DOB

Coronary artery disease, uncontrolled hypertension, peripheral vascular disease, and structural heart disease. Vasoconstriction is a documented DOx class effect.

Seizure disorders of any type. Convulsions were documented in the sole confirmed DOB fatality.

Bipolar I and bipolar II disorder. Risk of manic episode precipitation compounded by the ultra-long duration making intervention difficult.

Personal or family history of schizophrenia, schizoaffective disorder, or other primary psychotic disorders. DOB's potent 5-HT2A agonism and exceptionally long duration (18–30 hours) increase both the probability and severity of psychotic reactions.

Pregnancy and breastfeeding. No safety data exist. Contraindicated by precautionary principle.

Concurrent lithium therapy. Absolute contraindication by class consensus for all serotonergic psychedelics.

Concurrent use of monoamine oxidase inhibitors. Dual pharmacokinetic and pharmacodynamic risk.