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Kelan Thomas, PharmD, MS, BCPS, BCPP
Latest posts by Kelan Thomas, PharmD, MS, BCPS, BCPP (see all)

While there has been promising evidence of safety and effectiveness for ayahuasca macrodosing to treat depression, the medical risks and benefits of ayahuasca microdosing remain unknown (Palhano-Fontes et al., 2019).

I have recently noticed several websites advertising and selling commercial products for “ayahuasca microdosing,” but unlike microdosing with the classic psychedelic serotonin 2A receptor agonists psilocybin or LSD, microdosing with ayahuasca has a unique pharmacologic effect due to β-carboline alkaloids (harmaline, harmine, tetrahydroharmine) contained in the Banisteriopsis caapi (B. caapi) vine. While there has been promising evidence of safety and effectiveness for ayahuasca macrodosing to treat depression, the medical risks and benefits of ayahuasca microdosing remain unknown (Palhano-Fontes et al., 2019). As a board-certified psychiatric pharmacist, one of my primary responsibilities is to educate clients about psychotropic medications so they can evaluate the risks and benefits to make informed treatment decisions, so I wanted to discuss the potential for ayahuasca microdosing to have drug-drug interactions that could possibly cause serotonin toxicity.

What is Ayahuasca Microdosing? 

Several websites describe two distinct types of ayahuasca microdosing; some mention consuming very low doses of a typical ayahuasca brew with both B caapi vines and the Psychotria viridis leaves that contain N,N-dimethyltryptamine (DMT), while others mention taking the B. caapi vine alone. The β-carboline alkaloids in B. caapi are monoamine oxidase inhibitors (MAOIs) that allow the DMT from Psychotria viridis to be orally available in the brew; but, unfortunately, these various extract products sold online usually do not inform the consumer how much plant matter is in the extract or, more importantly, how many milligrams of these compounds (DMT, harmaline, harmine, tetrahydroharmine) are contained in the product.

What are monoamine oxidase enzymes (MAOs) and inhibitors (MAOIs)?

Monoamine oxidase (MAO) enzymes metabolize monoamine neurotransmitters like serotonin, norepinephrine, and dopamine. There are two main isoforms of MAO: MAO-A and MAO-B, with MAO-A responsible for metabolizing serotonin. Prescription medications that are reversible inhibitors of MAO-A (RIMAs) are used to treat anxiety and depression. The B. caapi β-carbolines (harmaline, harmine, tetrahydroharmine) are also RIMAs, and therefore prevent serotonin breakdown.