scattered-different-pills-and-capsules-100749017.jpg

Drug interaction

Although the benefits of psilocybin outweigh the risks, it is still extremely important that you are aware of all risks and drug interactions while considering psilocybin.

Also it is common  to experience hallucinations, numbness, heaviness and strong emotions during the retreat. Please remember this is all part of the process and it will pass.

In our experience there are a few circumstances for which psilocybin should not be taken, please make sure you read below and are aware of some of the risks involved in taking this plant medicine. 

Please check this list and if you are taking any of the medications listed, make sure you get clearance from your doctor, we do not recommend you go off your medication unless directed by your doctor. 

SSRI’s

Selective serotonin reuptake inhibitors (SSRI’s) are the most commonly prescribed antidepressants. Specific variants are (generic name, brand name(s)):

  • citalopram (Celexa, Cipramil)

  • escitalopram (Lexapro)

  • fluoxetine (Prozac)

  • fluvoxamine (Luvox, Fevarin)

  • paroxetine (Seroxat, Paxil)

  • sertraline (Zoloft, Serlain)

SNRI’s

Serotonin-Norepinephrine Re-uptake Inhibitors (SNRI’s). The effects and side-effects are comparable to SSRI’s. Some SNRI’s are used for other purposes (ADHD, obesity, fibromyalgia, pain). Specific variants are (generic name, brand name(s)):

  • venlafaxine (Effexor)

  • duloxetine (Cymbalta)

  • desvenlafaxine (Pristiq)

  • atomoxetine (Strattera)

  • levomilnacipran (Fetzima)

  • milnacipran (Ixel, Savella, Impulsor)

  • sibutramine (Meridia)

  • tramadol (Ultram)

TCA/TeCA
Tricyclic Antidepressants (TCAs) and Tetracyclic Antidepressants (TeCAs) are medications that are less commonly seen in Western medicine due to the preference for so-called “third generation” antidepressants (SSRIs, SNRIs).
Some of the most well-known TCAs and TeCAs are:

  • Amineptine (Survector, Maneon)

  • Amitriptyline (Elavil, Endep)

  • Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)

  • Amoxapine (Asendin)

  • Clomipramine (Anafranil)

  • Desipramine (Norpramin, Pertofrane)

  • Dibenzepin (Noveril, Victoril)

  • Dimetacrine (Istonil)

  • Dosulepin (Prothiaden)

  • Doxepin (Adapin, Sinequan)

  • Imipramine (Tofranil)

  • Lofepramine (Lomont, Gamanil)

  • Maprotiline (Ludiomil)

  • Melitracen (Dixeran, Melixeran, Trausabun)

  • Mianserin (Tolvon)

  • Mirtazapine (Remeron)

  • Nitroxazepine (Sintamil)

  • Nortriptyline (Pamelor, Aventyl)

  • Noxiptiline (Agedal, Elronon, Nogedal)

  • Opipramol (Insidon)

  • Pipofezine (Azafen/Azaphen)

  • Protriptyline (Vivactil)

  • Setiptiline (Tecipul)

  • Tianeptine (Stablon, Coaxil)

  • Trimipramine (Surmontil)

TCAs and TeCAs work in a similar way to SNRIs, by boosting the levels of serotonin and norepinephrine in the brain. However they also activate a wide range of additional receptors, and also block some ion channels, contributing to their dangerously diverse range of side-effects.
Since TCAs and TeCAs have a less sophisticated effect on physiology and have been known to cause deaths by their effects on the heart, it is not recommended to mix these with psilocybin. In doubt, please contact your mental health care provider. The psychedelic experience is intense, and it is not wise to combine any substance that affects your heart or physiology with psilocybin.

NRI/NDRI
Norepinephrine Reuptake Inhibitors (NRIs) and Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) are substances used in the treatment of depression and anxiety disorders. They work by increasing the amount of norepinephrine (or norepinephrine and dopamine, in the case of NDRIs) available in the brain.
NRIs have mixed evidence of effectiveness, and it’s possible that some are less effective than placebo.
Some classic NRIs and NDRIs include:

  • Atomoxetine (Strattera)

  • Bupropion (Wellbutrin)

  • Methylphenidate (Ritalin, Concerta)

  • Reboxetine (Edronax)

  • Teniloxazine (Lucelan, Metatone)

  • Viloxazine (Vivalan)

It is unknown if psilocybin and NRIs/NDRIs interact. As far as we know, psilocybin does not significantly affect the norepinephrinergic or dopaminergic neurotransmitter systems. However, to be safe, do not combine psilocybin with an NDRI.


