Cited by 144Forensic Toxicology and Drug AnalysisPsychedelics and Drug StudiesSynthesis and bioactivity of alkaloids

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A fatal intoxication following the ingestion of 5-methoxy-N,N-dimethyltryptamine in an ayahuasca preparation.

Sklerov, Jason, Levine, Barry, Moore, Karla A., King, Theodore, Fowler, David·2005·Journal of Analytical Toxicology

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Abstract

A case of a 25-year-old white male who was found dead the morning after consuming herbal extracts containing beta-carbolines and hallucinogenic tryptamines is presented. No anatomic cause of death was found at autopsy. Toxicologic analysis of the heart blood identified N,N-dimethyltryptamine (0.02 mg/L), 5-methoxy-N,N-dimethyltryptamine (1.88 mg/L), tetrahydroharmine (0.38 mg/L), harmaline (0.07 mg/L), and harmine (0.17 mg/L). All substances were extracted by a single-step n-butyl chloride extraction following alkalinization with borate buffer. Detection and quantitation was performed using liquid chromatography-electrospray mass spectrometry. The medical examiner ruled that the cause of death was hallucinogenic amine intoxication, and the manner of death was undetermined.

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Potentiation of 5-methoxy-N,N-dimethyltryptamine-induced hyperthermia by harmaline and the involvement of activation of 5-HT1A and 5-HT2A receptors
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“…years, including a number of confirmed deaths caused by the abuse of 5-MeO-DMT or 5-MeO-DiPT (Bjornstad et al., 2009; Brush et al., 2004; Fuse-Nagase and Nishikawa, 2013; Hill and Thomas, 2011; Long et al., 2003; Muller, 2004; Sklerov et al., 2005; Smolinske et al., 2005; Tanaka et al., 2006).”
Background
Development of a LC–MS/MS Method to Analyze 5-Methoxy-N,N-Dimethyltryptamine and Bufotenine: Application to Pharmacokinetic Study
Shen, H.-W., Jiang, X.-L., & Yu, A. (2009) · Bioanalysis · doi:10.4155/bio.09.7 · Cited by 26
Ayahuasca and the traveller: A scoping review of risks and possible benefits
Houle, S. K. D., Evans, D., Carter, C. A., & Schlagenhauf, P. (2021) · Travel Medicine and Infectious Disease · doi:10.1016/j.tmaid.2021.102206 · Cited by 20
A Systematic Review on the Therapeutic Effects of Ayahuasca
Gonçalves, J., Luís, Â., Gallardo, E., & Duarte, A. P. (2023) · Plants · doi:10.3390/plants12132573 · Cited by 27
The State of the Art in Post-Mortem Redistribution and Stability of New Psychoactive Substances in Fatal Cases: A Review of the Literature
Menéndez-Quintanal, L. M., Matey, J. M., González, V. D. F., Serrano, B. B., Hernández-Díaz, F. J., Zapata, F., Montalvo, G., & García‐Ruiz, C. (2024) · Psychoactives · doi:10.3390/psychoactives3040033 · Cited by 23
Evaluation of the Cytotoxicity of Ayahuasca Beverages
Simão, A. Y., Gonçalves, J., Gradillas, A., Garcı́a, A., Restolho, J., Fernández, N., Rodilla, J. M., Barroso, M., Duarte, A. P., Cristóvão, A. C., et al. (2020) · Molecules · doi:10.3390/molecules25235594 · Cited by 19
“Due to the fact that these compounds are present in several di ﬀ erent plants, it is possible to replace those used in the traditional preparation for other plants, such as P. harmala and Mimosa tenuiﬂora also known as M. hostilis , amongst others [3,12–15].”
5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study
Ragnhildstveit, A., Khan, R., Seli, P., Bass, L. C., August, R. J., Kaiyo, M., Barr, N., Jackson, L. K., Gaffrey, M. S., Barsuglia, J. P., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1271152 · Cited by 24
“Combining 5-MeO-DMT with harmala alkaloids, short-term MAOIs found in ayahuasca, can also produce toxic interactions, and even death (21).”
Background
Tryptamines
Greene, S. L. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-415816-0.00015-8 · Cited by 20
Potential significance of medicinal plants in forensic analysis: A review
Alotaibi, S. S., Alshoaibi, D. S., Alamari, H. A., Albogami, S. M., Khan, E., AL-Shanbari, A. H., Darwish, H., Alshanqiti, B., Alghamdi, H., & Almalki, W. M. (2021) · Saudi Journal of Biological Sciences · doi:10.1016/j.sjbs.2021.03.071 · Cited by 18
Light microscopy can reveal the consumption of a mixture of psychotropic plant and fungal material in suspicious death
Wiltshire, P. E. J., Hawksworth, D. L., & Edwards, K. J. (2015) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2015.05.010 · Cited by 17
