MAOIs Fentanyl

Uses Obesity Action Blocks uptake of norepinephrine, serotonin, dopamine Dose 10 mg/d PO, may to 5 mg after 4 wk Caution [C, -] w/ SSRIs, Li, dextromethorphan, opioids Contra MAOI w/in 14 d, uncontrolled HTN, arrhythmias Disp Caps SE HA, insomnia, xerostomia, constipation, rhinitis, tach, HTN Interactions T Risk of serotonin synd W/ dextromethorphan, ergots, fentanyl, Li, meperidine, MAOIs, naratriptan, pentazocine, rizatriptan, sumatriptan, SSRIs, tryptophan, zolmitriptan, St. John s wort effects W/ cimetidine, erythromycin, ketoconazole T CNS depression W/ EtOH EMS Use fentanyl w/ caution, may T risk of serotonin synd concurrent EtOH use can T CNS depression OD May cause tach, HTN, diaphoresis, HA, fever, agitation, muscle tremors, and Szs symptomatic and supportive... 

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... 

Because sibutramine inhibits serotonin uptake, and because the serious serotonin syndrome has been seen when serotonergic drugs were taken with SSRIs, the manufacturers say that sibutramine should not be taken with any serotonergic drugs. They name dextromethorphan, dihydroergot-amine, fentanyl, pentazocine, pethidine (meperidine), SSRIs, sumatriptan, and tryptophan. Possible cases have been reported for sibutramine and SSMs , (below).The US manufacturers also include lithium in their list. Note that this list is not exhaustive (see MAOIs under (d) above) and a case of the serotonin syndrome has been seen when venla-faxine was given with sibutramine. ... 

Fentanyl has been used without problems in a few reports, but one fatal case of hyperthermia has occurred, and also a case of hypertension and tachycardia. Case reports describe the uneventful use of alfentanil, remifentanil and sufentanil in patients taking MAOIs. 

Fentanyl has been used safely in a number of patients receiving MAOIs. However, a fatality due to a serotonin-like syndrome has occurred in a patient taking an MAOI given fentanyl, and another case of hypertension and tachycardia has occurred. The authors of one of these reports, considered that there was insufficient evidence to conclude that patients on MAOIs can be given fentanyl safely, and call for all cases of combined use to be reported. Case reports also describe the safe use of alfentanil, remifen-tanil, and sufentanil. However, one UK manufacturer of fentanyl patches recommends that they should not be used during the use of, or within 14 days of stopping, an MAOI. ... 

Note that fentanyl and related drugs are frequently used during surgery, and it is generally considered that MAOIs should be discontinued 2 weeks before surgery, see Anaesthetics, general + MAOIs , p.lOO. 

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