricyclic antidepressants (amitriptyline, nortriptyline, etc.)
• MAOIs (phenelzine, tranylcypromine) - NEVER combine MAOIs
• Bupropion (Wellbutrin) - less dangerous but still risky

Why it’s dangerous:

• Serotonin syndrome: Potentially fatal
• Symptoms: Confusion, agitation, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, hyperthermia, seizures
• Can be lethal
• MAOI + SSRI is one of the most dangerous drug combinations

How long to wait after stopping:

• Most SSRIs/SNRIs: Minimum 6 weeks
• Fluoxetine (Prozac): Minimum 8 weeks (long half-life)
• NEVER stop psychiatric medications without doctor supervision
• Tapering improperly can cause severe withdrawal

Stimulants and ADHD medications:

• Amphetamines (Adderall, Vyvanse)
• Methylphenidate (Ritalin, Concerta)
• Modafinil

Why it’s dangerous:

• Cardiovascular stress
• Hypertensive crisis risk
• Dangerous interaction with MAOIs

How long to wait: At least 24-48 hours, ideally longer

Opioids:

• Prescription opioids (oxycodone, hydrocodone, morphine, etc.)
• Tramadol (especially dangerous with MAOIs)
• Fentanyl
• Methadone, suboxone

Why it’s dangerous:

• Respiratory depression
• Serotonin syndrome (especially tramadol)
• Altered consciousness + opioids = dangerous

How long to wait: At least 24-48 hours for short-acting, longer for long-acting

Other dangerous medication interactions:

• Dextromethorphan (DXM, in cough syrup) - serotonin syndrome risk
• St. John’s Wort - MAOI interaction
• 5-HTP - serotonin overload
• Weight loss medications (phentermine, etc.)
• Decongestants (pseudoephedrine) - hypertensive crisis
• Some muscle relaxants

See our Medication Interactions page for comprehensive list.

🚨 Pregnancy and Breastfeeding

Pregnancy:

• Any stage of pregnancy
• Trying to conceive
• Possibly pregnant

Why it’s dangerous:

• Unknown effects on fetal development
• Uterine contractions (ayahuasca has been used to induce abortion)
• Cardiovascular stress
• No safety studies (obviously)

Traditional use: Some indigenous traditions use ayahuasca during pregnancy for specific purposes, but this is culturally-specific and not advised for non-traditional use.

Recommendation: Do not drink if pregnant or trying to conceive.

Breastfeeding:

• DMT and alkaloids likely pass into breast milk
• Effects on infant unknown
• Recommendation: Do not drink while breastfeeding

🚨 Liver and Kidney Disease

Liver conditions:

• Cirrhosis
• Hepatitis (active)
• Severe liver disease
• Liver failure

Why it’s dangerous:

• Liver metabolizes ayahuasca compounds
• Impaired metabolism = dangerous buildup
• Additional stress on compromised liver
• Risk of hepatic encephalopathy

Kidney conditions:

• Kidney failure
• Severe chronic kidney disease
• Dialysis

Why it’s dangerous:

• Kidneys filter ayahuasca metabolites
• Impaired filtration = dangerous buildup
• Additional stress on compromised kidneys

What to do:

• Mild/well-controlled liver/kidney disease: Get medical clearance
• Moderate to severe: Do not drink

🚨 Seizure Disorders

Epilepsy and seizure history:

• Epilepsy (all types)
• History of seizures
• Seizure disorder

Why it’s potentially dangerous:

• Mixed evidence: Some studies suggest ayahuasca may lower seizure threshold
• Other anecdotal reports suggest it may help
• Interaction with seizure medications
• Risk vs. benefit unclear

What to do:

• Consult neurologist
• Only with medical supervision
• Never stop seizure meds without doctor approval
• Ensure facilitator knows and has emergency protocol

🚨 Other Medical Contraindications

Diabetes (poorly controlled):

• Type 1 or Type 2 with poor control
• Recent diabetic ketoacidosis
• Severe complications

Why it’s risky:

• Vomiting interferes with medication/eating
• Blood sugar regulation disrupted
• Cardiovascular risks compounded

