MAOIs Disulfiram

Drugs that may affect MAOIs include dibenzazepine-related entities, disulfiram, methylphenidate, metrizamide, and sulfonamide. 

Temazepam (Restoril) [C-IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia, anxiety, depression, panic attacks Action Benzodiaz ine Dose 15-30 mg PO hs PRN X in elderly Caution [X, /-] Potentiates CNS dqjressive effects of opioids, barbs, EtOH, antihistamines, MAOIs, TCAs Contra NAG Disp Caps SE Confusion, dizziness, drowsiness, hangover Interactions T Effects W/ cimetidine, disulfiram, kava kava, valerian T CNS depression W/ anticonvulsants, CNS depressants, EtOH t effects OF haloperidol, phenytoin X effects W/ aminophylline, dyphylline, OCPs, oxtriphylline, rifampin, theophylline, tobacco X effects OF levodopa EMS Use caution w/ other benzodiazepines, antihistamines, opioids and verapamil, can T CNS depression concurrent EtOH can T CNS depression abruptly D/C after >10 d use may cause withdrawal OD May cause profound CNS depression, confusion, bradycardia, hypotension, and altered reflexes flumazenil can be used as antidote, activated charcoal may be effective... 

Estazolam potentiates the CNS depressant effects of phenothiazines, narcotics, antihistamines, MAOIs, barbiturates, alcohol, general anesthetics, and TCAs. Use with cimetidine, disulfiram, oral contraceptives, and isoniazid may diminish hepatic metabolism and result in increased plasma concentrations of estazolam and increased CNS depressant effects. Fleavy smoking (more than 20 cigarettes/day) accelerates estazolam s clearance. Theophylline antagonizes estazolam s pharmacological effects. 

Triazolam potentiates the CNS depressant effects of phenothiazines, narcotics, antihistamines, MAOIs, barbiturates, alcohol, general anesthetics, and antidepressants. Use with cimetidine and disulfiram may increase triazolam s plasma concentration. 

Ciraulo DA. Can disulfiram (Antabuse) be safely co-administered with the monoamine oxidase inhibitor (MAOI) antidepressants . J Clin Psychopharmacol (1989) 9, 315-16. 

The authors of this report attribute the reaction to an interaction between tranylcypromine and disulfiram. However, there would seem to be other possible explanations for this reaction. MAOIs have rarely been seen to interact adversely with lithium , (p. 1136), and there also seems potential for an interaction between the two MAOIs , (p. 1137). 

This seems to be the only report of an adverse reaction between disulfiram and an MAOI, so it is possible that this is just an idiosyncratic reaction. However, warnings about this drug combination, based on theoretical considerations and studies in animals, have previously been... 

---