SMS/SARI
Serotonin Modulators and Stimulators (SMSs) and Serotonin Antagonists and Reuptake Inhibitors (SARIs) are two classes of antidepressant medications that are similar to SSRIs, but in addition to boosting serotonin levels in the brain, also activate (or deactivate) a number of additional serotonin receptors.
As such, these medications have more complex effects on the serotonergic system. Medications include:

  • Trazodone (Desyrel)

  • Vilazodone (Viibryd)

  • Vortioxetine (Trintellix)

Since these substances will affect the serotonin system in a potentially less predictable way than SSRIs. To be safe, we do not recommend combining these with psilocybin.

Lithium
Lithium is often given as a mediator in combination with TCAs, but can also be prescribed on its own for the treatment of depression.
Lithium is often given as a mediator in combination with TCAs. Numerous reports suggest that Lithium, when mixed with psychedelics, can cause fatal seizures or heart attacks. Do not mix psilocybin and Lithium.
Its mode of action is unknown, but there are multiple reports of Lithium being a dangerous substance to combine with psychedelics. It has been reported to cause seizures, heart failure, and even death.
We advise to consider the potential risks of psilocybin if you are taking Lithium.

MAOI's

Monoamine-oxidase inhibitors are an older class of antidepressants, especially the older variants. They had more side effects and a few were even dangerous in combination with tyramine-containing foods (like some cheeses and sauerkraut).

  • Hydrazine (antidepressant)

  • Isocarboxazid (Marplan)

  • Nialamide (Niamid)

  • Phenelzine (Nardil, Nardelzine)

  • Hydracarbazine

  • Tranylcypromine (Parnate, Jatrosom)

  • Bifemelane (Alnert, Celeport)

  • Moclobemide (Aurorix, Manerix)

  • Pirlindole (Pirazidol)

  • Toloxatone (Humoryl)

  • Rasagiline (Azilect)

  • Selegiline (Deprenyl, Eldepryl, Emsam, Zelapar)

  • Safinamide (Xadago)

Other psychoactive that should not be combined with MAOIs:

  • Kratom

  • Kava

Illegal or recreational drugs that may be dangerous to combine with MAOIs:

  • Opiates

  • Mescaline (any phenethylapsychoactiverates

Some specific pharmaceutical drugs that should not be combined with MAOIs (some are mild risks, others serious):

  • Actifed

  • Adderall

  • Alaproclate

  • Albuterol (Proventil, Ventolin)

  • Amantadine hydrochloride (Symmetrel)

  • Amineptine

  • Amitriptaline

  • Amoxapine (Asendin)

  • Atomoxedine

  • Befloxetone

  • Benadryl

  • Benylin

  • Benzedrine

  • Benzphetamine (Didrex)

  • Bicifadine

  • Brasofensine

  • Brofaromine

  • Bupropion (Wellbutrin)

  • Buspirone (BuSpar)

  • Butriptyline

  • Carbamazepine (Tegretol, Epitol

  • Chlorpheniramine

  • Chlor Trimeton

  • Cimoxetone

  • Citalopram

  • Clomipramine (Anafranil)

  • Codeine

  • Cyclobenzaprine (Flexeril)

  • Cyclizine (Marezine)

  • Dapoxotine

  • Desipramine (Pertofrane, Norpramin)

  • Desvenlafaxine

  • Dextroamphetamine (Dexedrine)

  • Dextromethorphan (DXM)

  • Dibenzepin

  • Dienolide kavapyrone desmethoxyyangonin

  • Diethylpropion

  • Disopyramide (Norpace)

  • Disulfiram (Antabuse)

  • Dopamine (Intropin)

  • Dosulepin

  • Doxepin (Sinequan)

  • Duloxetine

  • Emsam

  • Ephedrine

  • Epinephrine (Adrenalin)

  • Escitalopram

  • Femoxitine

  • Fenfluramine (Pondimin)

  • Flavoxate Hydrochloride (Urispas)

  • Fluoxetine (Prozac)

  • Fluvoxamine

  • Furazolidone (Furoxone)

  • Guanethedine

  • Guanadrel (Hylorel)

  • Guanethidine (Ismelin)

  • Hydralazine (Apresoline)

  • 5 Hydroxytryptophan

  • Imipramine (Tofranil)

  • Iprindole

  • Iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida)

  • Iproclozide

  • Isocarboxazid (Marplan)

  • Isoniazid (Laniazid, Nydrazid)

  • Isoniazid rifampin (Rifamate, Rimactane)

  • Isoproterenol (Isuprel)

  • L dopa (Sinemet)

  • Levodopa (Dopar, Larodopa

  • Linezolid (Zyvox, Zyvoxid)

