MAO Inhibitors- Interactions and Warnings

MAO Inhibitors
– Interactions and Warnings

MAOI-drug and MAOI-food interactions are possible, particularly with sympathomimetic medications or tyramine-containing foods, resulting in hypertensive reactions. Use caution with regard to the dietary intake of foodstuffs likely to contain a high tyramine content. Concomitant prescription of serotonin-enhancing drugs should only be undertaken with caution for patients on moclobemide, toloxatone or selegiline. Coprescription of sympathomimetic drugs should also be avoided with these newer MAOIs and patients should be advised against purchasing over-the-counter preparations that may contain sympathomimetic drugs.
– Drug Saf 1996 Apr;14(4):219-27 — Monoamine oxidase inhibitors. An update on drug interactions. — Livingston MG, Livingston HM.

Isoniazid is an antitubercular drug with some monamine oxidase (MAO) inhibition. Perhaps because this is only weak inhibition, a few clinicians consider dietary or drug restrictions for their patients on isoniazid. However recent reports suggest the combination of isoniazid and antidepressants may cause adverse events possibly related to isoniazid’s MAO inhibition activity.
– Int Clin Psychopharmacol 1995 Sep;10(3):197-8 — Isoniazid, tricyclics and the “cheese reaction”. — DiMartini A.

Despite the increase in use of alternative and safer antidepressants, MAOI interactions still occur and unless they are managed appropriately, are potentially fatal. Patients need to be warned that restrictions apply for up to 2 weeks after stopping the medication, and doctors need to be aware that serious interactions can occur in this time period.
– J Accid Emerg Med 1995 Mar;12(1):49-51 — Dangerous monoamine oxidase inhibitor interactions are still occurring in the 1990s. — Dawson JK, Earnshaw SM, Graham CS.

All triptans narrow coronary arteries by 10% to 20% at clinical doses and should not be administered to patients with coronary or cerebrovascular disease. Some triptans have the potential for significant drug-drug interactions (sumatriptan, rizatriptan, and zomitriptan and monoamine oxidase inhibitors; rizatriptan and propanolol; zolmitriptan and cimetidine; and eletriptan and CYP3A4 metabolized medications and p-glycoprotein pump inhibitors).
– Med Clin North Am 2001 Jul;85(4):959-70 — Safety and rational use of the triptans. — Tepper SJ.

Consult with your physician before using any herbs, herbal products or supplements especially ones that have an effect on mood, the heart or the brain. Use extreme caution.

last update: November 2008

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