Medication Interactions - Critical Safety Information

This Information Could Save Your Life

Ayahuasca contains MAOIs (monoamine oxidase inhibitors). These interact dangerously with many common medications, substances, and even some foods.

These interactions can cause:

• Serotonin syndrome (potentially fatal)
• Hypertensive crisis (dangerously high blood pressure)
• Severe adverse reactions
• Death

This is not fear-mongering. This is basic pharmacology.

If you take ANY medications, you must:

1. Inform your facilitator (every single medication and supplement)
2. Consult with your prescribing doctor
3. Be honest about everything you’re taking
4. Follow proper discontinuation timelines
5. Never stop psychiatric medications without medical supervision

What Are MAOIs and Why Do They Matter?

The Science (Simplified)

Monoamine oxidase inhibitors (MAOIs) prevent the breakdown of certain neurotransmitters:

• Serotonin
• Dopamine
• Norepinephrine
• Tyramine

This is why ayahuasca works:

• DMT would normally be broken down in your stomach
• MAOIs (from the Banisteriopsis caapi vine) allow DMT to be active orally
• They also have their own psychoactive and healing properties

But MAOIs interact with:

• Other medications that affect serotonin
• Tyramine-rich foods
• Stimulants and other substances
• Many over-the-counter medications

The result can be life-threatening.

Dangerous Interactions: DO NOT Combine

CATEGORY 1: Antidepressants (MOST COMMON & DANGEROUS)

SSRIs (Selective Serotonin Reuptake Inhibitors)

Interaction: Serotonin syndrome (potentially fatal)

Common SSRIs:

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

Washout period:

• Most SSRIs: Minimum 6 weeks after last dose
• Fluoxetine (Prozac): Minimum 8 weeks (longer half-life)

Why so long: SSRIs stay in your system for weeks after stopping. You must be completely clear before ceremony.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

Interaction: Serotonin syndrome, hypertensive crisis

Common SNRIs:

• ❌ Venlafaxine (Effexor)
• ❌ Duloxetine (Cymbalta)
• ❌ Desvenlafaxine (Pristiq)
• ❌ Levomilnacipran (Fetzima)

Washout period: Minimum 6 weeks

Other Antidepressants

Tricyclic Antidepressants (TCAs):

• ❌ Amitriptyline (Elavil)
• ❌ Nortriptyline (Pamelor)
• ❌ Imipramine (Tofranil)
• Washout: 6 weeks minimum

MAOIs (yes, medication MAOIs):

• ❌ Phenelzine (Nardil)
• ❌ Tranylcypromine (Parnate)
• ❌ Isocarboxazid (Marplan)
• Washout: 6-8 weeks minimum
• Extremely dangerous to combine MAOIs

Atypical Antidepressants:

• ❌ Bupropion (Wellbutrin) - Seizure risk
• ⚠️ Mirtazapine (Remeron) - Consult doctor
• ⚠️ Trazodone - Consult doctor
• Washout: 4-6 weeks typically

CATEGORY 2: Stimulants & ADHD Medications

Interaction: Hypertensive crisis, cardiovascular stress

Common medications:

• ❌ Amphetamine/Dextroamphetamine (Adderall)
• ❌ Methylphenidate (Ritalin, Concerta)
• ❌ Lisdexamfetamine (Vyvanse)
• ❌ Modafinil (Provigil)
• ❌ Armodafinil (Nuvigil)

Washout period: Minimum 2 weeks

CATEGORY 3: Appetite Suppressants & Weight Loss

Interaction: Hypertensive crisis

• ❌ Phentermine
• ❌ Diethylpropion
• ❌ Sibutramine
• ❌ Any “diet pills” or appetite suppressants

Washout period: Minimum 3-4 weeks

CATEGORY 4: Cough/Cold Medications

Interaction: Hypertensive crisis, serotonin syndrome

Over-the-counter dangers:

• ❌ Dextromethorphan (DXM) - found in many cough syrups
• ❌ Pseudoephedrine - decongestant
• ❌ Ephedrine
• ❌ Phenylephrine

Washout period: Minimum 1-2 weeks (read labels!)