What to do:

• Well-controlled diabetes: May be okay with monitoring
• Poor control: Stabilize first

Severe asthma or respiratory disease:

• Severe COPD
• Severe asthma
• Respiratory failure risk

Why it’s risky:

• Stress on respiratory system
• Panic can trigger asthma attack
• Need to be able to breathe through intensity

Thyroid disease (severe):

• Uncontrolled hyperthyroidism
• Thyroid storm history

Why it’s risky:

• Cardiovascular stress
• Metabolic interactions

Active infections or acute illness:

• Fever, flu, COVID
• Active infection
• Acute illness

Why it’s risky:

• Body already under stress
• Immune system compromised
• Vomiting/diarrhea with illness = severe dehydration

Wait until fully recovered.

Relative Contraindications (Proceed with Extreme Caution)

These conditions may allow for ayahuasca use with proper precautions, medical clearance, and experienced facilitation:

Moderate Mental Health Conditions

Anxiety disorders:

• Generalized anxiety
• Panic disorder
• Social anxiety
• OCD

Risk:

• Ceremony can be intensely anxiety-provoking
• Panic during ceremony
• May worsen temporarily before improving

Precautions:

• Strong therapeutic support
• Integration plan
• Experienced facilitator
• Start with lower dose
• Have anxiety management tools

Depression:

• Moderate to severe depression (without psychotic features)
• Treatment-resistant depression

Risk:

• May worsen temporarily
• Suicidal ideation can emerge
• Need support for integration

Precautions:

• Therapist involvement
• Safety plan
• Screen for bipolar (depression can be bipolar depressive phase)
• Support system

PTSD and trauma history:

• Complex PTSD
• Childhood trauma
• Sexual trauma
• Combat trauma

Risk:

• Retraumatization
• Overwhelming activation
• Dissociation
• May worsen symptoms without proper support

Precautions:

• Trauma-informed facilitator essential
• Trauma therapist for integration
• Somatic support
• Go slow, small doses
• Strong safety container

Well-Controlled Chronic Conditions

Controlled hypertension:

• Blood pressure managed with medication
• Consistently below 140/90

Precautions:

• Medical clearance
• Blood pressure monitoring
• May need to adjust timing of meds
• Facilitator aware

Well-controlled hypothyroidism:

• On stable thyroid medication
• Normal TSH levels

Precautions:

• Take medication as normal
• Inform facilitator

Controlled diabetes:

• Type 1 or 2 with good control
• A1C in healthy range
• No recent complications

Precautions:

• Blood sugar monitoring
• Adjust insulin carefully around fasting/vomiting
• Inform facilitator
• Have emergency supplies

Medications That Require Caution (Not Absolute)

Birth control:

• Generally safe
• Vomiting may reduce effectiveness
• Use backup method around ceremony

Blood pressure medications:

• Usually safe
• Timing may need adjustment
• Monitor blood pressure

Thyroid medication:

• Safe to continue
• Take as normal

Allergy medications:

• Non-sedating antihistamines generally okay
• Avoid decongestants (pseudoephedrine)

Sleep medications:

• Discontinue night before ceremony
• Melatonin is safe

When in doubt: Consult your doctor and the facilitator.

How to Assess Your Personal Risk

Medical Screening Checklist

Ask yourself:

☑️ Do I have any heart conditions or cardiovascular disease?
☑️ Do I have high blood pressure (controlled or uncontrolled)?
☑️ Have I ever had a stroke, TIA, or aneurysm?
☑️ Do I have any psychiatric diagnosis (especially psychosis or bipolar)?
☑️ Do I have seizures or epilepsy?
☑️ Do I have liver or kidney disease?
☑️ Am I pregnant, breastfeeding, or trying to conceive?
☑️ Am I taking any psychiatric medications (SSRIs, SNRIs, etc.)?
☑️ Am I taking stimulants, opioids, or other contraindicated medications?
☑️ Do I have severe asthma or respiratory issues?
☑️ Do I have poorly controlled diabetes?
☑️ Do I have any acute illness or infection?
☑️ Do I have family history of schizophrenia or psychosis?
☑️ Am I currently in psychiatric crisis?

