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Using stimulants with MAOIs is particularly dangerous and can be potentially fatal. Using cocaine, amphetamines or MDMA (Ecstasy) with MAOIs may cause a severe increase in blood pressure, increasing the chances for stroke and cerebral haemorrhage. MAOIs may make it possible to overdose on a relatively small amount of cocaine. (A fatality has been recorded involving combination of Peganum harmala and cocaine. Fatalities resulting from combining amphetamines with pharmaceutical MAOIs are recorded in the medical literature.

) ​ Using other serotonin agonists (SSRIs) or precursors with an MAOI can lead to serotonin syndrome. Serotonin syndrome is rare but can be fatal. The main symptom of serotonin syndrome may be a severe and long-lasting headache (the same symptom as MAOI tyramine interaction) and/or fever (as high as 40 °C / 104 °F or more) Other symptoms of serotonin syndrome may include rapid heartbeat, shivering, sweating, dilated pupils, intermittent tremor or twitching, overactive or overresponsive reflexes, hyperactive bowel sounds, high blood pressure.

Severe serotonin syndrome may lead to shock, agitated delirium, muscular rigidity and high muscular tension, abnormal blood clotting and bleeding, respiratory failure, renal failure, and seizures, and can be life-threatening. This interaction can happen even if weeks have passed between stopping the SSRI and taking the MAOI. For further information on serotonin syndrome see this web page: http://www. psychotropical. com/ ​ Using other MAOIs with Ayahuasca may result in hypertensive crisis, convulsive seizures, fever, marked sweating, excitation, delirium, tremor, coma and circulatory collapse.

​ Using 5-MEO-DMT with Ayahuasca or Ayahuasca analogs can be fatal. There is a documented case of fatality combining 5-MeO-DMT with Ayahuasca and another documented case of fatality combining 5-MeO-DMT with an Ayahuasca analog. Using opiates (opium, heroin, morphine, codeine) or barbiturates with MAOIs can increase the sedative effect and result in respiratory depression. Using MAOIs with heroin or morphine can theoretically push a normal dose to the overdose threshold.

Opium (whether smoked or drunk as tea) is especially dangerous to combine with MAOIs, because it contains not only morphine and codeine, but another active alkaloid called thebaine, which can cause convulsions when combined with MAOIs, and which is also a stimulant (see above paragraph on stimulants). Painkillers synthesized from thebaine (buprenorphine, etorphine, oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone) should also be regarded as highly dangerous to combine with MAOIs. ​ Using alcohol with MAOIs may cause side effects like angina (chest pain) or headaches.

The headache may mask or be mistaken for hypertensive crisis caused by MAOI interaction. MAOIs can also increase the sedative effect of alcohol. ​ Using diuretics with MAOIs may cause a greater drop in blood pressure than normal and increase in MAOI blood levels. ​ Using anesthetics with MAOIs may potentiate or increase the anesthetic effect. ​ Using sleeping pills or tranquilizers (major or minor) with MAOIs may increase the sedative effect.

​ Using nutmeg (at psychoactive levels) with MAOIs can cause hypotensive crisis (extremely low blood pressure), rapid heartbeat, unconsciousness and potentially death. ​ Using cowhage (Mucuna pruriens) with MAOIs may result in high blood pressure, although there are unverified reports of this plant (of African and Asian origin) being used in some Ayahuasca preparations because of its minor DMT and 5-MeO-DMT content.

​ Using vasodilators with Ayahuasca may cause fainting (which carries the slight risk of choking on vomit) and increases the chances of having an experience in which one believes one is dying. Using vasodilators immediately after an Ayahuasca session also carries the risk of fainting or passing out. ​ Using Tricyclic antidepressants too close to MAOI exposure may cause serious side effects including sudden fever, extremely high blood pressure, convulsions, and death.

​ Using Fluoxetine (Prozac) within a longer, medication-specific interval of taking MAOIs may cause high fever, rigidity, high blood pressure, mental changes, confusion and hypomania. ​ Using Amitryptamine or Amoxipine with MAOIs may cause hyperpyretic crises, disseminated intravascular coagulation, convulsions, and death.

​ Using Benzedrine, Benzphetamine, Desipramine, Desoxyn, Dexedrine, Dopamine, Ephedrine (contained in Marax, Quadrinal, and other asthma drugs), Epinephrine, Guanadrel, Guanethidine, Hydralazine, Isoproterenol, L-dopa, Metaraminol, Methyldopa, Mirtazapine, Norepinephrine Oxymetazoline, Phendimetrazine, Phentermine, Phenylephrine, Phenylpropanolamine, Pseudoephedrine, Ritalin, or Venlafaxine with MAOIs may cause a hypertensive crisis (severe spike in blood pressure) which can lead to brain haemorrhage or stroke. ​ Using Adderall with MAOIs can result in high body temperature (hyperpyrexia crisis), severe increase in blood pressure (hypertensive crisis), seizures, and coma.

(See paragraph above on stimulants) ​ Using Bupropion (Wellbutrin) too close to MAOI exposure may cause serious side effects such as seizures. ​ Using Buspirone (Buspar) with MAOIs may cause high blood pressure and increased sedative effects. ​ Using Carbamazepine (Tegretol) with MAOIs may result in fever (hyperpyrexia crisis) and may cause seizures or increase seizures in epileptics. ​ Using Citalopram with MAOIs may result in severe and sometimes fatal reactions involving elevations in blood pressure, hyperthermia, rigidity, and autonomic instability.

