Basic Information
ID DDInter1362 and DDInter1186
Interaction By inhibiting serotonin metabolism, monoamine oxidase inhibitors (MAOIs) may potentiate the pharmacologic activity of serotonergic agents such as serotonin reuptake inhibitors, 5-HT1 receptor agonists, ergot alkaloids, buspirone, dextromethorphan, and most antidepressants. The result may be an increased risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors.
Management In general, serotonergic agents should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with serotonergic agents.
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Arch Gen Psychiatry 33 (1976): 828-30 [23] Brubacher JR, Hoffman RS, Lurin MJ "Serotonin syndrome from venlafaxine-tranylcypromine interaction." Vet Hum Toxicol 38 (1996): 358-61 [24] Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13 [25] Thomas JM, Rubin EH "Case report of a toxic reaction from a combination of tryptophan and phenelzine." Am J Psychiatry 141 (1984): 281-3 [26] Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11 [27] Phillips SD, Ringo P "Phenelzine and venlafaxine interaction." Am J Psychiatry 152 (1995): 1400-1 [28] Mathew NT, Tietjen GE, Lucker C "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia 16 (1996): 323-7 [29] Cetaruk EW, Aaron CK "Hazards of nonprescription medications." Emerg Med Clin North Am 12 (1994): 483-510 [30] Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763 [31] Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2 [32] Suchowersky O, deVries JD "Interaction of fluoxetine and selegiline." Can J Psychiatry 35 (1990): 571-2 [33] Pope HG Jr, Jonas JM, Hudson JI, Kafka MP "Toxic reactions to the combination of monoamine oxidase inhibitors and tryptophan." Am J Psychiatry 142 (1985): 491-2 [34] Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5 [35] Sovner R, Wolfe J "Interaction between dextromethorphan and monoamine oxidase inhibitor therapy with isocarboxazid ." N Engl J Med 319 (1988): 1671 [36] Heisler MA, Guidry JR, Arnecke B "Serotonin syndrome induced by administration of venlafaxine and phenelzine." Ann Pharmacother 30 (1996): 84 [37] "Product Information. Manerix (moclobemide)." Hoffmann-La Roche Limited, Mississauga, IA. [38] Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL "Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings." J Clin Psychopharmacol 13 (1993): 312-20 [39] "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories, Philadelphia, PA. [40] White K, Pistole T, Boyd JL "Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study." Am J Psychiatry 137 (1980): 1422-5 [41] "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC, New Haven, CT. [42] Jacob JE, Wagner ML, Sage JI "Safety of selegiline with cold medications." Ann Pharmacother 37 (2003): 438-41 [43] Schulz R, Antonin KH, Hoffmann E, et al "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." 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Br J Anaesth (2005): [51] White K, Simpson G "Combined MAOI-tricyclic antidepressant treatment: a reevaluation." J Clin Psychopharmacol 1 (1981): 264-82 [52] "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company, Indianapolis, IN. [53] "Product Information. Savella (milnacipran)." Forest Pharmaceuticals, St. Louis, MO. [54] Bhatara VS, Bandettini FC "Possible interaction between sertraline and tranylcypromine." Clin Pharm 12 (1993): 222-5 [55] "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ. [56] "Product Information. Zyvox (linezolid)" Pharmacia and Upjohn, Kalamazoo, MI. [57] Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499 [58] "Product Information. Marplan (isocarboxazid)" Roche Laboratories, Nutley, NJ. [59] Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651 [60] Martin TG "Serotonin syndrome." 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Alternative for Oxitriptan -
Alternative for Methylene blue V03A
Sodium cellulose phosphate Dimercaprol Amyl Nitrite Iron sucrose Phentolamine Flumazenil
Palifermin Nitrous acid Deferoxamine Sodium zirconium cyclosilicate Levoleucovorin
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.