MAOI, drug interactions, MAOI interactions with other drugs, Depression, Alternative therapies, mind-body medicine, integrative therapies

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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