Reference tool
MAOI Interaction Checker
MAO inhibitors interact with a wide range of foods, medications, and supplements -- some interactions are dangerous, others manageable with care. This reference lists what to research before working with ayahuasca, Syrian rue, or other harmala-containing medicines.
This is reference material, not medical advice. Always verify your specific situation with a healthcare provider. Stopping prescribed medications without supervision can also be dangerous.
Important: The most dangerous interactions involve antidepressants and other serotonergic medications. Combinations can cause serotonin syndrome -- a life-threatening reaction.
Ayahuasca uses reversible MAO-A inhibitors with shorter wash-out windows than irreversible MAOIs like phenelzine. Users of prescribed MAOIs should follow their physician's guidance specifically.
SSRIs
fluoxetine · Prozac · sertraline · Zoloft …
Selective serotonin reuptake inhibitors flood the synapse with serotonin. Combined with an MAOI they can trigger serotonin syndrome -- agitation, hyperthermia, muscle rigidity, seizures, coma.
Timing:Wash-out minimum two weeks for most SSRIs; fluoxetine (Prozac) requires five to six weeks due to long half-life.
This is among the most dangerous combinations. Never stop a prescribed SSRI to use an MAOI without supervised tapering -- doing so can also be dangerous.
SNRIs
venlafaxine · Effexor · duloxetine · Cymbalta …
Serotonin-norepinephrine reuptake inhibitors increase both serotonin and norepinephrine; combined with MAOI action, the risk of serotonin syndrome and hypertensive crisis is severe.
Timing:Wash-out minimum two weeks; longer for higher doses.
Tricyclic antidepressants
amitriptyline · nortriptyline · clomipramine · imipramine
TCAs have serotonergic and noradrenergic action. Combined with MAOIs, serotonin syndrome and hypertensive crisis are documented.
Timing:Wash-out minimum two weeks.
Other MAOIs
phenelzine · Nardil · tranylcypromine · Parnate …
Stacking MAO inhibitors compounds their effects unpredictably. Irreversible MAOIs require especially long wash-out periods before any second serotonergic substance can be safely introduced.
Timing:Wash-out minimum two weeks for irreversible MAOIs after discontinuation. Reversible MAOIs (like ayahuasca harmalas) wash out faster but should not be stacked.
Triptans
sumatriptan · Imitrex · rizatriptan · Maxalt …
Migraine medications that act on 5-HT1B/1D receptors. Combined with MAOIs can cause serotonin syndrome.
Timing:Avoid for 24 hours before and 24 hours after ceremony.
Tramadol
Ultram · Tramal
Synthetic opioid with significant serotonin and norepinephrine reuptake inhibition. Documented serotonin syndrome with MAOI combination.
Timing:Avoid for 24 hours before and 24 hours after.
Meperidine
Demerol · pethidine
Opioid with serotonergic activity. Combination with MAOIs has caused fatal reactions historically.
Timing:Avoid completely in any MAOI context.
Dextromethorphan (DXM)
DXM · cough syrup · Robitussin · Delsym
Common over-the-counter cough suppressant with serotonergic action. Easily overlooked -- check cold medicine labels carefully.
Timing:Avoid for at least 24 hours before and 24 hours after.
Linezolid
Zyvox
Antibiotic with intrinsic MAO inhibition. Combination with another MAOI is double-dipping.
Timing:Consult prescribing physician before any MAOI work.
Aged cheeses
cheddar · parmesan · blue cheese · aged gouda …
Aging breaks down protein into tyramine, which an active MAO-A would normally neutralize. Hypertensive crisis is documented from cheese-MAOI combinations.
Timing:Avoid for 24-48 hours before and 24 hours after.
Fresh cheeses -- cream cheese, ricotta, fresh mozzarella, cottage cheese -- are generally safe in moderation.
Cured and aged meats
salami · pepperoni · prosciutto · chorizo …
Curing and aging accumulate tyramine. Fresh meats are safe; aged forms can trigger hypertensive episodes.
Timing:Avoid for 24-48 hours before and 24 hours after.
Fermented soy products
soy sauce · miso · tempeh · natto …
Fermentation produces tyramine. Soy sauce in particular concentrates it; even small amounts can trigger reactions.
