Last update Aug. 23, 2021
Ayahuasca is a decoction made with the bark of the yagé or ayahuasca liana (Banisteriopsis caapi) that contains beta-carboline alkaloids or harmalines (harmine, harmaline, tetrahydroharmine or THH, harmol and harmalol) mixed with leaves of the “chacrona” shrub (Psychotria viridis), or “chagropanga” or “chaliponga” (Diplopterys cabrerana) or other plants such as Brugmansia or jurema (Mimosa hostilis) that contain N, N-dimethyltryptamine (DMT) (Hamill 2019, Neyra 2017, Gambelunge 2008, Santos 2007).
It is a hallucinogenic drink used since ancient times by Andean and Amazonian populations of Bolivia, Brazil, Colombia, Ecuador, Peru and Venezuela for religious and medicinal purposes. Its use has spread to several countries of the world in recent times for recreational and potentially therapeutic purposes of addictions, drug addiction and other psychiatric disorders (Domínguez 2019, Hamill 2019, Neyra 2017, Santos 2007) and forming part of some Ayahuasque religions of Brazilian origin (Labate 2012).
The β-carbolines harmine, harmaline and tetrahydroharmine are inhibitors of the enzyme monoamine oxidase.
DMT has hallucinogenic and sympathomimetic properties similar to LSD but of shorter duration, being an agonist of serotonin receptors (Lanaro 2021); it produces increased levels of prolactin, cortisol and growth hormone (Santos 2013)
The administration is mainly oral in the course of a ceremony or ritual preceded by a special diet low in salt that includes the abundant ingestion of vomitory-purgative drinks. Consumption can also be smoked or inhaled.
At the date of the last update, there was no available published data on its excretion in breast milk.
The published pharmacokinetic data does not allow prediction of possible passage into breast milk. The low molecular weight and the basic pKa of the alkaloids would favor their excretion, while their high volume of distribution would make it difficult.
Apart from some deficient description (Santos 2013, Labate 2011, Giove 1998) there are no anthropological or medical reports that adequately report on its possible consumption and effects on nursing mothers, children or pregnant women from indigenous populations in which its use is traditional.
Observed side effects include hallucinations, confusion, disorientation, anxiety, euphoria, tachycardia, agitation, hypertension, mydriasis, nausea, vomiting, diarrhea, hypernatremic dehydration, psychotic attacks, instability, tremors, seizures, cardio-respiratory arrest and death (Palma 2021, Neu 2020, van den Berg 2020, Bauer 2018, Heise 2017, Vallersnes 2016).
The risk of serious poisoning and death is higher in recreational use, with the use of synthetic tryptamines and smoking or inhalation (Lanaro 2015, Araújo 2015).
Various practice guides and associations consulted that organize ayahuasca ceremonies-retreats or are interested in its dissemination formally advise against taking ayahuasca during pregnancy and lactation (ICEERS 2019, Ayahuasca Retreat Peru, ConsumoConCiencia, OM-Mij, Mistical Ayahuasca).
There are times during the ayahuasca retreat when the mother and/or father will not be in a position to properly care for their baby.
It is known from Pharmacokinetics that after 5 elimination half-lives (T½), 96.9% of an ingested substance is eliminated from the body and after 7 T½ the plasma concentrations of the substance are negligible and would constitute the safe waiting period to return to breastfeeding after having taken ayahuasca.
Taking as reference the longest published T½ (5.5 h) of DMT and the harmalines found in ayahuasca (Lanaro 2021, Riba 2003, Callaway 1999), these 7 T½ would correspond to a day and a half. Meanwhile, breast milk must be expressed and discarded regularly and the infant should be fed, ideally with a reserve of breast milk previously expressed days before or, failing that, with an artificial formula.
It is not recommended to share a bed with the baby if you are taking this drug (UNICEF UK 2018, 2014, 2013 2006, Sachs 2013, Landa 2012, ABM 2008).
Suggestions made at e-lactancia are done by APILAM team, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.
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