4-AcO-MiPT

Significant cardiovascular disease, uncontrolled hypertension, or history of cardiac arrhythmia. Transient sympathomimetic effects expected.

Personal or family history of psychotic disorders or schizophrenia spectrum disorders. Serotonergic psychedelics are well-established triggers for psychotic episodes in vulnerable individuals.

Bipolar disorder (types I and II). Risk of precipitating manic episodes. Relative contraindication — risk may be manageable under clinical supervision but uncontrolled use carries elevated risk.

Pregnancy and breastfeeding. No safety data available. Standard precautionary absolute contraindication.

Concurrent use of monoamine oxidase inhibitors (MAOIs), including pharmaceutical MAOIs (phenelzine, tranylcypromine, moclobemide) and plant-derived MAOIs (harmine, harmaline). Severe, potentially life-threatening serotonin syndrome risk.

Concurrent tramadol use. Mechanistically supported dangerous interaction via dual serotonergic challenge. Tramadol-induced serotonin syndrome is documented in published case series.

Concurrent use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. Dual risk: attenuated psychedelic effects (leading to dose escalation) and increased serotonin syndrome risk.