Effects of Hallucinogens on Neuronal Activity
Lladó-Pelfort, L., Celada, P., Riga, M. S., Troyano‐Rodriguez, E., Santana, N., & Artigas, F. (2017) · Current topics in behavioral neurosciences · doi:10.1007/7854_2017_473 · Cited by 17
Three Naturally-Occurring Psychedelics and Their Significance in the Treatment of Mental Health Disorders
Vorobyeva, N. S., & Kozlova, A. A. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.927984 · Cited by 20
“However, these cases were observed when co-ingested with other substances (Sklerov et al., 2005; Gable, 2007).”
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Frecska, E., & Luna, L. E. (2006) · PubMed · Cited by 16
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Gibbons, S., & Arunotayanun, W. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-415816-0.00014-6 · Cited by 16
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Serotonin 1A Receptors Modulate Serotonin 2A Receptor-Mediated Behavioral Effects of 5-Methoxy- N , N -dimethyltryptamine Analogs in Mice
Glatfelter, G. C., Clark, A. A., Cavalco, N. G., Landavazo, A., Partilla, J. S., Naeem, M., Golen, J. A., Chadeayne, A. R., Manke, D. R., Blough, B. E., et al. (2024) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.4c00513 · Cited by 15
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Ayahuasca and Kambo intoxication after alternative natural therapy for depression, confirmed by mass spectrometry
de Morais, D. R., Lanaro, R., Barbosa, I. L., Santos, J. M., da Cunha, K. F., Hernandes, V. V., Tessaro, E. P., Gomes, C. S., Eberlin, M. N., & Costa, J. L. (2017) · Forensic Toxicology · doi:10.1007/s11419-017-0394-5 · Cited by 14
“Although there have been only a few case reports involving probable intoxication by Ayahuasca [28] or Kambo [16, 29], this is the first case involving both Ayahuasca and Kambo to our knowledge.”
Background
Ayahuasca: uma revisão dos aspectos farmacológicos e toxicológicos
Pires, A. P. S., de Oliveira, C. D. R., & Yonamine, M. (2010) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · Cited by 14
Effects of hallucinogenic drugs on the human heart
Neumann, J., Dhein, S., Kirchhefer, U., Hofmann, B., & Gergs, U. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1334218 · Cited by 16
Qualitative and Quantitative Analysis of Tryptamines in the Poison of Incilius alvarius (Amphibia: Bufonidae)
Schwelm, H. M., Zimmermann, N., Scholl, T., Penner, J., Autret, A., Auwärter, V., & Neukamm, M. A. (2021) · Journal of Analytical Toxicology · doi:10.1093/jat/bkab038 · Cited by 13
Ayahuasca as a Decoction Applied to Human: Analytical Methods, Pharmacology and Potential Toxic Effects
Nižňanský, Ľ., Nižnanská, Ž., Kuruc, R., Szórádová, A., Šikuta, J., & Zummerová, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11041147 · Cited by 13
“Since the concentrations of 5-MeO-DMT, and also of harmaline, in the blood significantly exceeded the concentrations of these substance detected in humans in various clinical studies and taking into account a high oral dose (gastric content), and accumulation of this substance in liver, kidney and brain, it was ascert…”
BackgroundInfluential
Modification of 5-methoxy-N,N-dimethyltryptamine-induced hyperactivity by monoamine oxidase A inhibitor harmaline in mice and the underlying serotonergic mechanisms
Jiang, X.-L., Shen, H.-W., & Yu, A.-M. (2016) · Pharmacological Reports · doi:10.1016/j.pharep.2016.01.008 · Cited by 13
Syrian rue seeds interacted with acacia tree bark in an herbal stew resulted in N,N-dimethyltryptamine poisoning
Liu, C.-H., Chu, W.-L., Liao, S., Yang, C., & Lin, C.-C. (2019) · Clinical Toxicology · doi:10.1080/15563650.2019.1576877 · Cited by 10
“However, death has been reported following the ingestion of 5-methoxy-N,N-dimethyltryptamine in an ayahuasca preparation [5].”
Background
Hypothetical biosynthetic pathways of pharmaceutically potential hallucinogenic metabolites in Myristicaceae, mechanistic convergence and co-evolutionary trends in plants and humans
Barman, R., Bora, P. K., Saikia, J., Konwar, P., Sarkar, A., Kemprai, P., Saikia, S. P., Haldar, S., Slater, R. J., & Banik, D. (2023) · Phytochemistry · doi:10.1016/j.phytochem.2023.113928 · Cited by 9
Fatal intoxications and inherited cardiac disorders in the young: where to draw the line?
