1V-LSD

Severe hypertension, unstable angina, recent myocardial infarction, aortic stenosis, or other conditions where acute sympathomimetic stress poses risk. Moderate cardiovascular increases documented in controlled LSD studies (Holze et al. 2021).

Active seizure disorder or history of epilepsy. The combination with tramadol (which also lowers seizure threshold) poses compounded risk.

Personal or family history of schizophrenia, schizoaffective disorder, or other primary psychotic illness. Risk extends to first-degree relatives without personal history.

Bipolar I and II disorder. Risk is elevated in individuals not stabilized on mood stabilizers. Clinical trial protocols for psychedelic research typically exclude bipolar disorder.

Pregnancy at any stage. No safe dose has been established. Breastfeeding is also contraindicated due to unknown excretion into breast milk.

Current lithium therapy. This is a medication-based rather than disease-based contraindication. The interaction appears idiosyncratic and potentially life-threatening.