Hypertensive Emergency Secondary to Combining Psilocybin Mushrooms, Extended Release Dextroamphetamine-Amphetamine, and Tranylcypromine
Peter Kenneth Gillman, Brian S. Barnett, Curtis J. Koons, Vincent Van den Eynde, J. Alexander Bodkin
Journal of Psychoactive Drugs June 21, 2024 DOI: 10.1080/02791072.2024.2368617 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 42-year-old man with treatment-resistant major depressive disorder |
| Interventions | Psilocybe cubensis mushrooms tranylcypromine extended-release dextroamphetamine-amphetamine |
| Dose | 1 g |
| Topics | Psilocybin |
| Keywords | Tranylcypromine Dextroamphetamine Anesthesia Hallucinogen Pharmacology |
| Citations | 9 |
| Key findings | Combining psilocybin mushrooms with a monoamine oxidase inhibitor and dextroamphetamine-amphetamine may cause hypertensive emergency and myocardial infarction, likely due to phenylethylamine in the mushrooms. |
Abstract
Data on medication interactions with psychedelics are limited. Here we present what may be the first published report of a hypertensive emergency following the combination of psilocybin mushrooms with a monoamine oxidase inhibitor (MAOI). A 42-year-old man with treatment-resistant major depressive disorder took 1 g of Psilocybe cubensis mushrooms, while prescribed tranylcypromine, extended-release dextroamphetamine-amphetamine, and other medications. Approximately half an hour later, he developed severe hypertension with chest pain, palpitations, and headache. Upon hospital presentation, the electrocardiogram demonstrated ST-elevation. The patient was diagnosed with a myocardial infarction and treated with lorazepam, nitroglycerin, and aspirin. He subsequently underwent emergency cardiac catheterization, which revealed no significant cardiac abnormalities. Following overnight hospitalization, he was discharged home with no lasting physical sequelae. Though data are few, past studies suggest that classic serotonergic psychedelics (5HT-2A receptor agonists) such as dimethyltryptamine (DMT), lysergic acid (LSD), and synthetic psilocybin should not produce hypertensive emergency when combined with MAOIs. We suspect phenylethylamine, found in Psilocybe cubensis and other species of psilocybin mushrooms, interacted with tranylcypromine and dextroamphetamine-amphetamine to produce this hypertensive emergency. Patients prescribed MAOIs should be warned of the potential for hypertensive emergency when consuming psilocybin mushrooms, particularly when also prescribed norepinephrine releasers such as dextroamphetamine-amphetamine.
Comparable studies
Other case reports and case series on psilocybin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psilocybin Mushroom (Psilocybe semilanceata) Intoxication with Myocardial Infarction 18-year-old man | 1998 | Case study | n = 1 |
| Relief from intractable phantom pain by combining psilocybin and mirror visual-feedback (MVF) Person with leg amputation and phantom-limb pain | 2018 | Case study | n = 1 |
| Hallucinogen persisting perception disorder after psilocybin consumption: a case study 18-year-old man with HPPD after mixed psilocybin and cannabis intoxication | 2005 | Case study | n = 1 |
| Microdosing psilocybin for chronic pain: a case series Individuals with chronic neuropathic pain | 2022 | Case series | n = 3 |
| Psilocybin and Obsessive Compulsive Disorder Individual with Obsessive Compulsive Disorder | 2014 | Case study | n = 1 |
Citations in the library
Cited by 9
- Concomitant use of antidepressants and classic psychedelics: A scoping review Journal of Psychopharmacology September 12, 2025
- Psychiatric Residents' Perspectives on Psychedelics and Psychedelic Assisted Therapy. Journal of Psychoactive Drugs July 2, 2025
- Safety and Efficacy of Monoamine Oxidase Inhibitors in Patients Who Use Psychoactive Substances: Potential Drug Interactions and Substance Use Disorder Treatment Data. CNS Drugs January 17, 2026
- Multilevel Mechanisms and Clinical Efficacy of Psilocybin in Depression Treatment: A Systematic Review International Journal of Molecular Sciences September 10, 2026
- Naturally Derived Psilocybin for Therapeutic Use: A Six-Criterion Framework for Evidence, Safety, and Benefit–Risk Considerations in Policy and Clinical Development Biomolecules July 3, 2026
and 4 more in the library
Cites 15
- Global Street Food: la cocina de la calle Diseño interior 2009
- Acute Effects of Lysergic Acid Diethylamide in Healthy Subjects Biological Psychiatry November 29, 2014
- Neuropharmacology of N,N-dimethyltryptamine Brain Research Bulletin April 30, 2016
- Serotonin toxicity of serotonergic psychedelics Psychopharmacology July 12, 2021
- Simultaneous Production of Psilocybin and a Cocktail of β‐Carboline Monoamine Oxidase Inhibitors in “Magic” Mushrooms Chemistry - A European Journal November 14, 2019
and 10 more in the library