A-PHP

Pre-existing cardiovascular conditions including hypertension, coronary artery disease, arrhythmias, and cardiomyopathy are absolutely contraindicated due to documented sympathomimetic cardiovascular toxicity.

Seizure disorders represent a relative contraindication. Stimulants lower seizure threshold; α-PHP-specific seizure data are absent but the mechanism predicts increased risk.

Pre-existing psychotic spectrum disorders (schizophrenia, schizoaffective disorder) are absolutely contraindicated. α-PHP produces stimulant psychosis that may be protracted due to its long elimination half-life.

Bipolar disorder is absolutely contraindicated due to risk of precipitating manic or psychotic episodes via sustained dopaminergic stimulation.

Pregnancy is absolutely contraindicated. Fetal death has been documented in association with α-PHP use (Adamowicz 2019), and in utero transfer confirmed by neonatal meconium testing (Grapp 2023).

Concurrent MAO inhibitor use is absolutely contraindicated. The combination of MAO inhibition with α-PHP's reuptake blockade creates uncontrolled catecholamine accumulation and risk of hypertensive crisis.

Concurrent use of other DAT/NET-active stimulants (cocaine, amphetamines, MDPV, α-PVP) produces additive cardiovascular and neuropsychiatric risk. The 90% polydrug rate in clinical cases (Grapp 2023) makes this a common real-world scenario.