CATEGORY 5: Mood Stabilizers & Antipsychotics

Varies by medication - consult doctor

Lithium:

• ⚠️ Can be dangerous with ayahuasca
• Consult psychiatrist - do not stop without supervision

Antipsychotics:

• ⚠️ May dampen or block effects
• ⚠️ Stopping can cause destabilization
• Consult psychiatrist - do not stop on your own

Examples:

• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Aripiprazole (Abilify)
• Olanzapine (Zyprexa)

These require individual medical guidance.

CATEGORY 6: Opioids & Pain Medications

Interaction: Respiratory depression, serotonin syndrome (some)

Dangerous combinations:

• ❌ Tramadol (very dangerous - serotonergic)
• ❌ Meperidine (Demerol)
• ⚠️ Codeine
• ⚠️ Oxycodone
• ⚠️ Hydrocodone
• ⚠️ Morphine

Washout period:

• Tramadol: 2 weeks minimum (very important)
• Others: 1 week minimum
• Fentanyl patches: Consult doctor

CATEGORY 7: Recreational Substances

Interaction: Various severe reactions

• ❌ MDMA/Ecstasy (serotonin syndrome - potentially fatal)
• ❌ Cocaine (cardiovascular crisis)
• ❌ Amphetamines (hypertensive crisis)
• ❌ DXM (found in cough medicine)
• ⚠️ Alcohol (dangerous, but interaction is intoxication not MAOI)
• ⚠️ Cannabis (won’t kill you, but can intensify experience unpredictably)

Washout period: Minimum 1-2 weeks for all

CATEGORY 8: Other Medications

Antihistamines (some):

• ⚠️ Diphenhydramine (Benadryl) - use caution
• Generally okay but can potentiate sedation

Muscle Relaxants:

• ⚠️ Cyclobenzaprine - potential interaction
• Consult doctor

Immunosuppressants:

• ⚠️ Varies by medication
• Consult doctor

Blood Pressure Medications:

• ⚠️ Can interact with MAOI effects
• Consult doctor - do not stop

Diabetes Medications:

• ⚠️ Ayahuasca can affect blood sugar
• Monitor closely, consult doctor

Supplements & Herbal Interactions

Many “natural” supplements interact dangerously with MAOIs.

Definitely Avoid

• ❌ St. John’s Wort (serotonergic)
• ❌ 5-HTP (serotonin precursor)
• ❌ L-Tryptophan (serotonin precursor)
• ❌ SAM-e
• ❌ Kava
• ❌ Ephedra/Ma Huang
• ❌ Yohimbe
• ❌ Kratom

Washout: 2-4 weeks

Use Caution

• ⚠️ Rhodiola
• ⚠️ Ginkgo biloba
• ⚠️ Ginseng
• ⚠️ Ashwagandha (likely okay, but inform facilitator)

When in doubt, stop 2 weeks before ceremony and inform facilitator.

Serotonin Syndrome: What You Need to Know

Serotonin syndrome is a medical emergency caused by too much serotonin in your system.

Symptoms

Mild to Moderate:

• Agitation, restlessness
• Confusion
• Rapid heart rate
• High blood pressure
• Dilated pupils
• Muscle twitching or rigidity
• Heavy sweating
• Diarrhea
• Headache

Severe (Life-Threatening):

• High fever (>103°F/39.4°C)
• Seizures
• Irregular heartbeat
• Unconsciousness
• Death

If you experience these symptoms during ceremony, GET MEDICAL HELP IMMEDIATELY.

This is why medical screening and honest disclosure are critical.

Hypertensive Crisis: The Tyramine Connection

MAOIs prevent the breakdown of tyramine (found in certain foods).

Result: Dangerous spikes in blood pressure.

