Medical conditions and medications

As previously discussed, it is not recommended to use entheogens when suffering from mental disorders. Other problems can emerge from illnesses linked to our bodies capacity to detoxify - i.e. liver and kidney problems. Also, since many entheogens have effects on the cardiovascular system, they may cause extra stress which can become problematic if prior conditions exist. This can be especially dangerous if these illnesses have not already been diagnosed, meaning that you may not know what is happening. For this reason, among others, it is highly recommended to start very low in dose when introducing oneself to entheogens and to monitor ones reactions closely.
The interactions of different medications can carry well known dangers, which is why med- ication generally arrives with instructions of use, counter-indications, and a list of medicines to avoid. These should be read carefully. Unfortunately, entheogens generally do not come with said instructions. However, they can cause equally adverse interactions with several types of medications and other illegal substances. Most medication, however, has never been tested with entheogens, so information on actual interactions is hard to come by.
Some medications specifically state that they should not be taken in combination with MAOI and this should be followed strictly. This means that RIMA should also be avoided in combination with these medications. For cases in which you are unsure, it is better to postpone your journey to a time when you are not taking medication, rather than risk adverse interactions.
The following tables are taken from the article: Folke Sjqvist. “Psychotropic Drugs (2) Interaction Between Monoamine Oxidase (MAO) Inhibitors and Other Substances”. In: Proc R Soc Med. 58(11 Pt 2) (1965), 967978 and list known interactions between MAOI and generic medications. Due to their reversibility and selectivity, RIMA may have less severe effects than indicated here, however you should never test your luck in this respect.

Specific Agents Symptoms Caused Fatality Comments
Noradrenaline Potentiated adren- ergic effects

Dopamine Hypertension

Tyramine Hypertension

Amphetamine Severe headache, hypertensive crisis, cardiac arrhythmias, chest pain, circulation insufficiency. For drugs passing the blood-brain barrier central excitation possible as well Yes All fatal complications with tranylcypromine. Less dramatic cases reported also with phenelzine
Methamphetamine Yes Dextroamphetamine
Ephedrine Yes Methylphenidate
Antihypertensive drugs

Specific Drugs Symptoms Caused Fatality Comments
Thiazide diuretics Hypotension

Methyldopa Hypertesnsive reaction and central ex- citation possible
Central excitation not yet reported in man
Reserpine and re- lated compounds Reversal of the reserpine syndrome: marked hyperexcita- tion
High dose of reserpine necessary. Rarely seen in man. Hypertensive crisis after MAOI should not be treated with reserpine
Anti depressant drugs

Specific Agents Symptoms Caused Fatality Comments
Imipramine Excitation, tremor, profuse sweating, hyperpyrexia, delirium, clonic and tonic convulsions, rigidity, coma. Yes Reported after therapeutic doses of imipramine-like drugs
Amitrypyline Agitation, tremor, opisthotonus, coma, hyperpyrexia

Tranylcypromine Hypertensive crisis (mainly systolic hypertension). Clinical picture may resemble pheochromo- cytoma or sub- arachnoid bleeding. In rare instances death because of intracerebral bleeding Yes At least 20 fatal cases reported in both England and the United States
Phenelzine Similar, but less dramatic pictures de- scribed
No fatal complications reported
CNS depressants

Specific Agents Symptoms Caused Fatality Comments
Barbituates Enhanced and pro- longed sedation
Reported after therapeutic doses of imipramine-like drugs
Pheothiazines Increased extrapyramidal reactions. Hypertension

Pethidine Excitation, rigidity and coma within minutes after the injection. Hypo or hypertension, impaired respiration, hyperpyrexia, shock. Also pro- longed pethidine effects Yes The syndrome has been described after iproniazid, phenelzine and pargyline
Other drugs (found empirically)

Specific Agents Symptoms Caused Fatality Comments
Anesthetics Enhanced CNS de- pression
Poor documentation
Chloral hydrate Enhanced CNS de- pression
Poor documentation
Anti-Parkinson drugs Potentiation
Poor documentation
Insulin Hypoglycemic reactions
Reported for mebanazine
Cocaine Hyperexcitation
Uncertain association