2-MMC

coronary artery disease, heart failure, uncontrolled hypertension, structural heart defects, history of arrhythmia

Cathinone-induced norepinephrine release produces dose-dependent increases in heart rate and blood pressure. Serious cardiac events including myocardial infarction, cardiac arrest, and ventricular tachycardia are documented in the synthetic cathinone class. No 2-MMC-specific cardiac data exist; classification based on shared sympathomimetic mechanism with 3-MMC and mephedrone.

epilepsy, history of seizures, conditions lowering seizure threshold

Seizures are documented in approximately 8% of 3-MMC intoxication presentations (Swedish STRIDA project data). Monoamine releasing agents lower seizure threshold through excessive catecholamine release. No 2-MMC-specific seizure data exist; risk inferred from cathinone class.

active psychosis, bipolar disorder, severe anxiety disorders, schizophrenia spectrum disorders

Dopaminergic stimulation from monoamine releasing agents can precipitate or exacerbate psychotic symptoms, manic episodes, and panic attacks. Cathinone-class literature documents hallucinations in 20% and agitation in 42% of intoxication presentations. Individuals with pre-existing psychiatric vulnerability are at elevated risk.

liver disease, hepatic insufficiency, CYP2D6 poor metabolizer status

If CYP2D6 and CYP2E1 mediate 2-MMC metabolism as predicted from 3-MMC hepatocyte data (Dias da Silva 2019), impaired hepatic function would alter drug clearance and potentially increase exposure to toxic metabolites. 3-MMC induces oxidative stress, apoptosis, and autophagy in rat hepatocytes at human-relevant concentrations.

pregnancy, lactation

No reproductive toxicity data exist for 2-MMC. Sympathomimetic stimulants as a class carry risks of placental vasoconstriction, fetal tachycardia, preterm labor, and developmental effects. The contraindication is mechanism-based and applies to all monoamine releasing agents.

phenelzine use, tranylcypromine use, moclobemide use, selegiline use, harmine/harmaline use

Combination of any monoamine oxidase inhibitor with a monoamine releasing agent like 2-MMC produces catastrophic monoamine accumulation. This can result in hypertensive crisis, serotonin syndrome, hyperthermia, and death. The contraindication is absolute and mechanism-based — no substance-specific data are needed to classify this interaction as life-threatening.

vigorous physical exertion, hot environmental conditions, dehydration

Physical exertion in hot environments compounds the cathinone-class risk of hyperthermia, which is documented in 6% of 3-MMC intoxication presentations. Cathinones impair thermoregulation through sympathomimetic mechanisms. Dance venues and festivals represent particular risk settings.