If you answered YES to any of these:

• Do more research on your specific condition
• Consult your doctor
• Be honest with facilitator during screening
• Consider whether the risk is worth it
• Explore alternatives

Getting Medical Clearance

If you have health conditions but want to proceed:

1. Consult your doctor

• Be honest about what ayahuasca is
• Explain the physiological effects (increased heart rate/BP, MAOIs, etc.)
• Ask about your specific risks
• Get clearance in writing if possible

2. Work with the facilitator

• Full disclosure of health conditions
• Provide medical records if requested
• Discuss dose adjustments
• Emergency protocols

3. Medication tapering plan (if needed)

• Never stop psych meds without medical supervision
• Work with prescribing doctor
• Slow taper (weeks to months)
• Monitor for withdrawal
• Support during transition

4. Risk mitigation

• Medical monitoring during ceremony (if high-risk)
• Lower doses
• Hospital proximity
• Experienced facilitator with emergency training

5. Have a backup plan

• What if ceremony is contraindicated?
• Alternative healing modalities
• Accept that ayahuasca may not be for you

Family History Considerations

Even if you don’t have these conditions, family history matters:

Schizophrenia or psychosis:

• First-degree relative (parent, sibling) with schizophrenia
• Significantly increases your risk
• Ayahuasca may trigger first psychotic break

Recommendation: Extreme caution, possibly avoid entirely

Bipolar disorder:

• Family history increases risk
• Depression might be undiagnosed bipolar

Recommendation: Careful screening, psychiatric evaluation

Heart disease:

• Family history of early heart attack, sudden cardiac death
• May indicate undiagnosed risk

Recommendation: Cardiac screening before ceremony

Addiction:

• Family history of addiction
• May increase vulnerability

Recommendation: Strong integration support, monitor substance use patterns

Alternatives If You Can’t Drink Safely

If ayahuasca is contraindicated for you, other healing modalities exist:

Somatic and Body-Based Therapies

• Somatic Experiencing (SE)
• EMDR (Eye Movement Desensitization and Reprocessing)
• Sensorimotor Psychotherapy
• Hakomi
• Trauma-sensitive yoga
• Breathwork (with caution, can be intense)

Other Psychedelic-Assisted Therapies (May Also Have Contraindications)

• Ketamine-assisted therapy (fewer contraindications, legal in clinical settings)
• MDMA-assisted therapy (for PTSD, in clinical trials, some cardiac contraindications)
• Psilocybin therapy (fewer physical contraindications than ayahuasca, some psychiatric contraindications remain)

Note: These also have contraindications. Research thoroughly.

Non-Psychedelic Modalities

• Internal Family Systems (IFS)
• Traditional therapy (psychodynamic, Jungian, etc.)
• Meditation and mindfulness practices
• Plant medicine alternatives (cacao ceremonies, less intense)
• Holotropic breathwork (powerful, can access altered states without substances)
• Spiritual practices (prayer, ritual, ceremony without substances)
• Support groups and community
• Wilderness therapy or nature immersion

Healing is possible without ayahuasca.

The medicine is one tool, not the only tool.

What to Tell Facilitators During Screening

Be Completely Honest

Responsible facilitators ask about:

• Medical history
• Psychiatric history
• Current medications
• Substance use
• Allergies
• Pregnancy/breastfeeding
• Family history

Tell them everything, even if:

• You’re afraid they’ll say no
• You think it’s not relevant
• You stopped medication recently
• You’re embarrassed
• You really want to participate

Your life is more important than drinking ayahuasca.

Red Flags in Facilitator Screening

If a facilitator:

• Doesn’t ask detailed health questions
• Minimizes your health concerns
• Says “the medicine will heal you” despite contraindications
• Encourages you to hide info from your doctor
• Will serve you despite clear contraindications
• Doesn’t have emergency protocols

Do not drink with them. Find a different facilitator or don’t drink.