Grassi, S., Vaiano, F., Dimitrova, A., Vullo, C., Croce, E. B., Rossi, R., Arena, V., Rossi, S. S., Campuzano, Ó., Brugada, R., et al. (2025) · International Journal of Legal Medicine · doi:10.1007/s00414-025-03439-9 · Cited by 9
Understanding ayahuasca effects in major depressive disorder treatment through in vitro metabolomics and bioinformatics
Zandonadi, F. D. S., Silva, A., Melo, A. A. S., Ignarro, R. S., Matos, T. S., dos Santos, E. A. F., Barbosa, L. D., de Oliveira, A. L. R., Porcari, A. M., & Sussulini, A. (2023) · Analytical and Bioanalytical Chemistry · doi:10.1007/s00216-023-04556-3 · Cited by 10
Synthetic Cannabinoids, Synthetic Cathinones, and Other Emerging Drugs of Abuse
Wilson, B., Tavakoli, H., DeCecchis, D., & Mahadev, V. (2013) · Psychiatric Annals · doi:10.3928/00485713-20131206-08 · Cited by 9
Toxicology of natural and synthetic aphrodisiacs
Hess, C., & Boehmer, A. (2020) · Rechtsmedizin · doi:10.1007/s00194-019-00368-x · Cited by 10
Optimizing real-world benefit and risk of new psychedelic medications: the need for innovative postmarket surveillance
Black, J. C., Monte, A. A., Dasgupta, N., Jewell, J. S., Rockhill, K. M., Olson, R. A., & Dart, R. C. (2024) · Nature Mental Health · doi:10.1038/s44220-024-00233-1 · Cited by 7
“Overall, the literature so far suggests that certain combinations, such as ayahuasca with 5-methoxy-N , N -dimethyltryptamine (5-MeO DMT)—a strongly serotonergic com-bination—have greater risk 64 .”
Phalaris Toxicoses in Australian Livestock Production Systems: Prevalence, Aetiology and Toxicology
Alden, R., Hackney, B. F., Weston, L. A., & Quinn, J. C. (2014) · Journal of Toxins · doi:10.13188/2328-1723.1000003 · Cited by 7
“Exposure of animals to 5-MeO-DMT, in the presence of monoamine-oxidase inhibitors, such as the as indole alkaloid harmaline or its derivatives which can be found in some plant and seeds [42-44], can result in fatal 5-MeO-DMT toxicity [45] not dissimilar to that observed in phalaris toxicoses.”
Background
Intoxicación por ayahuasca
Márquez, B. D. P., & Dietl, B. (2017) · Medicina Clínica · doi:10.1016/j.medcli.2017.02.017 · Cited by 6
Infoveillance and Critical Analysis of the Systematically Reviewed Literature on Dimethyltryptamine and the “God Molecule”
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Ayahuasca et vulnérabilité chimique : à propos d’un cas
Hoizey, G., Chèze, M., Muckensturm, A., Eliot, E., Borlot, A.-L., Pépin, G., & Deveaux, M. (2017) · Annales de Toxicologie Analytique · doi:10.1016/j.toxac.2017.02.001 · Cited by 5
Tryptamines
Greene, S. L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818788-3.00014-0 · Cited by 5
Cardiac effects of two hallucinogenic natural products, N,N-dimethyl-tryptamine and 5-methoxy-N,N-dimethyl-tryptamine
Neumann, J., Dietrich, T., Azatsian, K., Hofmann, B., & Gergs, U. (2025) · Scientific Reports · doi:10.1038/s41598-025-91400-6 · Cited by 4
Analysis of N,N‐dimethyltryptamine ( DMT ) and its metabolites using LC – MS / MS for forensic purposes
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Development of a mechanism-based pharmacokinetic/pharmacodynamic model to characterize the thermoregulatory effects of serotonergic drugs in mice
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A simple method for the determination of stimulant substances in postmortem blood: development, validation, and application in nearly 1000 forensic cases
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“In the case reported by Sklerov et al. (2005), a 25-year-old male was found dead after the consumption of “herbal tonics”.”
Safety and Efficacy of Monoamine Oxidase Inhibitors in Patients Who Use Psychoactive Substances: Potential Drug Interactions and Substance Use Disorder Treatment Data
Rached, G., Campana, A. M., Fiani, D., Nguyen, C. Y., den Eynde, V. V., Gillman, P. K., & Barnett, B. S. (2026) · CNS Drugs · doi:10.1007/s40263-025-01256-7 · Cited by 3
How to set up a psychedelic study: Unique considerations for research involving human participants
Glennon, M. J., Bird, C., Yadav, P., Kleine, P., Suseelan, S., Boman-Markaki, C., Kotoula, V., Butler, M., Leech, R., Roseman, L., et al. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106657 · Cited by 5
Bufotenina como droga facilitadora de agresión sexual
Escayola, E. N., Vega, C. V., & Torrecilla, C. H. (2022) · Medicina Clínica · doi:10.1016/j.medcli.2022.06.012 · Cited by 3