  • Lithium (Eskalith)

  • Lofepramine

  • Loratadine (Claritin)

  • Maprotiline (Ludiomil)

  • Medifoxamine

  • Melitracen

  • Meperidine (Demerol)

  • Metaproterenol (Alupent, Metaprel)

  • Metaraminol (Aramine)

  • Methamphetamine (Desoxyn)

  • Methyldopa (Aidomet)

  • Methylphenidate (Ritalin)

  • Mianserin

  • Milnacipran

  • Minaprine

  • Mirtazapine (Remeron)

  • Moclobemide

  • Montelukast (Singulair)

  • Nefazodone

  • Nialamide

  • Nisoxetine

  • Nomifensine

  • Norepinephrine (Levophed)

  • Nortriptyline (Aventyl)

  • Oxybutynin chloride (Ditropan)

  • Oxymetazoline (Afrin)

  • Orphenadrine (Norflex)

  • Pargyline (Eutonyl)

  • Parnate

  • Paroxetine (Paxil)

  • Pemoline (Cylert)

  • Percocet

  • Pethedine (Demerol)

  • Phendimetrazine (Plegiline)

  • Phenergen

  • Phenmetrazine

  • Phentermine

  • Phenylephrine (Dimetane, Dristan decongestant, Neo Synephrine)

  • Phenylpropanolamine (in many cold medicines)

  • Phenelzine (Nardil)

  • Procarbazine (Matulane)

  • Procainamide (Pronestyl)

  • Protriptyline (Vivactil)

  • Pseudoephedrine

  • Oxymetazoline (Afrin)

  • Quinidine (Quinidex)

  • Rasagiline (Azilect)

  • Reboxetine

  • Reserpine (Serpasil)

  • Risperidone

  • Salbutemol

  • Salmeterol

  • Selegiline (Eldepryl)

  • Sertraline (Zoloft)

  • Sibutramine

  • Sumatriptan (Imitrex)

  • Terfenadine (Seldane D)

  • Tegretol

  • Temaril

  • Tesofensine

  • Theophylline (Theo Dur)

  • Tianeptine

  • Toloxatone

  • Tramidol

  • Tranylcypromine (Parnate)

  • Trazodone

  • Tricyclic antidepressants (Amitriptyline, Elavil)

  • Trimipramine (Surmontil)

  • Triptans

  • Vanoxerine

  • Venlafaxine (Effexor)

  • Viloxezine

  • Yohimbine

  • Zimelidine

  • Ziprasidone (Geodon)

Other Substances

If your antidepressant isn’t listed here, or if you are curious about non-antidepressant interactions with psilocybin, we first recommend contacting your healthcare provider.

  • Bupropion (Wellbutrin / Zyban)

  • Vortioxetine (Trintellix)

Illegal or recreational drugs that are very dangerous to combine with MAOIs:

  • Cocaine

  • Amphetamines (meth-, dex-, amphetamine)

  • MDMA (Ecstasy)

  • MDA

  • MDEA

  • PMA

  • Dextromethorphan (DXM)

Avoid 2-weeks prior to consuming psilocybin:

  • St. Johns Wort

  • Kava

  • Kratom

  • Ephedra

  • Ginseng

  • Yohimbe

  • Sinicuichi

  • Rhodiola Rosea

  • Kanna

  • Boswellia

  • Nutmeg

  • Scotch Broom

  • Licorice Root

Other medications you must suspend taking are decongestants, cold medications, allergy medications, antihistamines, sedatives, tranquilizers, amphetamines (including Adderall), some hypertensive medications, sympathomimetic amines including pseudoephedrine and ephedrine, carbamazipine, methylphemidate (Ritalin), macromerine, phenelanine, tyrosine, tryptophan, asarone/calamus, asthma inhalers and diet pills.

 If you have a heart condition or high blood pressure you are advised to not participate in this retreat.

Special note to diabetics: MAOIs may change the amount of insulin or oral anti-diabetic medication that you need. If you are diabetic is best to refrain from taking psilocybin.

It is preferable to not take any other substances or medicines, as it may interfere with the plants energy and provoke unwanted reactions.

References:

  1. Carhart-Harris, R. L. (2019). How do psychedelics work? Current Opinion in Psychiatry, 32, 16-21. doi:10.1097/yco.0000000000000467

  2. Johnson, M., Richards, W., & Griffiths, R. (2008). Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology, 22(6), 603–620. doi:10.1177/0269881108093587

  3. Griffiths, R. R., Richards, W. A., McCann, U., & Jesse, R. (2006). Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology, 187(3), 268–283. doi:10.1007/s00213-006-0457-5