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Understanding the safety profile of MAOIs

bk2492

Established member
There is a divide in the psychedelic movement. Some people see ayahuasca as a burden, changing their diets and ceasing meds and supplements before its use, while others aren't especially concerned and even go experimental. The reason for this divide is that there is a lot of literature that warns about the interactions of medications, foods, and beverages with MAOIs. The problem with this is that "much of what is published by doctors in books and journals about MAOIs is either poorly informed, or just plain wrong."[1]

I'm intent on understanding the true safety profile of these substances. Indeed, even the indigenous appear to do things that go against medical spin:

First of all, B. caapi contains a serotonin reuptake inhibitor.[2]

In fact, there is evidence that one tribe increases the SRI content in their brews by adding a unique herb that contains only the SRI.[3][4]


"Ayahuasca con coca or cocahuasca is made by cooking Banisteriopsis caapi and chakruna together with plenty of coca leaves. It is said that the coca produces a greater centering of consciousness. It also appears to stimulate talking."

Ayahuasca especial²⁴ ²⁵

Banisteriopsis caapi stem
Psychotria viridis leaves
coca leaves
San Pedro slices
Opuntia (prickly pears) pieces
peyote buttons
toé blossoms

"This special concoction from Guillermo Arévalo is only intended for really experienced ayahuasca drinkers, and certainly not for beginners! It may well be the most potent pharmaceutical discovery of the ayahuasqueros to date."[5]


"Although B. caapi can be the sole ingredient of the tea[7], up to 100 different plants have been described as admixtures to ayahuasca. These plants contain a wide variety of psychotropic substances such as nicotine (from Nicotiana spp.), scopolamine (from Brugmansia spp.), caffeine (from Ilex guayusa and Paullinia yoco), cocaine (from Erythoxylum coca) and N,N-dimethyltryptamine (DMT, from Psychotria viridis and Diplopterys cabrerana)[2, 8.]"[6]


"Coca is a beautiful plant. At retreats they often offer a Mambe, which is a Coca leafs powder with some admixtures. It gives you good energy and concentration during the night. So Coca is perfectly suitable with Ayahuasca."[7]

"Best Ayahuasca I ever had was brewed with coca inside it."[8]

Additional testimonies are on this page: reddit.com/r/Ayahuasca


So far I've gathered a lot of evidence that speaks against the status quo. I invite others to join me on this mission. This is a thread of mine that includes a lot of the evidence I've gathered so far ⇩

https://www.bluelight.org/community/threads/945930/


Note that phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) are the three nonselective, irreversible MAOIs that can be prescribed in the United States.


1. MAOIs (Parnate, Nardil): Misconceptions and Questions No. 1. Ken Gillman, MD. PsychoTropical Research. 2012-11-14


2. Inhibition by β-carbolines of monoamine uptake into a synaptosomal preparation: Structure-activity relationships. Buckholtz, N., Boggan, W. 1977. Life Sciences, 20(12), p. 2093, doi: 10.1016/0024-3205(77)90190-4

The name of the SRI is tetrahydroharmine and the above study shows that THH is an SRI.


3. "THH is another major alkaloid in B. caapi. I have also detected this alkaloid in the leaves of Calliandra pentandra, which are sometimes added to ayahuasca by the Shuar in Equador, where it is reported to enhance the visionary effects of this brew (Fericgla 1997). This is a bit surprising, as THH is not remarkably psychoactive on its own, even after MAO inhibition (unpublished results). THH, like other 1-methyl-tetrahydro-ß-carbolines, probably serves to further increase serotonin concentrations by weakly inhibiting serotonin’s reuptake into presynaptic neurons after MAO inhibition by harmine (Airaksinen et al. 1980). This effect is not trivial, as the reuptake mechanism and MAO metabolism are the primary processes that clear excess serotonin from the synaptic cleft."

"Fericgla, J. M. 1997. Al Trasluz de la Ayahuasca: Coleccion Cogniciones, Estados Modificados de Consciencia. Barcelona: Los Libros de la Liebre de Marzo."

"Airaksinen, M. M., H. Svensk, J. Tuomisto, and H. Komulainen. 1980. Tetrahydro ß-carbolines and corresponding tryptamines: In vivo inhibition of serotonin and dopamine uptake by human blood platelets. Acta Pharmacologia et Toxicologia 46:308–13."

J. C. Callaway, Ph.D. Chapter 3. Phytochemistry and Neuropharmacology of Ayahuasca. [The Ayahuasca Experience: A Sourcebook on the Sacred Vine of Spirits. Ralph Metzner (editor). 2014.]


4. "I have recently learned of analysis of an Ayahuasca brew that had used the plant Calliandra pentandra as a component, instead of the usual Psychotria viridis."

[…]

"Calliandra pentandra has good amounts of THH in the leaves, and it is used as an add mixture by some groups like the Shuar in Equador, and visions have been reported by reliable western folk from this and Banisteriopsis caapi. so, there still may be something there to look at more closely."

"I am not aware of any other analyses on this plant species, aside from my own investigations (which are what Sasha refers to in TIHKAL)."

Jace Callaway, Ph.D. Calliandra Chemistry? The Entheogen Review, vol. XII, #2, summer solstice, 2003


5. Christian Rätsch. ETHNOBOTANICA AYAHUASCA / COCA: THE “LEAF OF LIFE” [Ayahuasca: Rituals, Potions and Visionary Art from the Amazon. Adelaars, A., Müeller-Ebeling, C., Rätsch, C. 2016. Divine Arts. ISBN: 9781611250510


6. The alkaloids of Banisteriopsis caapi, the plant source of the Amazonian hallucinogen Ayahuasca, stimulate adult neurogenesis in vitro. Morales-García JA, de la Fuente Revenga M, Alonso-Gil S, Rodríguez-Franco MI, Feilding A, Perez-Castillo A, Riba J. Sci Rep. 2017 Jul 13;7(1):5309. doi: 10.1038/s41598-017-05407-9


7. PonyKillStation, 2023-09-15, reddit.com/r/Ayahuasca


8. MapachoCura, 2023-09-14, reddit.com/r/Ayahuasca
 
If you ask me, the diet stuff is ironically totally overblown and also underrated. Overblown in that a lot of the dietary restrictions have no basis in traditional use in South America and come from western ideas of MAOIs.

Coca likely isn't an issue because it's not pure cocaine, not only are there a plethora of other compounds at work but also the quantity of cocaine is small.

SRIs are another matter..I had typed a story of a personal story shared by a friend about a guy he knew where there might be some flexibility re RIMAs and SRIs but I decided that it wasn't worth sharing due to risk of illness and the weakness of the already anecdotal evidence. Needless to say there might be some leniency there but serotonin syndrome isn't something I'd want to risk myself but would like to hear solid evidence that pharmaceutical SRIs could be used safely with Ayahuasca and it's analogues.

THH is weakly SRI so might not be enough to actually be affected negatively. It might also be something specifically about the pharmacology of THH which makes it some how compatible.
 
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