Ayahuasca is a South American (pan-Amazonian) psychoactive brew used both socially and as ceremonial spiritual medicine among the indigenous peoples of the Amazon basin. It is a psychedelic and entheogenic brew commonly made out of the Banisteriopsis caapi vine, the Psychotria viridis shrub or a substitute, and possibly other ingredients; however, a chemically similar preparation, sometimes called "pharmahuasca", can be prepared using N,N-Dimethyltryptamine (DMT) and a pharmaceutical monoamine oxidase inhibitor (MAOI), such as isocarboxazid. B. caapi contains several alkaloids that act as MAOIs, which are required for DMT to be orally active. Ayahuasca is prepared in a tea that, when consumed, causes an altered state of consciousness or "high", including visual hallucinations and altered perceptions of reality.The other required ingredient is a plant that contains the primary psychoactive, DMT. This is usually the shrub P. viridis, but Diplopterys cabrerana may be used as a substitute. Other plant ingredients often or occasionally used in the production of ayahuasca include Justicia pectoralis, one of the Brugmansia (especially Brugmansia insignis and Brugmansia versicolor, or a hybrid breed) or Datura species, and mapacho (Nicotiana rustica).