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Are MAOIs dangerous in combination with some Trichocereus cacti?
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Some people combine MAOIs and other drugs to increase their effects and I read in some Erowid Experience Reports that people had combined Trichocereus cacti with MAOIs. From what I can tell, this may be OK with T. pachanoi, but T. peruvianus contains high amounts of tyramine (see www.entheogen.com/News/print/sid=46.html), a potentially deadly substance when combined with an MAOI. I am concerned that you do not have a clear warning about this in your cacti vault. |
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| A: |
First, you are quite correct that combining MAOIs with other psychoactive drugs can lead to dangerous medical problems including serotonin syndrome, hypertensive crisis, and other related serious issues.
Second, it is important to note that not all MAOIs are equal in what they do and how they do it.
There is a more complete discussion of this in my book Sacred Cactis and Some Selected Succulents and the forthcoming version will have more, but here is a brief overview.
Tyramine is not believed to be dangerous with harmine or harmaline since it readily displaces either one. The harmala alkaloids are highly selective and highly reversible MAOIs. They are quite different than some of the prescription drugs such as Phenelzine (Nardil) or Tranycypromine (Parnate) which actually bind irreversibly to the MAO enzymes. With irreversible MAOIs, restoration of normal MAO metabolic function requires that more of the enzymes be produced by the body.
Moclobemide is a pharmaceutical, reversible MAOI that has far fewer food restrictions associated with it and has been used by some in their non-medical exploration of sacred cactus, however there is far too little data about these experiments to say it is safe. Moclobemide is probably the pharmaceutical MAOI most widely used for unapproved experiments with psychoactives, yet there is still far too little data: one would want hundreds or thousands of clear reports of the combinations, not just a few dozen lightly documented cases. The variability between individuals and plant sources are just too great to suggest 'safety'.
It is often said that moclobemide is less 'sedating' and more 'stimulating' in its effects than the harmala alkaloid MAOIs, but it is unclear what this might mean for health safety issues.
Many combinations of drugs with MAOIs can, in fact, be quite dangerous and those experimenting with MAOIs should be aware that they are taking risks.
Of course, whether mescaline (also showing some MAOI activity itself) is safe in combination with any significant level of tyramine has not really been established.
I think it is reasonable to be concerned about combining cactus and MAOIs. The primary reason I've encountered for why people want to use MAOIs with cactus is that they want to be able to use less cactus and get strong effects. A primary reason given is that cactus alone makes them nauseous or that there is a perceived body load. However the reports I've received sugguest that nausea is actually more pronounced in most people who take cactus with MAOIs. Many people do not experience either nausea or vomiting with trichocereus cactus alone.
There is also commonly reported to be more of a body load, more somatic distress and the addition of a strongly sedative component from the combination. One person told me that it actually put them to sleep a couple of hours after onset. The combination of harmala and cactus does apparently work well for some people, though, and they do not seem to have any problems. Dose, careful titration, prep, individual biochemistry? Who knows?
Unfortunately these issues are complicated by the problems with biochemical analyses of the cactus and extrapolating from individual tests. It's probably a mistake to extrapolate any one analysis to mean anything for the broader class of cacti.
Many of these cacti seem to show substantial variation in both their content and composition within any given species and even within a single clone. Reasons for this are not clear as the issue has barely begun to be studied.
Within just the published analysis of T. peruvianus:
1. Agurell reported over 50% of the alkaloid he recovered was tyramine but they also reported finding a TOTAL alkaloid content of between 0.01-0.001% and did NOT find ANY mescaline.
2. Pardanani reported recovering 0.82% mescaline from their peruvianus which was a recovery of 3268 mg of mescaline contaminated with DMPEA, along with 34 mg of tyramine and 40 mg of 3-MeO-tyramine.
3. An HPLC analysis from Health Canada reported even less mescaline from theirs along with what seemed to be an isoquinoline as the major alkaloid. Eight phenethylamines and other unidentified alkaloids were present also but much detail was lacking.
To put it in a nutshell: every analysis of peruvianus I've seen has failed to agree with each other. In fact the only analysis within a single species where there a consistent result is when that species has only been analyzed one time.
- Trout |
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