Medication Interactions

Medication classes and interaction risk

• SSRIs and SNRIs (antidepressants)

  Moderate, retreat-type dependent

  For psilocybin retreats (Awaken): SSRIs and SNRIs are Tier 2, pharmacist-reviewed tapering is assessed on a case-by-case basis. For ayahuasca retreats (Heal): SSRIs and SNRIs are effectively Tier 1 because ayahuasca contains an MAOI, and the combination creates serious serotonin syndrome risk.

  Washout timing varies by specific agent. See our medication tapering guide for detail.

• Pharmaceutical MAOIs

  High, absolute contraindication with ayahuasca

  Pharmaceutical MAOIs combined with the MAOI in ayahuasca create hypertensive crisis and serotonin syndrome risk. This is a disqualifying combination. MAOIs combined with psilocybin carry meaningful serotonin syndrome risk and are also generally contraindicated.

• Antipsychotics

  Moderate, individual assessment required

  Antipsychotics may blunt psychedelic effects and may increase dystonia risk. Their presence in an applicant's regimen is a signal for deeper psychiatric review, not automatic disqualification.

• Lithium

  High, likely Tier 1

  Lithium combined with psychedelics has documented cases of seizure and unpredictable potentiation. Treated as a likely Tier 1 contraindication pending psychiatric clearance and pharmacist review. Applicants on lithium require their prescribing psychiatrist's direct involvement.

• Tramadol and opioids

  High, generally contraindicated

  Tramadol is serotonergic and creates meaningful serotonin syndrome risk in combination with psychedelics. Opioids more broadly carry unpredictable potentiation risk. Both are generally contraindicated; exceptions require case-by-case pharmacist review.

• Stimulants (amphetamines, methylphenidate)

  Moderate, tapering usually recommended

  Stimulants raise cardiovascular baseline and can increase tachycardia and hypertension risk during ceremony. Tapering before retreat is generally recommended.

• Cardiovascular medications (beta-blockers, ACE inhibitors, calcium channel blockers)

  Generally compatible, monitoring required

  Most cardiovascular medications are compatible with psychedelic retreats. Hypertension and tachycardia monitoring during ceremony is standard. The specific agent, dose, and the applicant's cardiovascular history determine individual risk.

• Benzodiazepines

  Moderate, blunts experience, timing matters

  Benzodiazepines significantly blunt psychedelic effects. They are sometimes used to abort a difficult experience. Taking them before or during ceremony reduces therapeutic value and may mask signals that warrant medical attention.

Does my medication need to be tapered?

Not all medications require stopping. Some require dose adjustment and timing. Some require a gradual taper supervised by your prescriber. We build a tapering plan with you, we do not ask anyone to taper unsupported or without prescriber involvement.

See our medication tapering guide for the full framework.