MAOIs Chlorpromazine

Hypertensive crises are characterized initially by headache, but can evolve to include neck stiffness, chest discomfort, palpitations, confusion, and, ultimately, hemorrhage or stroke. Treatment of MAOI-associated hypertension may include a watch-and-wait stance by the patient if the symptoms are mild. Some patients have the ability to check and monitor their own blood pressure. Others may consult with a physician for blood pressure checks and observation, but if symptoms are severe, the patient may need to go to an emergency room or self-medicate. Standard emergency room treatment is intravenous phentolamine, an a-adrenergic blocker, continuous monitoring and management until blood pressure is normalized without medication. Some doctors will provide patients with small doses of chlorpromazine or nifedipine to treat hypertension if a problem arises. 

Serotonin syndrome SSRIs, second generation antidepressants, MAOIs, linezolid, tramadol, meperidine, fentanyl, ondansetron, sumatriptan, MDMA, LSD, St. John s wort, ginseng Hypertension, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhea, mydriasis, agitation, coma onset within hours Sedation (benzodiazepines), paralysis, intubation and ventilation consider 5-HT2 block with cyproheptadine or chlorpromazine... 

Sulfonylureas In acute poisoning with sulfonylureas, the stomach should be washed and treated with activated charcoal, and hypoglycemia must be treated. Sulfonylureas interact with oral contraceptives, thiazide diuretics, corticosteroids, adrenaline, chlorpromazine, ACE inhibitors, some NSAIDs, antihistamines, anticoagulants, MAOIs, antidepressants, and many other drugs. Care must be exercised when treating with sulfonylureas. 

Overdose with MAOIs can cause hypomania, coma and hypotension or hypertension. General measures are used as appropriate with minimal administration of drugs chlorpromazine for restlessness and excitement phentolamine for hypertension, no vasopressor drugs for hypotension, because of risk of hypertension (use posture and plasma volume expansion). 

The concurrent use of MAOIs and phenothiazines is usually safe and effective. However, rarely, cases of possible neuroleptic malignant syndrome or hyperpyrexia have been reported with MAOIs and chlorpromazine, levomepromazine or trifluoperazine. Some of these cases were fatal Chiorpromazine has been successfully used for treatment of the serotonin syndrome occurring with MAOIs and other drugs. Moclobemide has been used with various phenothiazines without problem, but one case of fatal overdose is attributed to an interaction between moclobemide and perazine. 

MAOIs and phenothiazines have been safe and effective when used together in the treatment of psychiatric conditions, particularly in the form ofa preparation containing both tranylcypromine and trifluoperazine, " which is still marketed in some countries. There is also a report of the beneficial use of tranylcypromine with chlorpromazine. ... 

Hypertensive reactions have been controlled by intravenous phen-tolamine, phenoxybenzamine, intramuscular chlorpromazine, labetalol or sublingual nifedipine. The manufacturers of phenelzine state that on the basis of present evidence, slow intravenous injection of phentolamine is recommended. However, it is advisable to refer to current guidelines on the management of hypertensive crises for up-to-date advice. See also Importance and Management under MAOIs or RIMAs + Tyramine-rich foods , p.II53. 

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