5-MAPB

Pre-existing cardiac conditions (coronary artery disease, arrhythmia, uncontrolled hypertension, heart failure) increase risk of adverse cardiovascular events. Chronic use carries additional risk from 5-HT2B-mediated valvulopathy.

Personal or family history of psychotic disorders (schizophrenia, schizoaffective disorder) is an absolute contraindication. Dopaminergic stimulation and serotonergic disruption carry risk of psychosis precipitation.

Bipolar disorder increases risk of mood episode destabilization. The acute monoamine surge followed by depletion-driven comedown mirrors the manic-depressive cycle and may trigger either pole.

Hepatic impairment may increase 5-MAPB exposure due to reduced CYP2B6-mediated clearance. Dose adjustment considerations apply but cannot be quantified without PK data.

Pregnancy and breastfeeding are absolute contraindications. No reproductive or developmental toxicity data exist; contraindication is based on class-level risk of monoamine releasing agents.

Concurrent use of any MAO inhibitor (irreversible: phenelzine, tranylcypromine; reversible: moclobemide) with 5-MAPB is an absolute contraindication. Four deaths from MDMA + moclobemide are documented, and the identical mechanism applies.

Concurrent use of SSRIs, SNRIs, tramadol, other serotonin releasers (MDMA, MDA), or lithium is contraindicated due to elevated serotonin toxicity risk. Tramadol combination carries particularly high risk.