This medicine requires an individualized, clinician-led interval before Ayahuasca. Do not stop it independently. ​ Using Clomipramine with MAOIs may cause high fever (hyperpyrexia crisis), seizures, disseminated intravascular coagulation, and death. ​ Using CNS depressants with MAOIs may increase the depressant effects. ​ Using Desipramine (Norpramin, Pertofrane) with MAOIs may result in hypertensive crisis, hyperpyretic crises, disseminated intravascular coagulation, convulsions, and death.

​ Using Dextromethorphan (DXM) at psychoactive levels with MAOIs may cause serotonin syndrome, extremely high blood pressure (hypertensive crisis), high body temperature (hyperpyrexia crisis), episodes of psychosis, and in high doses can potentially be fatal. ​ Using Dobutamine with MAOIs may precipitate severe hypertensive reaction. ​ Using Doxepin with MAOIs may cause hyperpyretic crises, disseminated intravascular coagulation, convulsions, and death. ​ Using Entacapone with MAOIs can stop the catalyst enzyme catechol-O-methyltransferase (COMT) from metabolizing levodopa to 3-O-methyldopa in the periphery, and in the brain.

​ Using Fenfluramine with MAOIs may result in fever (hyperpyrexia crisis). ​ Using Fluoxedine or Fluvoxamine with MAOIs may result in severe and sometimes fatal reactions involving elevations in blood pressure, hyperthermia, rigidity, and autonomic instability. This medicine requires an individualized, clinician-led interval before Ayahuasca. Do not stop it independently. ​ Using Gabapentin with MAOIs may result in increased blood pressure, rapid heartbeat, and/or seizures. ​ Using Horny Goat Weed with MAOIs may result in hypotensive crisis (severe blood pressure drop).

​ Using Imipramine with MAOIs may cause hyperpyretic crises, disseminated intravascular coagulation, convulsions, and death. ​ Using Isoproterenol with MAOIs may precipitate severe hypertensive crisis. ​ Using Kava with MAOIs may result in hypotensive crisis (severe blood pressure drop). ​ Using Levodopa with MAOIs can stop the catalyst enzyme catechol-O-methyltransferase (COMT) from metabolizing levodopa to 3-O-methyldopa in the periphery, and in the brain. ​ Using Linezolid with MAOIs can cause serotonin syndrome. ​ Using Lithium with MAOIs may cause fever (hyperpyrexia crisis) and serotonin syndrome (see serotonin syndrome above).

​ Using Meperidine (Demerol) with pharmaceutical MAOIs has resulted in deaths from a single dose. Immediate onset of sweating, rigidity and hypertension can occur. ​ Using Metaproterenol or other beta-adrenergic bronchodilators with MAOIs may cause blood pressure elevation and rapid heartbeat. ​ Using Mirtazapine (Remeron) with MAOIs may result in hypertensive crisis. ​ Using Nefazodone (Serzone) may result in high fever (hyperpyrexia crisis). ​ Using Paroxetine (Paxil) with MAOIs may result in severe and sometimes fatal reactions involving elevations in blood pressure, hyperthermia, rigidity, and autonomic instability.

This medicine requires an individualized, clinician-led interval before Ayahuasca. Do not stop it independently. ​ Using Sertraline with MAOIs may result in severe and sometimes fatal reactions involving elevations in blood pressure, hyperthermia, rigidity, and autonomic instability. This medicine requires an individualized, clinician-led interval before Ayahuasca. Do not stop it independently. ​ Using Temaril with MAOIs may increase chance of side effects. ​ Using Terfenadine with MAOIs may cause an increase in MAOI blood levels. ​ Using Theophylline with MAOIs may cause rapid heartbeat and anxiety.

​ Using Tolcapone with MAOIs can stop the catalyst enzyme catechol-O-methyltransferase (COMT) from metabolizing levodopa to 3-O-methyldopa in the periphery, and in the brain. ​ Using Trazodone (Desyrel) with MAOIs may result in high fever (hyperpyrexia crisis). ​ Using Tryptophan or L-tryptophan with MAOIs may cause disorientation, confusion, amnesia, delirium agitation, memory impairment, hypomanic signs, shivering. ​ Using Venlafaxine (Effexor) with MAOIs may result in hypertensive crisis or serotonin syndrome. ​ Using Ziprasidone (Geodon) with MAOIs may cause serotonin syndrome.

​ Using Zoloft (Sertraline) with MAOIs has produced fatal cases of serotonin syndrome, and can also result in fever, muscle rigidity, instability of the autonomic nervous system, delirium, and coma. ​ Special note to diabetics: MAOIs may change the amount of insulin or oral antidiabetic medication that you need

Never stop or taper prescribed medication on your own. Speak with the prescribing clinician and disclose the medicine to MERAYA before making plans.

No. Timing depends on the exact medicine, dose, duration, metabolism, withdrawal risk and clinical history. Some medicines require longer intervals.

Disclose it anyway. The list is conservative but cannot be exhaustive, and brand names and formulations change.

Potentially. Where Ayahuasca is unsuitable, MERAYA may discuss other forms of participation or plant work.

Herbs and supplements can affect serotonin, blood pressure, sedation, metabolism or other systems and can interact with medicines.

Disclose the diagnosis, symptoms, treatment history and current support. Suitability is reviewed individually.

Seek emergency medical care immediately. A retreat screening page cannot diagnose or manage an acute reaction.