Foods to Avoid on the Dieta

High tyramine (AVOID completely):

• ❌ Aged cheeses (cheddar, blue cheese, parmesan, etc.)
• ❌ Cured/processed meats (salami, pepperoni, hot dogs, bacon)
• ❌ Fermented foods (sauerkraut, kimchi, miso, soy sauce)
• ❌ Pickled foods
• ❌ Yeast extracts (Marmite, Vegemite)
• ❌ Fava beans
• ❌ Overripe or dried fruits
• ❌ Tap beer and red wine

Start avoiding 2 weeks before ceremony.

See Dieta Guide for complete dietary information.

How Long to Wait After Stopping Medications

General Guidelines

Antidepressants (SSRIs, SNRIs, TCAs):

• 6 weeks minimum after last dose
• 8 weeks for Fluoxetine (Prozac)
• Blood test can confirm clearance if available

Stimulants (ADHD meds):

• 2 weeks minimum

Appetite suppressants:

• 3-4 weeks

Tramadol:

• 2 weeks minimum (very important)

Other opioids:

• 1 week

Cough/cold medications:

• 1-2 weeks (check labels for DXM, pseudoephedrine)

Recreational substances:

• 1-2 weeks minimum

Supplements (St. John’s Wort, 5-HTP, etc.):

• 2-4 weeks

Why These Timelines Matter

Medications have different half-lives:

• How long they stay in your system
• How long they affect brain chemistry
• How long metabolites remain

Even if you feel “normal” after stopping, the medication may still be active in your system.

Err on the side of caution. Wait longer if unsure.

The Psychiatric Medication Dilemma

This is a real ethical and practical problem:

Many people seek ayahuasca because they’re suffering from depression, anxiety, PTSD - the same conditions being treated with SSRIs and other psych meds.

But to do ayahuasca safely, they must discontinue medications.

Critical Guidelines

NEVER stop psychiatric medications without medical supervision.

Stopping antidepressants can cause:

• Withdrawal syndrome (brain zaps, dizziness, mood destabilization)
• Return of depression/anxiety (sometimes worse)
• Suicidal ideation
• Dangerous destabilization

Working With Your Doctor

If you want to do ayahuasca and you’re on psychiatric medications:

1. Talk to your prescribing doctor

   • Be honest about wanting to try ayahuasca
   • Ask about safe discontinuation
   • Some doctors understand, some don’t (find one who does)

2. Taper slowly under supervision

   • Typically over weeks to months
   • Monitor for withdrawal and symptom return
   • Have support systems in place

3. Stabilize before ceremony

   • Don’t do ceremony while actively withdrawing
   • Wait until you’re stable off meds
   • Have crisis plan in case symptoms return

4. Consider if this is the right time

   • Is it safe for you to be off medications?
   • Are you stable enough without them?
   • Do you have adequate support?

Sometimes the answer is: “Not now.”

Your safety is more important than doing ceremony.

Alternatives to Consider

If you can’t safely discontinue medications:

• Continue with conventional treatment
• Therapy (EMDR, IFS, somatic work can be profoundly healing)
• Other modalities (breathwork, meditation, bodywork)
• Wait until you’re in a place where discontinuation is safe
• Accept that ayahuasca might not be an option for you right now

Ayahuasca is powerful, but it’s not the only path to healing.

Medical Screening: What Facilitators Should Ask

Responsible facilitators will require:

Comprehensive Medical Questionnaire

• Complete medication list (prescriptions, OTC, supplements)
• When you stopped each medication (with dates)
• Medical history (heart conditions, seizures, psychosis, etc.)
• Mental health history
• Current symptoms
• Family psychiatric history
• Allergies
• Recent surgeries or injuries

Red Flags If Facilitator Doesn’t:

🚨 Doesn’t ask about medications at all
🚨 Asks but doesn’t follow up on interactions
🚨 Dismisses your concerns
🚨 Says “the medicine will heal you, don’t worry about meds”
🚨 Serves you despite contraindications

If your facilitator doesn’t take medical screening seriously, LEAVE.

See Red Flags for more on unsafe facilitators.