Timing:Avoid for 24-48 hours before and 24 hours after.
Aged red wine
Chianti · vermouth · sherry · port
Aged and fortified wines contain tyramine and other amines. Chianti is the classic example in MAOI literature.
Timing:Avoid for 24-48 hours before and 24 hours after.
Tap and draft beer
unpasteurized beer · craft beer (unfiltered)
Unpasteurized beer retains yeast and tyramine. Pasteurized bottled beer in moderation is lower-risk, but still not recommended.
Timing:Avoid for 24-48 hours before and 24 hours after.
Yeast extracts
Marmite · Vegemite · Bovril · nutritional yeast (large amounts)
Concentrated yeast extracts contain very high tyramine levels. Even small amounts can trigger hypertensive reactions.
Timing:Avoid for 24-48 hours before and 24 hours after.
Pseudoephedrine
Sudafed · decongestant
Common decongestant; releases norepinephrine. Combined with MAOI action causes hypertensive crisis. Frequently overlooked because it is over-the-counter.
Timing:Avoid for 24-72 hours before and 24 hours after.
Check cold and allergy medications carefully.
Phenylephrine
decongestant · nasal spray
Similar mechanism to pseudoephedrine. Found in many cold remedies and nasal sprays.
Timing:Avoid for 24-72 hours before and 24 hours after.
Amphetamines
Adderall · Vyvanse · Dexedrine · lisdexamfetamine
Prescription stimulants release norepinephrine and dopamine. Combination with MAOIs has caused fatal hypertensive reactions.
Timing:Wash-out minimum two weeks. Do not stop prescribed medication without supervision.
Methylphenidate
Ritalin · Concerta · Focalin
Dopamine and norepinephrine reuptake inhibitor. Hypertensive crisis risk with MAOIs.
Timing:Wash-out minimum one to two weeks; consult prescriber.
Cocaine
Powerful sympathomimetic. Combined with MAOI action, severe cardiovascular events are likely.
Timing:Avoid for 24-72 hours before and 24 hours after.
Methamphetamine
Severe hypertensive and serotonergic risk with MAOIs. Cardiovascular events documented.
Timing:Avoid completely in MAOI context.
Ephedrine and ma huang
ephedra · ma huang
Plant-derived sympathomimetic. Combined with MAOIs, severe hypertensive reactions are well documented.
Timing:Avoid for at least one week before and 24 hours after.
St. John's Wort
Hypericum perforatum
Strong serotonergic supplement that also induces metabolic enzymes. Serotonin syndrome with MAOIs is documented.
Timing:Wash-out minimum two weeks.
5-HTP
5-hydroxytryptophan
Direct serotonin precursor. Combined with MAOIs, floods serotonergic system; high serotonin syndrome risk.
Timing:Avoid for at least one week before and 24 hours after.
MDMA
ecstasy · molly
Massive serotonin release. Combined with MAOIs, severe serotonin syndrome is documented, with deaths reported. One of the most dangerous combinations.
Timing:Wash-out minimum two weeks before and three days after.
Bupropion
Wellbutrin · Zyban
Norepinephrine-dopamine reuptake inhibitor rather than serotonergic, but still raises catecholamines. Hypertensive risk with MAOI.
Timing:Wash-out minimum two weeks.
Trazodone
Serotonergic antidepressant, sometimes prescribed off-label for sleep. Documented serotonin syndrome risk with MAOIs.
Timing:Wash-out minimum two weeks.
Mirtazapine
Remeron
Atypical antidepressant with serotonergic action; combination has been associated with serotonin syndrome.
Timing:Wash-out minimum two weeks.
Buspirone
BuSpar
Partial 5-HT1A agonist used for anxiety. Theoretical serotonin syndrome risk with MAOIs.
Timing:Wash-out minimum one week.
Lithium
Mood stabilizer that affects serotonergic neurotransmission. Increased serotonin syndrome risk when combined with MAOIs.
Timing:Consult prescribing physician; do not stop without supervision.
Sauerkraut and aged fermented vegetables
kimchi · kombucha (aged)
Fermented vegetables accumulate tyramine, though typically less than aged meats or cheeses. Fresh sauerkraut and lightly fermented vegetables are lower risk.
