Basic Information
ID DDInter2064 and DDInter1631
Interaction Coadministration of a selective monoamine oxidase B (MAO-B) inhibitor with other MAO inhibitors, selective or nonselective, may increase the risk of a hypertensive crisis. Although selective inhibitors of MAO-B presumably have minimal effect on intestinal and hepatic MAO-A that catabolizes exogenous amines like tyramine, the selectivity may not be absolute even at recommended doses and may diminish with increasing doses.
Management Concurrent use of selective MAO-B inhibitors with other MAO inhibitors is considered contraindicated. At least 14 days should elapse between discontinuation of a nonselective MAO inhibitor and initiation of treatment with a selective MAO inhibitor, and vice versa. The recommended dosages of selective MAO-B inhibitors should not be exceeded, as it can increase the risk of nonselective MAO inhibition and precipitation of a hypertensive crisis.
References [1] McGrath PJ, Stewart JW, Quitkin FM "A possible L-deprenyl induced hypertensive reaction." J Clin Psychopharmacol 9 (1989): 310-1 [2] "Product Information. Eldepryl (selegiline)." Somerset Pharmaceuticals Inc (2001): [3] Lefebvre H, Noblet C, Morre N, Wolf LM "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf) 42 (1995): 95-8 [4] Ito D, Amano T, Sato H, Fukuuchi Y "Paroxysmal hypertensive crises induced by selegiline in a patient with Parkinson's disease." J Neurol 248 (2001): 533-4 [5] "Product Information. Emsam (selegiline)." Bristol-Myers Squibb (2006): [6] "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006): [7] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [8] "Product Information. Xadago (safinamide)." US WorldMeds LLC (2017):
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Pramipexole Amantadine
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.