EPT

Coronary artery disease, Hypertension, Heart failure, Arrhythmia

Tryptamine psychedelics produce class-level cardiovascular effects including vasoconstriction and increased heart rate. No EPT-specific cardiovascular data exist. Individuals with pre-existing cardiovascular disease face elevated risk.

Schizophrenia, Schizoaffective disorder

Serotonergic psychedelics acting at 5-HT2A receptors carry established class-level risk of precipitating or worsening psychotic episodes in individuals with psychotic spectrum disorders. EPT's presumed 5-HT2A agonist mechanism inherits this contraindication. No EPT-specific data exist.

Family history of schizophrenia, Family history of schizoaffective disorder, Family history of psychotic episodes

Individuals with first-degree relatives diagnosed with psychotic spectrum disorders carry elevated genetic risk for psychedelic-precipitated psychotic episodes. This is a class-level risk factor for all serotonergic psychedelics.

Bipolar I disorder, Bipolar II disorder

Serotonergic psychedelics carry class-level risk of precipitating manic episodes in individuals with bipolar disorder. No EPT-specific data exist.

Generalized anxiety disorder, Panic disorder, PTSD

Psychedelic experiences may acutely intensify anxiety symptoms. EPT user reports document psychological challenge and disorientation, particularly at higher doses. Individuals with severe anxiety disorders face elevated risk of adverse psychological outcomes.

CYP2D6 poor metabolizer genotype, Concurrent CYP2D6 inhibitor use

CYP2D6 contributes to DMT metabolism and is inferred to participate in EPT clearance based on the predominance of hydroxylated metabolites identified in vitro by Bergh et al. 2024. CYP2D6 poor metabolizers (~5-10% of Caucasian populations) or individuals taking CYP2D6 inhibitors (paroxetine, fluoxetine, bupropion, quinidine) may experience increased EPT plasma concentrations and prolonged effects.

Pregnancy, Breastfeeding

No reproductive or developmental toxicity data exist for EPT. The teratogenic profile is unknown. Psychoactive substances with uncharacterized reproductive safety are contraindicated by precautionary principle during pregnancy and breastfeeding.

Phenelzine, Tranylcypromine, Moclobemide, Isocarboxazid, Syrian rue, Harmaline, Harmine

Monoamine oxidase inhibitors block EPT's presumed primary metabolic clearance enzyme (MAO-A), drastically increasing exposure and duration. This mechanism underlies ayahuasca pharmacology (DMT + β-carboline MAOIs). Fatalities have been documented for MAOI combinations with structurally related tryptamines including 5-MeO-DMT. Combining EPT with any MAOI — irreversible (phenelzine, tranylcypromine) or reversible (moclobemide) — represents a potentially life-threatening interaction. No EPT-specific interaction data exist; this contraindication is class-level.

Lithium carbonate, Lithium citrate

Lithium combined with serotonergic psychedelics (particularly LSD) has been associated with seizure risk at the class level. No EPT-specific data exist, but the combination is considered contraindicated by precautionary principle given the severity of potential adverse outcome.

Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram, Venlafaxine, Duloxetine

Chronic SSRI/SNRI use causes 5-HT2A receptor downregulation, which may blunt psychedelic effects. Acute combined use raises theoretical serotonin toxicity risk, though Malcolm & Thomas 2022 note this risk is generally lower for tryptamines than phenethylamines. No EPT-specific interaction data exist.