Timing:Avoid for 24 hours before and 24 hours after.
Broad beans (fava beans)
fava beans · Vicia faba
Contain L-dopa as well as tyramine. Documented hypertensive reactions in MAOI patients.
Timing:Avoid for 24 hours before and 24 hours after.
Overripe fruits
overripe banana · overripe avocado · overripe plum
Tyramine increases as fruit ripens beyond optimal. Fresh, just-ripe fruit is safe.
Timing:Avoid clearly overripe fruit for 24 hours before and after.
Pickled or smoked fish
pickled herring · smoked salmon (aged) · anchovies
Pickling and aging fish increases tyramine content. Fresh fish is safe.
Timing:Avoid for 24 hours before and 24 hours after.
Chocolate (large amounts)
cacao (high doses) · dark chocolate
Contains phenylethylamine, a sympathomimetic amine. Small amounts are generally safe; large or ceremonial cacao doses can interact.
Timing:Avoid ceremonial doses for 24 hours before and after.
Caffeine (high doses)
energy drinks · pre-workout
Normal coffee consumption is generally tolerated. Very high doses, especially in energy drinks combined with other stimulants, can amplify cardiovascular load.
Timing:Moderate consumption; avoid energy drinks for 24 hours before and after.
Nicotine (high doses)
nicotine patches (high-dose) · vaping (heavy)
Stimulates norepinephrine release. Moderate use is generally tolerated; very heavy use can amplify blood pressure responses.
Timing:Use as normal; avoid significant dose increases around ceremony.
Note that traditional ceremonial tobacco preparations (rapé, mapacho) are often used WITH ayahuasca by experienced practitioners. Recreational nicotine context differs.
L-Tryptophan
tryptophan supplement
Serotonin precursor. Dietary tryptophan from food is generally fine; isolated supplemental doses can interact.
Timing:Avoid supplemental forms for one week before and 24 hours after.
L-Tyrosine and DLPA
tyrosine · DL-phenylalanine
Tyrosine is a tyramine precursor; high-dose supplementation can theoretically increase tyramine load.
Timing:Avoid supplemental forms for one week before and 24 hours after.
Ginseng (high doses)
Panax ginseng · American ginseng
Mild adaptogen with stimulant qualities. Theoretical interaction with MAOIs; moderate culinary use generally tolerated.
Timing:Avoid high-dose supplements for 48 hours before and 24 hours after.
Other psychedelics
LSD · psilocybin · DMT (additional) · mescaline
Stacking psychedelics with active MAOIs amplifies effects unpredictably and can prolong duration well beyond what is anticipated.
Timing:Wait at least two weeks between separate psychedelic experiences.
Note: ayahuasca itself combines DMT with MAO inhibition. The caution here is for ADDING other psychedelics on top of an active MAOI.
Alcohol (significant amounts)
Some wines and beers carry tyramine load. Alcohol itself increases cardiovascular stress and impairs the body's ability to process challenging experiences.
Timing:Avoid for 24 hours before and 24 hours after. Small amounts are not acutely dangerous but are unwise.
SAM-e
S-adenosylmethionine
Methyl donor with serotonergic effects. Limited evidence but theoretical serotonin syndrome risk.
Timing:Avoid for one week before and 24 hours after.
Cannabis
No known direct MAO interaction. Practical concern is that cannabis can amplify or unpredictably alter the trajectory of an MAOI/DMT experience.
Timing:Generally avoided during ceremony; small amounts before or after are personal choice.
Many experienced practitioners use cannabis with ayahuasca in specific contexts. Beginners should not.
Ketamine
No direct MAO interaction documented, but stacking dissociatives with classical psychedelics in close succession is generally not recommended.
Timing:Wait at least 48 hours between separate experiences.
Where MAOIs apply
MAOI-containing medicines
Ayahuasca
The brew combines DMT-containing leaves with the Banisteriopsis caapi vine, whose harmala alkaloids provide the reversible MAO-A inhibition.
Syrian Rue
Peganum harmala. Contains harmaline and harmine -- the same class of MAO inhibitors found in B. caapi. Used in ayahuasca analogues.
Chacruna
Psychotria viridis. The DMT-bearing leaf typically paired with B. caapi. Inactive without MAOI presence -- the partner makes it work.