Hypertensive Emergency Secondary to Combining Psilocybin Mushrooms, Extended Release Dextroamphetamine-Amphetamine, and Tranylcypromine
Journal of Psychoactive Drugs – June 21, 2024
Source: OpenAlex
Summary
A 42-year-old man suffered a hypertensive emergency after combining 1g of *Psilocybe cubensis* mushrooms, a potent hallucinogen, with Tranylcypromine and Dextroamphetamine-Amphetamine medicine. This rare event, observed in drug studies, highlights critical pharmacology concerns. The interaction, possibly involving phenylethylamine—an alkaloid found in the mushrooms—and the prescribed amphetamines, dramatically influenced his neurotransmitter receptors. Despite symptoms of a heart attack, emergency cardiac catheterization revealed no damage. This case underscores the dangers of combining psilocybin with MAOIs and norepinephrine-releasing drugs.
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.