Psilocybin and stimulants
CautionStimulant / ADHD medication · also: amphetamine, adderall, dexamphetamine, lisdexamfetamine, elvanse
Psilocybin and stimulants (ADHD medication, cocaine and similar): caution, both raise heart rate and blood pressure, and the combination is a known route to an anxious, overwhelming come-up.
Higher heart rate and blood pressure than either alone. Anxiety and panic are markedly more likely, and a panic reaction during the come-up is the most common route to a bad experience.
Claims re-checked against the cited sources:
Why it happens
Additive load on the heart and circulation. Prescription stimulants raise blood pressure and heart rate modestly on average, and psilocybin raises autonomic measures moderately; together the effects add. Higher psilocybin doses also increase anxiety.
What is known
Additive cardiovascular effects are predictable pharmacology. The anxiogenic interaction is consistently reported and is not controversial.
- 2026
- CNS stimulants raise blood pressure by about 2 to 4 mmHg and heart rate by about 3 to 6 bpm on average, and should be avoided in serious cardiac disease. ADDERALL XR US prescribing information, DailyMed (label version May 2026)
- 2024
- In a pooled analysis of 85 healthy participants, psilocybin raised autonomic measures only moderately, heart rate over 100 occurred in 7% of administrations, and 25 and 30 mg doses increased anxiety. Straumann et al., 'Safety pharmacology of acute psilocybin administration in healthy participants', Neurosci Appl (pooled analysis, 85 participants)
- 2024
- A man on extended-release dextroamphetamine-amphetamine and tranylcypromine developed a hypertensive emergency with chest pain after 1 g of mushrooms; the authors warn particularly about noradrenaline releasers such as amphetamine in people on MAOIs. Barnett et al., 'Hypertensive emergency secondary to combining psilocybin mushrooms, extended release dextroamphetamine-amphetamine, and tranylcypromine', J Psychoactive Drugs (online 2024, issue 2025)
- 2024
- A 2024 systematic review found no controlled human study of psilocybin with stimulants. Halman et al., 'Drug-drug interactions involving classic psychedelics: a systematic review', J Psychopharmacol
Safety guidance
- Expect a rougher, more anxious come-up if you have taken a stimulant that day.
- Any heart condition or high blood pressure moves this into avoid.
- Never combine stimulants and mushrooms if you also take an MAOI.
- Do not stop prescribed ADHD medication without talking to your prescriber.
When to seek help
Call emergency services for chest pain, a severe headache, fainting, or a racing heartbeat that does not settle with rest. Emergency red flags.
Common questions
Can I take my ADHD medication on a trip day?
It adds to heart rate and blood pressure and can make the come-up more anxious. Discuss timing with your prescriber rather than stopping it on your own.
Is cocaine different?
Cocaine was not covered by any study found here. It is a strong stimulant, so the same cardiovascular and anxiety concerns apply, likely more so.
Is it dangerous for a healthy heart?
Psilocybin's heart effects were moderate in healthy volunteers, and average stimulant effects are modest. The risk rises sharply with heart disease or an MAOI.
Sources
How we research this: sources, evidence grading, review and updates.