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 Depression  Holistic-online.com

Drug Interaction Guide For MAOI Antidepressants

The following is a list of interactions between Monoamine Oxidase Inhibitor (MAOI) antidepressants and other common medications/drugs.

MAOI Interactions With:

Other Antidepressants

Asthma Medicines

Cold, Cough, Allergy, Sinus, Decongestant and Hay Fever Medications

Diabetes Medications

Medications to Treat Low Blood Pressure

Medications for High Blood Pressure

MAOI Interactions With:

Mood Stabilizers

Painkillers and Anesthetics

Sedatives and Tranquilizers

Stimulants (Pep Pills) and Street Drugs

Weight Loss and Appetite-Suppression Medications

Other Medications

Interaction of MAOI antidepressants with other antidepressants

Interaction of MAOI antidepressants with Results in
Tricyclic antidepressants, especially desipramine (Norpramin, Pertofrane) and clomipramine (Anafranil) Some (e.g., clomipramine) may cause a hyperpyrexic crisis or seizures.
Others (e.g. desipramine) may cause a hypertensive crisis 
Tetracyclic antidepressants, especially Bupropion (Welibutrin) Hypertensive crisis (noradrenergic syndrome) 
SSRIs (all are extremely dangerous)  Hyperpyrexic crisis (serotonin syndrome) 
Other MAOIs Hyperpyrexic crisis (serotonin syndrome)
Hypertensive crisis (noradrenergic syndrome) 
Serotonin antagonists, including trazodone (Desyrel) and nefazodone (Serzone) Hyperpyrexic crisis (serotonin syndrome) 
Mirtazapine (Remeron)  Hypertensive crisis (noradrenergic syndrome) 
Venlafaxine (Effexor) Hypertensive crisis (noradrenergic syndrome) 

Interaction of MAOI antidepressants with Asthma Medicines

Interaction of MAOI antidepressants with Results in
Ephedrine, a bronchodilator contained in Marax, Quadrinal, and other asthma drugs Hypertensive crisis
Inhalants which contain albuterol (Proventil, Ventolin), metaproterenol (Alupent, Metaprel), or other beta- adrenergic bronchodilators Blood pressure elevations and a rapid heart.
Beclomethasone and other nonsystemic steroid inhalers are generally safer
Theophylline (Theo-Dur), a common ingredient in asthma drugs  Rapid heart and anxiety

 
Interaction of MAOI antidepressants with Cold, Cough, Allergy, Sinus, Decongestant and Hay Fever Medications

Interaction of MAOI antidepressants with Results in
Antihistamines: terfenadine (Seldane-D)
Can cause an increase in MAOI blood levels 
Dextromethorphan - found in many cold and cough medications, especially any drug with DM or Tuss in its name. These include Bromarest-DM or -DX, Dimetane-DX cough syrup, Dristan Cold & Flu, Phenergan with Dextromethorphan, Robitussin-DM, several Tylenol cold, cough, and flu preparations, and many others Hyperpyrexic crisis (serotonin syndrome).
May also cause brief episodes of psychosis or bizarre behavior
Ephedrine - found in Bronkaid, Primatene, Vicks Vatronol nose drops, and several other asthma and cold medications. Hypertensive crisis (noradrenergic syndrome)
Oxymetazoline (Afrin) nose drops or sprays used to treat nasal decongestion. Hypertensive crisis (noradrenergic syndrome)
Phenylephrine can be found in Dimetane, Dristan decongestant, Neo-Synephrine nasal spray and nose drops, and many other similar preparations, including some eye-drop medications  Hypertensive crisis (noradrenergic syndrome)
Phenylpropanolamine  - found in Alka-Seltzer Plus Cold and Night-Time Cold medicine, Allerest, Contac decongestants, Coricidin D decongestants, Dexatrim appetite pills, Dimetane-DC Cough syrup, Ornade Spansules, Robitussin-CF Sinarest, St. Joseph Cold Tablets, Tylenol Cold medicine, and many others Hypertensive crisis (noradrenergic syndrome)
Pseudoephedrine - found in Actifed, Allerest No Drowsiness formula, Benadryl combinations, CoAdvil, Dimetane DX cough syrup, Dristan Maximum Strength, Robitussin DAC syrup, Robitussin-PE, Seldane D tablets, Sinarest No Drowsiness, Sinutab, Sudafed, Triaminic Nite Light, Tylenol allergy, sinus, flu, and cold preparations,  several Vicks products including NyQuil, etc.  Hypertensive crisis (noradrenergic syndrome) 


Interaction of MAOI antidepressants with Diabetes Medications 

Interaction of MAOI antidepressants with Results in
Insulin May cause a greater drop in blood sugar 
Oral hypoglycemic agents  May cause a greater drop in blood sugar 

Interaction of MAOI antidepressants with Medications to Treat Low Blood Pressure

Interaction of MAOI antidepressants with Results in
Sympathomimetic amines including: 
dopamine (intropin) 
epinephrine (Adrenalin) 
isoproterenol (isuprel) 
metaraminol (Aramine) 
methyidopa (Aidomet) 
norepinephrine (Levophed)
Hypertensive crisis (noradrenergic syndrome) (These drugs cause blood vessels to constrict.)

