Who Should Not Take Ayahuasca: The Contraindications, In Full

Most free guides about ayahuasca are written to encourage you. This one is written to filter. If by the end of it you find you have an absolute contraindication, then it has done its job — arguably better than if it had walked you all the way to the ceremony.

1. The pharmacological list

If you take any of these, you must not participate without resolving it first with your doctor, with enough lead time. This is covered in depth in our article on antidepressants, because it is the interaction that has actually caused documented harm.

• SSRIs, SNRIs, tricyclics, pharmaceutical MAOIs, lithium, antipsychotics — risk of serotonin syndromeMAPS 1995
• Tramadol, pethidine/meperidine, dextromethorphan (in many cough syrups), St John's WortMAPS 1995
• Decongestants and cold remedies (pseudoephedrine, ephedrine), asthma inhalers, diet pills — risk of hypertensive crisisMAPS 1995
• Stimulants — amphetamines, methylphenidate, cocaine, MDMA, mescalineMAPS 1995
• Levodopa, dopamine, carbamazepine, certain antihypertensivesMAPS 1995

2. The psychiatric list

Here the criterion is different. We are not talking about a chemical reaction lasting a few hours, but about unearthing deep psychological material in a mind that may be vulnerable to it.

Exclusion — personal history, or a first-degree family history, of:

• Schizophrenia or psychotic-spectrum disorders
• Bipolar disorder, especially type I
• Psychotic episodes of any origin

The family component is not a technicality. A parent's or sibling's history can indicate vulnerability even if you have never had symptoms yourself. The ICEERS safety guide explicitly recommends that people with a personal or family history of psychosis, schizophrenia, bipolar disorder, or depression with psychotic symptoms abstainICEERS 2019

3. The physical list

• Significant cardiovascular disease — heart disease, arrhythmias, a history of heart attack or stroke. The purge and nervous-system activation involve real physical exertion.
• Uncontrolled hypertension — because of the hypertensive-crisis risk described above.
• Pregnancy and breastfeeding — exclusion.
• Liver disease — the liver metabolizes the alkaloids. Any degree, mild to severe, is a matter for mandatory medical discussion, not self-assessment.
• Epilepsy or seizure disorders — not established as an automatic exclusion, but a condition you must put explicitly on the table with your doctor, along with any anticonvulsant you take. Neither a categorical no nor a reassuring yes: an "ask first."
• Diabetes, kidney conditions, any chronic illness — not automatic exclusions, but mandatory medical conversation.

For any borderline condition the answer is the same, and it is not a dodge: ask your doctor, with a completed medical form in front of you. No article can assess your case remotely. What an article can do is give you the right questions.

What a good center does with this

A reputable retreat will ask for your medical and psychological history before accepting you, and will turn away people with contraindicationsICEERS 2019 If a center asks you nothing about your health or your medications, you have learned something important about that center — before you have learned anything about yourself.

If you land on the exclusion list

Then the honest thing to say is: not today. And, just as honestly, that this is a real outcome with real alternatives — psychotherapy, other contemplative practices, treating and stabilizing the underlying condition. If your situation changes later, under medical supervision, the door stays open.

The research is clear that the physical risk profile is favorable in healthy people in responsible settingsRuffell 2023 The whole purpose of a list like this one is to establish whether the word "healthy" applies to you, in the specific senses that matter here.