The biggest risk of Ayahuasca is undoubtedly a heart attack. And as a result of a heart attack, death can occur. Psilocybin mushrooms have a similar effect to DMT: in the Netherlands, the legislation for this substance was initially very loose, just like for cannabis, but after a higher incidence of fatal cases, the legislation for this substance was tightened again. However, of course, in all fatal cases, the people were suffering from heart disease. The heart may not be able to withstand Ayahuasca. It is a double burden on the heart. DMT (Ayahuasca) would be completely ineffective without the use of MAOIs. The monoamine oxidase inhibitor itself, abbreviated MAOI or IMAO (such as harmine, harmaline), radically increases blood pressure and increases the activity of noradrenaline nerve receptors, which has exactly the same effect as if a doctor injected adrenaline into your vein. Such a strong increase in blood pressure is in itself a serious risk to the heart.
The second risk to the heart is the active substance DMT itself. We have scientific studies on how DMT causes palpitations/arrhythmias in the heart, which is why the ayahuasca ritual would be fatal for a person with heart disease.
How to Avoid Risks
Before using DMT, it is absolutely essential (if one wants to do it responsibly and safely) to have a heart examination by a cardiologist. During the use of DMT, it is absolutely necessary to use an effective blood pressure-lowering drug such as a beta-blocker, and the dose must be high – blood pressure should ideally be slightly below average. High blood pressure during the effect of MAOIs, harmaline, and DMT is a serious health risk.
Under no circumstances should a combination of MAOIs (e.g. harmaline) and psilocybin or mescaline (= active ingredient of the hallucinogenic cactus) be used.
The dose of a plant containing MAOIs or harmaline, harmine must be relatively low. If only this type of substance alone were to cause hallucinations, the dose would be at least 5 times higher than necessary – unnecessary risks to the heart should be avoided. The purpose of MAOIs or harmaline, harmine is only to ensure the effectiveness of DMT.
"Expedition Peru" and Petr Chobot
Several people in the Czech Republic mediate trips to Peru for ayahuasca, including Petr Chobot, who calls it an "expedition to Peru". We strongly advise against this. In case of a heart attack, no one will help you in the jungle. In a publicly available lecture, I heard Petr Chobot say that the real ayahuasca is exclusively an MAOI. The guy clearly doesn't understand it. Yes, it is true that MAOIs themselves have psychoactive effects, but they are far from as intense as in combination with ayahuasca vines. If you take MAOIs alone, at low doses it will have no tangible effects, and at high doses you risk a heart attack.
I consider it only a matter of time before fatal cases occur on "expeditions to Peru". It's only by a miracle that this hasn't happened yet. Or maybe it has, but it was successfully covered up.
The ayahuasca mixture can be used safely on the "Peru expedition" – yes, it is actually possible to use it quite safely in low doses, but then the effects on the psyche will be negligible, which in practice means that people have thrown away 4000 EUR unnecessarily, even though they traveled to Peru for ayahuasca.
Psychosis
I have heard about the permanent consequences of some people from the Czech Republic after using Ayahuasca in South America. The person in question developed psychosis. There are no scientific studies that DMT use causes psychosis. The reason for this negative case could have been an excessively high dose, or something that does not belong in the Ayahuasca mixture, such as mescaline (hallucinogenic cactus) or psilocybin-containing mushrooms, was added. These substances can thus have their effect strengthened by up to 10 times, and their duration of action can be up to 3 days. These substances must not be used in combination with plants containing harmine, harmaline.
For acute psychosis, if a person is still under the influence of DMT and MAO A, the best drug is the antipsychotic risperidone alone.
Useful links
https://en.wikipedia.org/wiki/N,N-Dimethyltryptamine
https://en.wikipedia.org/wiki/Harmaline
https://en.wikipedia.org/wiki/Harmine
https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor
Why do ayahuasca and mescaline cause vomiting?
Especially with ayahuasca, vomiting is a serious health risk, with the danger of choking on vomit. The reason for vomiting is clearly explained in science. Many psychedelics that act on serotonin receptors also act on those types of serotonin receptors that are responsible for appetite and are highly present even in the digestive system itself, in the intestines. Specifically, serotonin receptor type three is responsible for this. If serotonin receptors type three (=5-HT3) are too active, it causes a feeling of vomiting and loss of appetite. Conversely, many antipsychotics reduce the activity of this receptor, which makes a person eat very well, and then the psychiatric patient gains weight and has a problem with obesity. Antagonists for type three receptors are used to increase appetite during chemotherapy, against vomiting after anesthesia (due to the low professional competence of doctors, these drugs are prescribed to oncological patients minimally in practice, although they need them very much). The side effect of vomiting with ayahuasca can be prevented if a drug that reduces the activity of 5-HT3 receptors is taken. These drugs do not reduce the effectiveness of ayahuasca, nor do they penetrate, they do not get into the brain through the blood-brain barrier.
https://en.wikipedia.org/wiki/5-HT3_receptor
https://www.adc.sk/databazy/humanne-lieky/atc-skupiny/A04AA/antagonisty-serotoninu-5ht3.html
Other ways to use Ayahuasca without the risk of vomiting:
-using MAOIs, inhale chemically pure DMT by vaporization (without MAOIs, it would only have an effect for a few seconds). There are a large number of shops that sell different types of vaporizers. Those with a higher price are more suitable for these purposes.
https://en.wikipedia.org/wiki/Vaporizer
– intravenous administration of DMT (much longer effect if it is in combination with MAOIs)
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Other safety principles
Since DMT with MAO is a significant burden on the brain, heart, and blood vessels, do not use Ayahuasca for several days in a row. Take breaks between uses. Use it one day and the next day should be reserved for rest, it is good to have enough sleep. Ayahuasca is not suitable for people over 55 years of age.