Green Flags in Facilitator Screening

Good facilitators:

• Ask thorough health questions (written + verbal)
• Request medical clearance for certain conditions
• Turn people away who aren’t safe to serve
• Have emergency protocols
• First aid/medical training
• Know contraindications thoroughly
• Prioritize safety over money
• Are conservative with dosing for health conditions

This is what responsible facilitation looks like.

Emergency Situations and Warning Signs

Serotonin Syndrome (Medical Emergency)

Symptoms:

• Confusion, agitation
• Rapid heart rate
• High blood pressure
• Dilated pupils
• Muscle rigidity, twitching
• Hyperthermia (high fever)
• Sweating, shivering
• Diarrhea
• Seizures (severe cases)

If suspected: Call 911 immediately. This is life-threatening.

Hypertensive Crisis (Medical Emergency)

Symptoms:

• Severe headache
• Chest pain
• Shortness of breath
• Nosebleed
• Severe anxiety
• Vision changes
• Blood pressure above 180/120

If suspected: Call 911 immediately.

Cardiac Events (Medical Emergency)

Symptoms:

• Chest pain (especially radiating to arm, jaw, back)
• Severe shortness of breath
• Irregular heartbeat
• Fainting or near-fainting
• Severe weakness

If suspected: Call 911 immediately.

Psychotic Break

Symptoms:

• Complete loss of reality
• Paranoid delusions
• Hallucinations persisting after ceremony ends
• Inability to function
• Bizarre or dangerous behavior

If suspected: Psychiatric evaluation, possibly hospitalization.

Facilitators must know when to call emergency services.

No ceremony is worth dying for.

The Dieta: Why It Matters for Safety

MAOIs (in ayahuasca) interact with tyramine in certain foods.

Foods to avoid before ceremony (at least 24-48 hours, ideally longer):

High tyramine foods:

• Aged cheeses
• Cured/processed meats (salami, pepperoni, etc.)
• Fermented foods (sauerkraut, kimchi, soy sauce)
• Aged/smoked fish
• Draft beer, red wine
• Chocolate (in large amounts)
• Overripe fruits

Why it matters:

• MAOI + tyramine = hypertensive crisis (dangerous blood pressure spike)
• Can cause stroke or heart attack
• This is a real risk, not just tradition

See our Dieta Guide for complete list.

If a facilitator doesn’t explain dietary restrictions, that’s a red flag.

Final Thoughts on Safety and Contraindications

After years of observation in this work, patterns have emerged:

• People who shouldn’t have drunk and suffered consequences
• People turned away by responsible facilitators (disappointed but safe)
• People who found other healing modalities that worked better
• People who got medical clearance and drank safely with monitoring
• Emergencies that required medical intervention
• Near-misses that scared everyone

What experienced practitioners know:

1. Contraindications exist for a reason.

• Not all risks, but real ones
• Based on pharmacology and case reports
• Ignoring them can be fatal

2. Ayahuasca is not for everyone.

• And that’s okay
• Other paths to healing exist
• Your life is more valuable than any ceremony

3. Responsible facilitators prioritize safety.

• They turn people away
• They screen thoroughly
• They have emergency plans
• They don’t serve everyone who pays

4. Be honest about your health.

• With yourself
• With your doctor
• With the facilitator
• Your life depends on it

5. When in doubt, don’t drink.

• If you’re unsure about safety
• If you can’t get medical clearance
• If something feels wrong
• Wait, research more, consult professionals

6. There’s no shame in being contraindicated.

• It doesn’t mean you’re broken
• It doesn’t mean you can’t heal
• It means this particular medicine isn’t safe for your particular body
• That’s information, not judgment

Resources

• Medication Interactions - Complete medication guide
• First-Timer’s Guide - Safety preparation
• Red Flags - Facilitator safety
• Crisis Resources - Emergency support
• MAPS - Research and safety information
• Fireside Project - Psychedelic support hotline

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Your safety is paramount.

Be honest. Get medical advice. Choose responsible facilitators.

If ayahuasca isn’t safe for you, that’s okay. Healing has many paths.

Please take care of yourself.