Authors: Sklerov, J., Levine, B., Moore, K. A., King, T., & Fowler, D.
Affiliations: State of Maryland (US)
Corresponding author: Levine, Barry
ORCID: Fowler, David
Venue: Journal of Analytical Toxicology
Publisher: Oxford University Press (OUP)
Published: 2005-11-01
Volume: 29
Issue: 8
Pages: 838-841
ISSN: 0146-4760 (ISSN-L)
1945-2403
DOI: 10.1093/jat/29.8.838
OpenAlex: W2159917347
Cited by: 144
References: 15
Citations by year: 2026: 8 · 2025: 7 · 2024: 8 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 12 · 2016: 12 · 2015: 11 · 2014: 9 · 2013: 6 · 2012: 4
FWCI: 4.61
Type: journal article
Language: en
Open access: closed
Locations: Journal of Analytical Toxicology (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
Physical Sciences › Chemistry › Organic Chemistry › Synthesis and bioactivity of alkaloids
Keywords: 5-MeO-DMT, ayahuasca, β-carbolines, tetrahydroharmine, harmaline, harmine, fatal poisoning, death investigation, postmortem toxicology
MeSH terms: Adult, Chromatography, Liquid, Humans, Male, Methoxydimethyltryptamines, Mass Spectrometry, Fatal Outcome, Banisteriopsis

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A fatal intoxication following the ingestion of 5-methoxy-N,N-dimethyltryptamine in an ayahuasca preparation.

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