Before you go

What can hurt you.

We send people toward retreats. That obliges us to tell you the parts nobody puts in the brochure. We are not doctors. This is the list to take to one.

The interaction that has killed people

Ayahuasca contains MAO inhibitors — that is what makes it orally active at all. MAOIs interact dangerously with a long list of common medicines.

The most important one: antidepressants. SSRIs (sertraline, fluoxetine, escitalopram, citalopram, paroxetine), SNRIs (venlafaxine, duloxetine), and other serotonergic drugs can combine with ayahuasca to produce serotonin syndrome — high fever, rigidity, racing heart, confusion, seizures. It can be fatal and it can happen fast.

Do not stop your medication to attend a ceremony on your own judgement. Some of these drugs take weeks to clear and stopping them abruptly is its own serious risk. This is a conversation with the doctor who prescribed them, started months before you travel — not a decision made in a booking form.

Other medicines that matter

  • Tramadol, dextromethorphan (in many cough medicines), triptans for migraine, lithium, St John's wort, and 5-HTP — all serotonergic.
  • Other MAOIs, including some Parkinson's medication.
  • Stimulants, including prescribed ADHD medication, and cocaine or MDMA.
  • Some blood-pressure medication, and some antipsychotics.

This list is not complete, and it is not a substitute for a pharmacist looking at what you actually take. Bring the whole list, including anything you buy without a prescription.

Conditions that mean you should think hard, or not go

  • A personal or family history of psychosis, schizophrenia or bipolar disorder. This is the one most often ignored and most often regretted. Ayahuasca can precipitate an episode that does not end when the ceremony does.
  • Heart conditions, uncontrolled high blood pressure, or a history of stroke. Blood pressure and heart rate rise during ceremony.
  • Pregnancy.
  • Epilepsy or seizure disorders.
  • Serious liver or kidney disease.
  • A recent suicide attempt, or being in acute crisis right now. A ceremony is not a substitute for care, and the days afterward can be destabilising rather than settling.

If you are grieving, or desperate

A great many people come to this medicine at the worst moment of their lives. That is understandable and it is not disqualifying. But it is worth saying plainly: ayahuasca is not an emergency service, it is not fast, and hope alone is not preparation.

If you are in crisis today, please talk to someone today — a doctor, a crisis line, someone who knows you. The vine will still be there in six months, and you will be in a better position to meet it. If you would like help finding support where you live, write to us and we will help you look.

What a screening should actually ask

A 2021 study in Frontiers in Pharmacology followed 200 people through a Shipibo-run programme near Iquitos, and published the centre’s intake criteria. It is a useful benchmark, because it tells you what a place that takes screening seriously refuses. They did not accept anyone under 18, and they excluded people with a history of psychosis, depersonalization or mania; anyone taking MAOIs or SSRIs; anyone with a heart condition; anyone with chronic high blood pressure; and anyone pregnant.

If a centre asks you none of that, you have learned something about the centre. Ask what their exclusions are before you ask anything else, and if the honest answer is that they take everybody, that is your answer.

Gonzalez D, Cantillo J, Perez I, Carvalho M, Aronovich A, Farre M, Feilding A, Obiols JE, Bouso JC (2021), Frontiers in Pharmacology 12:623923.

Questions to ask any centre before you pay

  • Who screens me medically, and what do they ask? If the answer is "nothing," leave.
  • What happens if someone needs a hospital? How far, how, whose vehicle, what hours?
  • Who is in the room overnight, and how many guests per staff member?
  • What is your written policy on sexual boundaries, and what happens if it is broken?
  • Who are the onanyabo — healers — by name, from which community, and how are they paid?
  • What happens if I decide not to drink after I arrive? Is anything refunded?

A centre that answers all six without hesitating is a different kind of place from one that gets uncomfortable. That discomfort is the most useful thing you will learn before you go. These questions are drawn from the twelve criteria we apply to every centre we list.

We teach Shipibo language and culture. We do not run ceremonies and we do not sell medicine. Only a doctor who knows your history can tell you whether this is safe for you — our job is to make sure you walk in knowing what to ask.