Hypertensive Emergency Secondary to Combining Psilocybin Mushrooms, Extended Release Dextroamphetamine-Amphetamine, and Tranylcypromine

A 42-year-old man with treatment-resistant depression experienced a hypertensive emergency with chest pain, palpitations, headache, and ST-elevation on electrocardiogram about half an hour after taking 1 g of Psilocybe cubensis mushrooms while on tranylcypromine, extended-release dextroamphetamine-amphetamine, and other medications. He was diagnosed with a myocardial infarction, treated with lorazepam, nitroglycerin, and aspirin, and underwent cardiac catheterization that showed no significant abnormalities. He was discharged after overnight hospitalization with no lasting physical effects. The authors suspect phenylethylamine in the mushrooms interacted with the MAOI and amphetamine to cause the event, noting past studies suggest classic serotonergic psychedelics alone with MAOIs should not produce such emergencies.

Study at a glance

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.