DOM

DOM causes centrally mediated tachycardia and hypertension. Individuals with uncontrolled hypertension, cardiac arrhythmias, or structural heart disease are at elevated cardiovascular risk during the extended 14-20 hour experience.

Seizures were documented among adverse effects during the 1967 mass exposure at high doses (10-20 mg). Individuals with epilepsy or lowered seizure threshold are at elevated risk.

Personal or family history of schizophrenia, schizoaffective disorder, or other psychotic spectrum disorders. DOM's potent 5-HT2A agonism and extended duration (14-20 hours) create prolonged exposure to altered cognitive states with elevated risk of precipitating psychotic episodes.

Bipolar disorder, particularly type I, represents a relative contraindication due to the risk of triggering manic or mixed episodes. The extended duration of DOM increases the period of vulnerability.

No reproductive toxicology data for DOM. Pregnancy is an absolute contraindication due to unknown fetal risks from 5-HT2A agonism and centrally mediated cardiovascular effects.

Chlorpromazine and other phenothiazine antipsychotics are absolutely contraindicated as pharmacological interventions for DOM adverse reactions. Clinical documentation from the 1967 Haight-Ashbury crisis showed chlorpromazine worsened rather than improved outcomes. Benzodiazepines are the preferred intervention for agitation.

Concurrent use of SSRIs or SNRIs potentiates DOM effects rather than attenuating them, via enhanced 5-HT2C receptor activation. This is opposite to the pattern seen with some tryptamine psychedelics. Elevated serotonin syndrome risk with any serotonergic co-medication.

Tramadol combined with DOM creates dangerous additive serotonergic activity with serotonin syndrome risk. This is a class-level concern for all serotonergic psychedelics combined with tramadol.