5 Critical Risk Factors That Turn Ayahuasca Deadly: The Latest 2025 Safety Warning

The conversation surrounding Ayahuasca, the potent psychoactive brew from the Amazon, has never been more intense, driven by both its profound therapeutic potential and the tragic, highly publicized reports of fatalities. As of December 18, 2025, the central question remains: does the ancient vine itself kill, or are there critical, often-ignored factors turning a spiritual journey into a fatal risk? This deep dive examines the most recent cases and the scientific consensus to provide an essential, updated safety guide for anyone considering this powerful plant medicine.

The truth is complex and often obscured by sensational headlines. While the global consumption of Ayahuasca is estimated to be in the millions, a small number of deaths have been reported, and forensic analysis consistently points away from the brew as the sole, direct cause of death. Instead, the danger lies in a handful of preventable, high-risk scenarios involving drug interactions, pre-existing conditions, and a lack of proper medical screening, which every potential participant must understand before entering a ceremony.

The Latest Reported Ayahuasca Fatalities (2024-2025)

Recent years have brought renewed attention to the inherent risks of Ayahuasca, particularly for tourists seeking spiritual retreats in countries like Peru and Colombia. These unfortunate events underscore the absolute necessity of rigorous medical screening and safe ceremonial practices.

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• Aaron Castranova (June 2024, Peru): A 41-year-old American tourist, Aaron Castranova, died after allegedly ingesting an Ayahuasca brew at a hostel in Loreto, Peru. While the exact cause of death is often pending or unreleased in the media, this case highlights the risks associated with consuming the brew in unregulated or non-clinical settings.
• Jarrad Antonovich (Date Varies, Peru): Another highly-cited case involves Jarrad Antonovich, who died after consuming Ayahuasca and having the frog toxin extract, Kambo, applied to burns on his skin. This case is a critical example of the danger of combining Ayahuasca with other potent substances, even those considered "natural" or "traditional."
• The Uncorroborated Truth: The International Center for Ethnobotanical Education, Research, and Service (ICEERS) estimates global lifetime Ayahuasca use at over four million. Crucially, their analysis of media-reported deaths suggests that among the dozens of fatalities linked to the brew worldwide, not a single autopsy has definitively attributed the death to the Ayahuasca brew alone.

The Scientific Consensus: Is Ayahuasca Itself Lethal?

The short answer, according to most scientific and ethnobotanical organizations, is no. The active ingredients in Ayahuasca are DMT (Dimethyltryptamine) and Monoamine Oxidase Inhibitors (MAOIs), primarily from the Banisteriopsis caapi vine. The MAOIs are necessary to make the DMT orally active.

The primary psychoactive component, DMT, is a naturally occurring substance and is generally well-tolerated by the body in a ceremonial dose. The MAOIs, however, are the component that introduces the most significant potential for fatal interaction. A fatality from a "pure" dose of Ayahuasca is extremely rare, typically requiring an astronomical overdose.

The real danger is not the brew itself, but the biochemical reaction that occurs when it is introduced to an already compromised system or one containing contraindicated substances. The vast majority of deaths are attributed to:

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• Drug-to-drug interactions.
• Pre-existing, undiagnosed medical conditions.
• Unsafe settings or practices (e.g., mixing with other potent substances like Kambo).

The 5 Critical Risk Factors That Turn Ayahuasca Deadly

Understanding these five factors is the most important step in mitigating the risk of a severe adverse event or fatality. These are the "silent killers" that have been implicated in nearly every reported death linked to the plant medicine.

1. Life-Threatening Drug Interactions (Serotonin Syndrome)

This is the number one cause of serious harm. The MAOIs in Ayahuasca block the breakdown of monoamines, including Serotonin. When combined with certain medications that also increase serotonin levels, the result can be a toxic overload known as Serotonin Syndrome, which can be fatal.

Absolute Contraindications Include:

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• SSRIs (Selective Serotonin Reuptake Inhibitors) like Prozac, Zoloft, or Lexapro.
• SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).
• Tricyclic Antidepressants (TCAs).
• Certain stimulants (e.g., Adderall, Ritalin).
• Other MAOIs or medications that affect the serotonin system.

A proper "washout period" for these medications (often several weeks) is non-negotiable and must be medically supervised.

2. Pre-existing Cardiovascular Conditions

Ayahuasca is known to cause a temporary but significant increase in both heart rate (tachycardia) and blood pressure. For individuals with undiagnosed or pre-existing heart conditions, such as severe hypertension, cardiac arrhythmias, or other cardiovascular issues, this stress on the system can lead to a heart attack or stroke. A thorough medical screening, including disclosure of any family history of heart issues, is essential.

3. Psychiatric and Emotional Vulnerability

While Ayahuasca is studied for its potential to treat depression and PTSD, it is absolutely contraindicated for individuals with a personal or family history of specific severe psychiatric disorders. The intense, often terrifying, psychological experience of the ceremony can trigger or exacerbate conditions like schizophrenia, bipolar disorder (especially manic phases), or psychosis. Emotional readiness and a stable mental health baseline are as important as physical health.

4. Unsafe or Unprofessional Ceremony Settings

The environment and the guide—often called a Curandero or Shaman—are critical safety factors. Fatalities are far more likely to occur in unregulated, tourist-driven settings where the quality of the brew is unknown, the dosage is uncontrolled, and there is no medical professional on-site.

• Lack of Screening: Reputable retreats require extensive medical questionnaires and often a consultation with a healthcare practitioner. Unsafe venues skip this vital step.
• Lack of Medical Emergency Plan: In a remote Amazonian setting, the absence of a clear plan for emergency medical evacuation (e.g., in case of a seizure or severe reaction) can be the difference between life and death.

5. Mixing Ayahuasca with Other Psychoactive Substances

The tragic death of Jarrad Antonovich, who combined the brew with Kambo (a frog secretion used for purification), serves as a stark warning. The combination of Ayahuasca with any other substance—including other psychedelics, recreational drugs, or even certain herbal supplements—can introduce unpredictable and potentially fatal synergistic effects. The chemical complexity of the MAOI interaction means that even seemingly benign substances can become dangerous.

Essential Safety Checklist: How to Mitigate the Risks

To engage with Ayahuasca safely, the responsibility lies with the participant to be fully transparent and diligent. Mitigating the risk of death is entirely possible by adhering to strict medical guidelines.

1. Complete Medical Disclosure: Be 100% honest about all medications, supplements, and pre-existing physical or mental health conditions to the retreat center's medical screener.
2. Observe Washout Periods: Strictly follow the required cessation period for all contraindicated medications, which can be up to 6 weeks for some SSRIs. Consult your primary care physician before discontinuing any prescribed medication.
3. Choose a Reputable Center: Select a retreat that has a clear, written safety protocol, on-site medical or psychiatric support, and a history of positive reviews that emphasize safety over tourism.
4. Adhere to the Ayahuasca Diet: Follow the dietary restrictions (often called the Dieta), which typically involve avoiding fermented foods, aged cheeses, and excessive caffeine, as these can also interact with the MAOIs.
5. Avoid All Other Substances: Do not mix Ayahuasca with alcohol, recreational drugs, Kambo, or even large amounts of caffeine or tyramine-rich foods during the preparation and ceremony period.

While the reports of death from Ayahuasca are shocking and tragic, they are, in almost every case, a failure of screening and preparation, not an inherent toxicity of the brew itself. By prioritizing medical safety, understanding the severe risks of drug interactions, and choosing a professional setting, participants can dramatically reduce the risk and focus on the profound healing potential that Ayahuasca offers.