Medication interaction checker

SSRI antidepressants with ayahuascaDangerous combination

The MAO-inhibiting harmala alkaloids in ayahuasca combined with SSRI antidepressants may induce a serotonin syndrome with a potentially grave outcome. ICEERS states that combining MAOIs with SSRIs or other serotonergic medications is contraindicated. (Journal of Psychoactive Drugs, 1998; ICEERS, 2026)

SNRI antidepressants with ayahuascaDangerous combination

ICEERS states that combining MAOIs, such as the harmala alkaloids in ayahuasca, with SSRIs or other serotonergic medications is contraindicated. A review of serotonin toxicity notes that true serotonin toxicity typically occurs when a drug that increases synaptic serotonin is combined with an MAOI. (ICEERS, 2026; Psychopharmacology (Berl), 2022)

MAO inhibitors with ayahuascaUse caution

Ayahuasca's harmine and harmaline reversibly inhibit monoamine oxidase A, which is how orally taken DMT becomes active. ICEERS lists any medication that interacts with MAO, including MAO inhibitors, as potentially contraindicated. (Journal of Pharmacology and Experimental Therapeutics, 2003; ICEERS, 2018)

Tricyclic antidepressants with ayahuascaUse caution

ICEERS lists antidepressants and other psychotropic medications as potentially contraindicated with ayahuasca, and says combining MAOIs with serotonergic medications is contraindicated. Some tricyclics are serotonergic: the tramadol label, for example, names TCAs among serotonergic drugs. (ICEERS, 2018; ICEERS, 2026; Rising Pharma Holdings, via DailyMed (US National Library of Medicine), 23 Oct 2026)

Tramadol with ayahuascaDangerous combination

The tramadol label says not to use tramadol in patients taking MAOIs or within 14 days of stopping them, because the interaction may cause serotonin syndrome or opioid toxicity. Ayahuasca's harmine and harmaline are MAO-A inhibitors, and ICEERS advises avoiding opioids in the days or weeks before a session. (Rising Pharma Holdings, via DailyMed (US National Library of Medicine), 23 Oct 2026; Journal of Pharmacology and Experimental Therapeutics, 2003; ICEERS, 2018)

St John's wort with ayahuascaDangerous combination

ICEERS names St John's wort and Ginkgo biloba as contraindicated herbal supplements with ayahuasca, alongside antidepressants and any medication that interacts with MAO. (ICEERS, 2018)

Opioids, including methadone and buprenorphine with ayahuascaUse caution

ICEERS advises avoiding alcohol, stimulants, opioids and other drugs in the days or weeks before an ayahuasca session. Some opioids are also serotonergic: the tramadol label names tramadol itself among drugs that can cause serotonin syndrome. (ICEERS, 2018; Rising Pharma Holdings, via DailyMed (US National Library of Medicine), 23 Oct 2026)

Stimulants with ayahuascaUse caution

ICEERS advises avoiding alcohol, stimulants, opioids and other drugs in the days or weeks before an ayahuasca session, and says people with serious cardiovascular conditions should not take ayahuasca because it can raise blood pressure. (ICEERS, 2018)

Alcohol with ayahuascaUse caution

ICEERS advises avoiding alcohol, stimulants, opioids and other drugs in the days or weeks before an ayahuasca session. (ICEERS, 2018)

SSRI antidepressants with psilocybinWeaker effects

In a survey of 611 reports of taking mushrooms with an antidepressant, the probability of weaker than expected effects was 0.47 for SSRIs, and reduced effects may persist up to 3 months after stopping. A review of serotonin toxicity concluded that serotonergic drugs without MAOIs are low risk with psychedelics that also lack MAOIs, such as psilocybin. (Journal of Psychopharmacology, 2023; Neuropsychopharmacology, 1996; Psychopharmacology (Berl), 2022)

SNRI antidepressants with psilocybinWeaker effects

In the same survey of 611 reports, the probability of weaker than expected psilocybin effects was 0.55 for SNRIs, and reduced effects may persist up to 3 months after stopping an SSRI or SNRI. The serotonin toxicity review rates serotonergic drugs without MAOIs as low risk with psilocybin. (Journal of Psychopharmacology, 2023; Psychopharmacology (Berl), 2022)

Bupropion with psilocybinWeaker effects

In a survey of 611 reports of taking mushrooms with an antidepressant, the probability of weaker than expected effects was 0.29 for bupropion, against 0.47 for SSRIs and 0.55 for SNRIs. (Journal of Psychopharmacology, 2023)

MAO inhibitors with psilocybinUse caution

A review of serotonin toxicity found that true serotonin toxicity typically occurs when a drug that increases synaptic serotonin is combined with an MAOI, and that the main danger arises when an MAOI is involved. A small questionnaire study of LSD (not psilocybin) found chronic MAOI use was associated with weaker responses. (Psychopharmacology (Berl), 2022; Behavioural Brain Research, 1996)

