Methylphenidate MAOIs

Amphetamines—contraindicated with MAOIs Methylphenidate (Ritalin)— contraindicated with MAOIs Seriously elevated blood pressure (hypertensive crisis), elevated temperature, seizures, cerebral hemorrhage, death... 

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

Patients with marked anxiety, tension, and agitation, because the drug may aggravate these symptoms hypersensitivity to methylphenidate or other components of the product patients with glaucoma, motor tics, or a family history or diagnosis of Tourette s syndrome during treatment with monoamine oxidase inhibitors (MAOIs), and also within a minimum of 14 days following discontinuation of an MAOl (hypertensive crises may result). 

Drugs that may affect methylphenidate include MAOIs. Drugs that may be affected by methylphenidate hydrochloride include guanethidine, anticonvulsants (eg, phenytoin, phenobarbital, primidone), selective serotonin reuptake inhibitors, coumarin anticoagulants, and tricyclic antidepressants. 

Antidepressants MAOIs, TCAs, SSRIs, SNRIs, mirtazapine, venlafaxine Amphetamines, phentermine, methylphenidate, sibutramine... 

Methylphenidate may decrease therapeutic effects of concomitantly administered antihypertensive medications and may potentiate effects of warfarin, phenytoin, phenylbutazone, and tricyclic antidepressants. When methylphenidate and MAOIs are coadministered, hypertensive crisis may result. 

HA, mild pain Action Nonnarco tic analgesic w/ barbiturate Dose 1—2 tabs or caps PO q4-6h PRN i in renal/hepatic impair 4 g/24 h APAP max Caution [C, D, +] Alcoholic liver Dz Contra G6PD deficiency Disp Caps, Liq, tabs SE Drowsiness, dizziness, hangover effect Interactions T Effects OF benzodiazepines, opiate analgesics, sedatives/hypnotics, EtOH, methylphenidate hydrochloride i effects OF MAOIs, TCAs, corticosteroids, theophylline, OCPs, BBs, doxycycline EMS See Acetaminophen may impair coordination, monitor for depression concurrent EtOH use T CNS depression butalbital is habit forming... 

In narcolepsy, patients usually need a stimulant for their hypersomnia and a TCA or SSRI for their cataplexy, so care should be taken when combining these. Dexamfetamine and methylphenidate must not be given with MAOIs. There is potential for interaction between methylphenidate and TCAs (hyperteirsion) and SSRI antidepressants. It appears that modafinil, methylphenidate and dexamfeta-mine may themselves be combined without adverse outcome (modafinil is occasionally used regularly and dexamfetamine added intermittently when peak alertness is particularly critical). Modafinil accelerates the metabolism of oral contraceptives, reducing their efficacy. 

Discuss the interaction of MAOIs with psychostimulant drugs (e.g., methylphenidate). 

Sympathomimetics (indirectly acting) Combining MAOis with agents such as amphetamines, cocaine, ephedrine, methylphenidate, pemoline, pseudoephedrine, phenylpropanolamine, and others (including many cold and allergy medications) can cause a potentially fatal hypertensive crisis. 

Drug interactions for the RIMAs include interaction with SSRI antidepressants, which can cause the 5-HT syndrome (see the discussion of SSRIs). The effect of stimulant drugs, such as methylphenidate and dextroamphetamine (used to treat ADHD), may be increased. Some over-the-counter cold and hay fever decongestants (i.e., sympathomimetic amines) can have increased stimulant effects. Selegiline, a selective MAO-B used for Parkinson s disease, should not be used concurrently with the RIMAs. Unlike the irreversible MAOIs, no significant interactions with foods occur, because the selective inhibition of MAO-Adoes not stop the metabolism of tyramine. The RIMAs must not be taken concurrently with a nonreversible MAOI. 

A case report describes a patient treated with trazodone, isocarboxazid and methylphenidate who developed symptoms of the serotonin syndrome. The US manufaeturer says due to the absence of clinical experience, if MAOIs are diseontinued shortly before or are to be given concurrently with trazodone, therapy should be initiated cautiously with a gradual increase in dosage until optimum response is achieved. However, the UK manufaeturer of trazodone says possible interactions with MAOIs have occasionally been reported they do not recommend concurrent use, nor should trazodone be given within 2 weeks of stopping an MAOI. MAOIs should not be taken within one week of stopping trazodone. ... 

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