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MDMA + MAOI

We recommend avoiding this combination. No numeric safety recommendation possible.

review pending

Content is undergoing medical and legal review. Changes possible.

Substances involved

Risk profile

MAO inhibitors block the breakdown of serotonin. MDMA floods the system with serotonin. Combination = classic serotonin syndrome, cardiac crisis and hypertensive emergency — established as deadly.

Acute emergency scenarios

MAO inhibitors show up in several contexts:

  • Pharmaceutical: moclobemide, selegiline, tranylcypromine, phenelzine
  • Plant-based: Banisteriopsis caapi (ayahuasca vine), Syrian Rue (Peganum harmala), some antidepressant teas
  • Recreational: some designer substances from the phenethylamine family

MDMA releases serotonin massively and blocks its reuptake. The MAO inhibitor prevents its breakdown. The result is a serotonin flood with:

  • Hypertensive crisis (blood pressure > 200 mmHg)
  • Hyperthermia above 40 °C
  • Seizures
  • Rhabdomyolysis (muscle breakdown)
  • Multi-organ failure

In the ayahuasca context, deaths from MDMA mixed use are documented — even at low MDMA doses. The washout period for pharmaceutical MAO inhibitors is at least 2 weeks before taking MDMA.

We recommend strictly avoiding this combination. If you take MAO inhibitors or plan ayahuasca ceremonies: no MDMA, no DXM, no other serotonergic substance.