Tricyclic antidepressants with psilocybinUse caution

A small retrospective questionnaire study (10 people using LSD, not psilocybin) found chronic tricyclic antidepressant use was associated with subjectively stronger physical, hallucinatory and psychological responses. (Behavioural Brain Research, 1996)

Lithium with psilocybinDangerous combination

An analysis of online reports found that 47% of 62 reports of lithium taken with a classic psychedelic (such as psilocybin or LSD) involved seizures and 39% involved medical attention. Oregon's licensed programme bars anyone who has taken lithium in the last 30 days from an administration session. (Pharmacopsychiatry, 2021; Oregon Health Authority, Public Health Division, 2026)

Lamotrigine with psilocybinLow risk reported

In the same analysis of online reports, none of 34 reports of lamotrigine taken with a classic psychedelic involved seizures, and most (65%) were judged not to affect the experience. These are self-selected internet reports, not a trial, and the authors call their conclusions provisional. (Pharmacopsychiatry, 2021)

Alcohol with psilocybinUse caution

The Trimbos Institute's DRUGSinfo advises against combining mushrooms or truffles with other drugs, and says alcohol increases the chance of a bad trip. (DRUGSinfo (Drugs Infolijn), Trimbos-instituut)

MAO inhibitors with mdmaDangerous combination

Australian forensic researchers reported four deaths from serotonin toxicity caused by MDMA combined with moclobemide, a reversible MAO-A inhibitor; two involved moclobemide at common prescribed concentrations. A review of 106 Victorian coroner cases with MDMA (2002 to 2008) classed 4 MDMA plus moclobemide cases as high-risk interactions. (Forensic Science International, Pilgrim JL, Gerostamoulos D, Woodford N, Drummer OH, 2012; Journal of Analytical Toxicology, Pilgrim JL, Gerostamoulos D, Drummer OH, 2011)

SSRI antidepressants with mdmaWeaker effects

In a placebo-controlled study of 16 healthy volunteers, pretreatment with the SSRI citalopram markedly reduced most of MDMA's psychological effects. A 2022 systematic review of 40 publications compiles the human evidence on psychiatric medications taken with MDMA or psilocybin. (Neuropsychopharmacology, Liechti ME, Baumann C, Gamma A, Vollenweider FX, 2000; Psychopharmacology (Berl), Sarparast A, Thomas K, Malcolm B, Stauffer CS, 2022)

SNRI antidepressants with mdmaWeaker effects

In a randomised, placebo-controlled study of 16 healthy subjects, duloxetine inhibited MDMA's effects, including rises in blood pressure, heart rate and the subjective effects, even though plasma MDMA levels were higher. (PLoS One, Hysek CM, Simmler LD, Nicola VG, et al., 2012)

Bupropion with mdmaUse caution

In a placebo-controlled crossover study of 16 healthy subjects, bupropion raised plasma MDMA concentrations and prolonged its subjective effects, and MDMA raised plasma bupropion concentrations; bupropion lowered MDMA's heart rate response. The authors conclude that MDMA during bupropion therapy may mean higher concentrations of both drugs. (Journal of Pharmacology and Experimental Therapeutics, Schmid Y, Rickli A, Schaffner A, et al., 2015)

Stimulants with mdmaUse caution

In a placebo-controlled crossover study in healthy subjects, the haemodynamic and adverse effects of methylphenidate and MDMA taken together were significantly higher than with either alone, without stronger psychoactive effects. On its own, MDMA raised systolic blood pressure above 160 mmHg in 33% of 166 healthy study subjects. (International Journal of Neuropsychopharmacology, Hysek CM, Simmler LD, Schillinger N, et al., 2014; Journal of Psychopharmacology, Vizeli P, Liechti ME, 2017)

SSRI antidepressants with ketamine or esketamineLow risk reported

The SPRAVATO label approves esketamine for treatment-resistant depression in adults alone or in conjunction with an oral antidepressant. That is the approved product given in a certified clinic with at least 2 hours of monitoring, not ketamine from other sources. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026)

SNRI antidepressants with ketamine or esketamineLow risk reported

The SPRAVATO label approves esketamine for treatment-resistant depression in adults alone or in conjunction with an oral antidepressant, under monitoring in a certified healthcare setting. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026)

MAO inhibitors with ketamine or esketamineUse caution

The SPRAVATO label says use with MAOIs may increase blood pressure and should be closely monitored. A 2022 review of 39 patients given ketamine with an MAOI found blood pressure and heart rate rises, clinically significant in 1 patient, and no hypertensive crisis or serotonin syndrome, but the authors say the sample was small and doses low. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026; Journal of Clinical Psychiatry, Veraart JKE, Smith-Apeldoorn SY, Kutscher M, et al., 2022)

