Basic Information
ID DDInter110 and DDInter1653
Interaction Topically administered alpha-2 adrenergic receptor agonists such as apraclonidine are systemically absorbed, with the potential for producing rare but clinically significant systemic effects. Despite relative alpha-2 selectivity, theoretical concerns exist that coadministration with monoamine oxidase inhibitors (MAOIs) may increase the risk of hypertension due to potentiation of alpha-1 stimulation, which produces vasoconstriction. However, the interaction has not been reported in the medical literature.
Management The use of apraclonidine ophthalmic solution with MAOIs is considered contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with apraclonidine.
References [1] "Product Information. Iopidine (apraclonidine)." Alcon Laboratories Inc, Fort Worth, TX. [2] Schulz R, Antonin KH, Hoffmann E, et al "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36 [3] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [4] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [5] King MH, Richards DW "Near syncope and chest tightness after administration of apraclonidine before argon laser iridotomy." Am J Ophthalmol 110 (1990): 308-9 [6] "Product Information. Alphagan (brimonidine ophthalmic)." Allergan Inc, Irvine, CA. [7] Kronig MH, Roose SP, Walsh BT, Woodring S, Glassman AH "Blood pressure effects of phenelzine." J Clin Psychopharmacol 3 (1983): 307-10 [8] Coleman AL, Robin AL, Pollack IP, Rudikoff MT, Enger C, Mayer PR "Cardiovascular and intraocular pressure effects and plasma concentrations of apraclonidine." Arch Ophthalmol 108 (1990): 1264-7 [9] Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62 [10] Nordlund JR, Pasquale LR, Robin AL, Rudikoff MT, Ordman J, Chen KS, Walt J "The cardiovascular, pulmonary, and ocular hypotensive effects of 0.2% brimonidine." Arch Ophthalmol 113 (1995): 77-83 [11] Pekdemir M, Yanturali S, Karakus G "More than just an ocular solution." Emerg Med J 22 (2005): 753-4 [12] "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ. [13] "Product Information. Marplan (isocarboxazid)" Roche Laboratories, Nutley, NJ. [14] "Product Information. Zyvox (linezolid)" Pharmacia and Upjohn, Kalamazoo, MI. [15] Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651 [16] Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499 [17] Ban TA "Drug interactions with psychoactive drugs." Dis Nerv Syst 36 (1975): 164-6 [18] Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6 [19] Maxwell MB "Reexamining the dietary restrictions with procarbazine (an MAOI)." Cancer Nurs 3 (1980): 451-7 [20] "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation, Eatontown, NJ. [21] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [22] Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31 [23] Nuessle WF, Norman FC, Miller HE "Pickled herring and tranylcypromine reaction." JAMA 192 (1965): 142-3 [24] Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62 [25] Walker JI, Davidson J, Zung WWK "Patient compliance with MAO Inhibitor therapy." J Clin Psychiatry 45 (1984): 78-80 [26] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [27] Sweet RA, Liebowitz MR, Holt CS, Heimberg RG "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol 11 (1991): 331-2 [28] Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol 14 (1994): 5-14 [29] Domino EF, Selden EM "Red wine and reactions." J Clin Psychopharmacol 4 (1984): 173-4 [30] "Product Information. Nardil (phenelzine)." Parke-Dvis, Morris Plains, NJ.
Alternative for Apraclonidine S01E
Brinzolamide Acetylcholine Neostigmine Latanoprost Levobunolol Pilocarpine
Travoprost Diclofenamide Physostigmine Brimonidine Methazolamide
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Alternative for Selegiline N04B
Cabergoline
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.