4-AcO-DMT

uncontrolled hypertension, coronary artery disease, arrhythmia, heart failure

Pre-existing cardiovascular disease, uncontrolled hypertension, or conditions predisposing to arrhythmia. Acute tachycardia and blood pressure elevation are expected effects.

epilepsy, seizure disorder

History of epilepsy or other seizure disorders. Possible seizure threshold reduction, though substance-specific evidence is lacking.

schizophrenia, schizoaffective disorder, brief psychotic disorder

Personal or family history of schizophrenia, schizoaffective disorder, or other psychotic disorders. Psychedelics can trigger first-episode psychosis or exacerbate existing psychotic conditions.

bipolar I disorder, bipolar II disorder

Personal history of bipolar I or bipolar II disorder. Risk of triggering manic, hypomanic, or mixed episodes.

pregnancy, breastfeeding

Pregnancy and breastfeeding. No reproductive safety data exist. Serotonergic activity poses theoretical risk to fetal neurodevelopment.

Concurrent use of tramadol with 4-AcO-DMT is dangerous due to serotonin toxicity risk. Multiple fatalities have been documented from tramadol in combination with other serotonergic drugs.

MAOI therapy

Concurrent use of monoamine oxidase inhibitors (MAOIs) with 4-AcO-DMT significantly prolongs and intensifies effects and elevates serotonin toxicity risk. Both irreversible (phenelzine, tranylcypromine) and reversible (moclobemide) MAOIs are included.