DOI

Uncontrolled hypertension is an absolute contraindication due to prolonged 5-HT2A-mediated vasoconstriction. The extreme duration (16-30 hours) means cardiovascular stress is sustained far longer than with shorter-acting psychedelics.

Coronary artery disease is an absolute contraindication. Prolonged vasoconstriction combined with stimulant-like cardiovascular effects creates significant ischemic risk over the extended duration.

Epilepsy and seizure disorders are relative contraindications. Preclinical data suggest 5-HT2A agonism can reduce seizure threshold, though no DOI-specific seizure cases have been published.

Personal or family history of psychotic disorders (schizophrenia, schizoaffective disorder) is an absolute contraindication. 5-HT2A agonists can trigger psychotic episodes, and DOI's extreme duration makes acute management extremely difficult.

Bipolar disorder is a relative contraindication. Risk of triggering manic or mixed episodes, compounded by the 16-30 hour experience window and subsequent sleep deprivation which independently destabilizes bipolar mood regulation.

Pregnancy is an absolute contraindication. Sustained vasoconstriction over 16-30 hours poses theoretical risk to placental blood flow. No reproductive safety data exist.

concurrent MAOI use, concurrent tramadol use, concurrent SSRI/SNRI use

Concurrent use of serotonergic medications (MAOIs, SSRIs, SNRIs, tramadol) is absolutely contraindicated due to serotonin syndrome risk. MAOIs pose the highest risk; tramadol combines SNRI activity with serotonin release.