What to Tell Your Facilitator

Be 100% honest about:

✅ Every medication you take or have recently stopped
✅ Exact dates when you stopped
✅ All supplements and herbs
✅ Recreational substance use
✅ Over-the-counter medications (including cold medicine taken recently)
✅ Any medical conditions
✅ Any psychiatric diagnoses
✅ Family history of psychosis, heart problems, or other relevant conditions

“I forgot” or “I didn’t think it mattered” can be deadly.

Facilitators can’t keep you safe if they don’t have accurate information.

Special Populations & Conditions

Absolute Contraindications (DO NOT Do Ayahuasca)

Cardiovascular conditions:

• Recent heart attack or stroke
• Severe heart disease
• Uncontrolled high blood pressure
• History of brain aneurysm

Psychiatric conditions:

• Active psychosis or schizophrenia
• Severe bipolar disorder (especially manic phase)
• Recent severe mental health crisis

Other:

• Pregnancy or breastfeeding
• Severe liver or kidney disease
• Epilepsy (seizure disorder) - consult doctor

Relative Contraindications (Proceed with Extreme Caution)

Mental health:

• Family history of schizophrenia or psychosis
• Bipolar disorder (even stable)
• Severe PTSD
• Dissociative disorders

Physical health:

• Moderate heart conditions (consult cardiologist)
• Diabetes (blood sugar can be affected)
• Autoimmune conditions (consult doctor)

If you have any of these, you need:

• Medical clearance
• Experienced facilitator who knows your situation
• Extra support during ceremony
• Clear crisis plan

Day-of-Ceremony Checklist

Before drinking ayahuasca, verify:

• [ ] I stopped all contraindicated medications for the appropriate washout period
• [ ] I followed the dieta (including tyramine-free foods)
• [ ] I informed the facilitator of ALL medications and supplements
• [ ] I am not on any SSRIs, SNRIs, MAOIs, or other interacting drugs
• [ ] I did not take any cold medicine, stimulants, or other contraindicated substances recently
• [ ] I am not pregnant
• [ ] I don’t have any absolute contraindications
• [ ] If I have relative contraindications, I’ve discussed with facilitator and have medical clearance

If you can’t check all relevant boxes, DO NOT DRINK.

If Something Goes Wrong

If you or someone in ceremony shows signs of serotonin syndrome, hypertensive crisis, or other medical emergency:

Do This Immediately

1. Alert the facilitator
2. Call 911 or emergency services
3. Tell paramedics what was consumed (ayahuasca, which contains MAOIs)
4. List all medications person has taken recently
5. Get to hospital

Don’t wait to see if it gets better. Medical emergencies require medical treatment.

Facilitators who refuse to call emergency services are dangerous.

Your Responsibility

Ultimately, your safety is your responsibility.

You must:

• Research medication interactions
• Provide honest information
• Follow discontinuation timelines
• Consult with your doctors
• Choose responsible facilitators
• Advocate for yourself

The medicine community has a saying: “The medicine will teach you.”

True. But the medicine can also kill you if you don’t respect basic pharmacology.

Final Thoughts

Ayahuasca is powerful medicine. It also contains a drug (MAOIs) with serious interactions.

Both things are true.

You can honor the sacred nature of the medicine AND take basic safety precautions.

Your life is worth more than any ceremony.

When in doubt:

• Wait longer
• Consult doctors
• Get medical clearance
• Choose experienced facilitators who take safety seriously
• Or don’t do ceremony right now

The medicine will wait. Your safety cannot.

Resources

• Red Flags Guide - Unsafe facilitators
• First-Timer’s Guide - Safety basics
• Dieta Guide - Food restrictions
• Crisis Resources - Emergency support

Additional Resources:

• Talk to your prescribing physician
• Consult a pharmacist about interactions
• Use interaction checkers (drugs.com interaction checker)
• Seek harm reduction information

---

Medical Disclaimer

This information is educational, not medical advice.

Always consult with qualified medical professionals about:

• Stopping or starting medications
• Drug interactions
• Your specific health conditions
• Whether ayahuasca is safe for you

When in doubt, consult a doctor. Your life depends on it.

---

Be safe. Be honest. Be responsible.

Your healing journey requires you to be alive.