Benzodiazepines with ketamine or esketamineUse caution

The SPRAVATO label says use with CNS depressants, for example benzodiazepines, opioids and alcohol, may increase sedation, which should be closely monitored. In trials 48% to 61% of patients on Spravato developed sedation. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026)

Opioids, including methadone and buprenorphine with ketamine or esketamineUse caution

The SPRAVATO label says use with CNS depressants, including opioids, may increase sedation, and that respiratory depression has been observed after marketing, which is why patients are monitored for at least 2 hours after each dose. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026)

Alcohol with ketamine or esketamineUse caution

The SPRAVATO label names alcohol among the CNS depressants whose use with esketamine may increase sedation. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026)

Stimulants with ketamine or esketamineUse caution

The SPRAVATO label says use with psychostimulants such as amphetamines, methylphenidate, modafinil and armodafinil may increase blood pressure, which should be closely monitored. Spravato alone raises blood pressure at all recommended doses, peaking about 40 minutes after a dose. (Janssen Pharmaceuticals, via DailyMed (US National Library of Medicine), 24 Sep 2026)

SSRI antidepressants with ibogaineDangerous combination

The GITA guidelines say SSRIs and SNRIs may present a risk of serotonin syndrome near ibogaine and that both share the CYP2D6 liver enzyme that breaks ibogaine down. In a study of 21 healthy volunteers, pretreatment with paroxetine, a CYP2D6 inhibitor, roughly doubled exposure to ibogaine plus its active metabolite. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016; Journal of Clinical Pharmacology, Glue P, Winter H, Garbe K, et al., 2015)

SNRI antidepressants with ibogaineDangerous combination

The GITA guidelines say SSRIs and SNRIs may present a risk of serotonin syndrome if taken close to ibogaine, although the extent is not clear, and that their use of the CYP2D6 enzyme may slow ibogaine's metabolism and present significant risks. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

MAO inhibitors with ibogaineDangerous combination

The GITA guidelines list MAOIs among medicines that raise serotonin and note that ibogaine also raises serotonin, with extreme levels able to cause serotonin syndrome. They advise that psychiatric medication be tapered and stopped before treatment only in communication with the patient's psychiatrist. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

Tramadol with ibogaineDangerous combination

The GITA guidelines name tramadol among the pain medicines that raise serotonin, which ibogaine also raises. They also warn that ibogaine resets opioid tolerance, so opioid use during or after treatment carries an acute overdose risk. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

St John's wort with ibogaineUse caution

The GITA guidelines list St John's wort among the dietary supplements that raise serotonin, which ibogaine also raises; extreme levels can cause serotonin syndrome. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

Opioids, including methadone and buprenorphine with ibogaineDangerous combination

The GITA guidelines warn that ibogaine resets opioid tolerance to that of an opioid-naive person, so using opioids during or after treatment carries an acute risk of overdose. They give specific transition rules for methadone and buprenorphine and note that large methadone doses can themselves prolong the QT interval. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

Benzodiazepines with ibogaineDangerous combination

A review of 19 deaths after ibogaine names seizures from alcohol and benzodiazepine withdrawal as an apparent risk factor. The GITA guidelines warn that stopping benzodiazepines suddenly or within 72 hours before treatment may cause life-threatening seizures, and that seizures under ibogaine can trigger lethal arrhythmias. (Journal of Forensic Sciences, 2012; Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

Alcohol with ibogaineDangerous combination

A review of 19 deaths after ibogaine names seizures associated with alcohol withdrawal as an apparent risk factor, and the GITA guidelines warn that stopping alcohol suddenly or within 72 hours before treatment may cause life-threatening seizures. (Journal of Forensic Sciences, 2012; Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

Medicines that prolong the QT interval with ibogaineDangerous combination

The GITA guidelines say other QT-prolonging drugs exacerbate ibogaine's effects on heart rhythm and can put a patient at greater risk of lethal arrhythmias. In a Dutch study of 14 patients given ibogaine, half reached a QTc over 500 ms. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016; Addiction, 2022; Addiction Biology, 2014)

Stimulants with ibogaineDangerous combination

The GITA guidelines say ibogaine can amplify the effects of stimulants taken with it, and that using opioids or stimulants during or after treatment carries an acute risk of overdose. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)

Antipsychotics with ibogaineUse caution

The GITA guidelines say all centrally acting drugs, a group that includes antipsychotics, benzodiazepines and anticonvulsants, should be avoided or managed with extreme vigilance with ibogaine, because the interactions are not well understood. (Global Ibogaine Therapy Alliance (Internet Archive copy), 2016)