NEP

Tachycardia documented in sole-substance NEP intoxication (Deville et al. 2023). Noradrenergic-mediated increases in heart rate, blood pressure, and myocardial oxygen demand pose direct danger to compromised cardiovascular systems.

No seizures documented in NEP case reports, but stimulant-mediated seizure threshold reduction is a well-established class effect. Individuals with epilepsy or other seizure disorders face elevated risk.

Persecutory delusions and severe agitation documented in NEP intoxication (Deville et al. 2023). Individuals with schizophrenia, schizoaffective disorder, or other psychotic spectrum conditions face amplified risk from dopaminergic overstimulation.

No NEP-specific data on bipolar risk, but DAT/NET stimulants are well-established triggers for mania in predisposed individuals. Classify as relative contraindication pending substance-specific evidence.

Rhabdomyolysis with acute renal failure requiring ICU admission documented in a single case of sole-substance NEP intoxication (Deville et al. 2023). Impaired renal function at baseline increases vulnerability to myoglobin-mediated tubular damage.

No reproductive studies exist for NEP. Sympathomimetic effects (vasoconstriction, tachycardia, hyperthermia) pose theoretical risks to fetal development and placental perfusion. Absolute contraindication in the absence of safety data.

Concurrent use of MAOIs (including moclobemide, phenelzine, tranylcypromine, selegiline, and the ayahuasca components harmine/harmaline) with an NDRI stimulant risks severe hypertensive crisis. This is a class-level absolute contraindication for all catecholaminergic stimulants.