Interaction of MAOI antidepressants with Medications to Treat Medications for High Blood Pressure 

Interaction of MAOI antidepressants with Results in
Guanadrel (Hylorel) 
Guanethidine (ismelin) 
Hydralazine (Apresoline) 
methyldopa (Aldomet) 
reserpine (Serpasil) 
These blood-pressure medications may cause an increase in blood pressure when combined with MAOIs 
Beta-blockers May be more potent when combined with MAOIs, leading to a greater than expected drop in blood pressure and dizziness when standing 
Calcium channel blockers Appear to be reasonably safe when combined with MAOIs. Check with your doctor and monitor blood pressure closely. Watch for a greater than expected drop in blood pressure 
Diuretics Watch for a greater than expected drop in blood pressure. May increase blood level of the MAOI 

Interaction of MAOI antidepressants with Mood Stabilizers

Interaction of MAOI antidepressants with Results in
Carbamazepine (Tegretol) Hyperpyrexic crisis (serotonin syndrome).
MAOI may cause carbarnazepine levels to fall, so epileptics may experience seizures 
Lithium (Eskalith)  Found to cause hyperpyrexic crisis (serotonin syndrome) in animal studies 

Interaction of MAOI antidepressants with Painkillers and Anesthetics

Interaction of MAOI antidepressants with Results in
Anesthetics: general  Tell your anesthesiologist you are on an MAOI. If possible, discontinue the MAOI two weeks before elective surgery.

Muscle relaxants such as succinylcholine and tubocurarine may have a more pronounced or prolonged effect. General anesthetics such as halothane may lead to excitement, excessive depression of the brain, or hyperpyrexic reactions.

Anesthetics: local Some contain epinephrine or other sympathomimetics-make sure you tell your dentist or surgeon you are taking an MAOI 
Cyclobenzaprine (Flexeril)  Hyperpyrexic crisis (serotonin syndrome) or severe seizures 
Meperidine (Demerol) A single injection can cause seizures, coma, and death (serotonin syndrome). Most other narcotics, including morphine and codeine, have been used safely with MAOIs 


Interaction of MAOI antidepressants with Sedatives and Tranquilizers

Interaction of MAOI antidepressants with Results in
Alcohol May have enhanced sedative effects, especially when combined with, pheneizine (Nardil.) This could be hazardous when driving or operating dangerous machinery.
Barbiturates (such as phenobarbital) Enhanced sedative effects. This could be hazardous when driving or operating dangerous machinery.
Buspirone (BuSpar)  Enhanced sedative effects.  This could be hazardous when driving or operating dangerous machinery.
Major tranquilizers (neuroleptics)  Enhanced sedative effects. Some neuroleptics may cause a drop in blood pressure when combined with MAOIs. May be hazardous when driving or operating dangerous machinery.
Minor tranquilizers (benzodiazepines) such as alprazolam (Xanax), diazepam (Valium), and others  Enhanced sedative effects. May be hazardous when driving or operating dangerous machinery.
Sleeping pills Enhanced sedative effects. May be hazardous when driving or operating dangerous machinery.
L-tryptophan Hyperpyrexic crisis (serotonin syndrome); blood-pressure elevations; disorientation, memory impairment, and other neurologic changes 

Interaction of MAOI antidepressants with Stimulants (Pep Pills) and Street Drugs

Interaction of MAOI antidepressants with Results in
Amphetamines ('speed' or 'crank') 
cocaine 
benzedrine 
benzphetamine (Didrex) 
dextroamphetamine (Dexedrine) 
methamphetamine (Desoxyn) 
methylphenidate (Ritalin) 
Hypertensive crisis (noradrenergic syndrome) is possible.

Methylphenidate considered somewhat less risky than the amphetamines 

Interaction of MAOI antidepressants with Weight Loss and Appetite-Suppression Medications

Interaction of MAOI antidepressants with Results in
Cylert (Pemoline) Drug interactions have not been studied in humans. Great caution is advised.
Fenfluramine (Pondimin) Hyperpyrexic crisis (serotonin syndrome) 
Phendimetrazine (Plegiline) Hypertensive crisis (noradrenergic syndrome) 
Phentermine and some over-the- counter medications Hypertensive crisis (noradrenergic syndrome) 
Phenylpropanolamine (Acutrim) Hypertensive crisis (noradrenergic syndrome) 


Interaction of MAOI antidepressants with Other Medications/Drugs

Interaction of MAOI antidepressants with Results in
Caffeine Probably safe in moderate amounts. Avoid large amounts - may cause 
blood-pressure elevations, a racing heart, and anxiety.
Disulfiram (Antabuse) (used to treat alcoholism)  Severe reactions when mixed with an MAOI 
L-dopa (Sinemet) (used to treat Parkinson's disease) Hypertensive crisis (noradrenergic syndrome)

Source: David D. Burns, M.D.: The Feeling Good Handbook ( Plume)

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