Pseudoephedrine MAOIs

Ephedrine —contraindicated with MAOIs Pseudoephedrine —contraindicated with MAOIs Phenylephrine —contraindicated with MAOIs Phenylpropanolamine —contraindicated with MAOIs Seriously elevated blood pressure (hypertensive crisis), elevated temperature, seizures, cerebral hemorrhage, death... 

Many commonly used medications also contain substances that are eliminated by the MAOIs and must not be taken by these patients. The list of medications to be avoided inclndes the narcotic pain reliever meperidine (Demerol), and many over-the-connter cold remedies containing dextromethorphan or pseudoephedrine. Finally, patients taking MAOIs must also avoid medications that elevate serotonin levels. This inclndes certain appetite snppressants and antidepressants including the SSRIs, venlafaxine, duloxetine, mirtazapine, nefazodone, and trazodone. Medications that interact with the MAOIs cannot be taken until at least 2 weeks after the MAOI has been stopped. 

Pseudoephedrine (Sudafed, Novafed, Afrinol, Others) [OTC] [Decongestant/Sympothomimetic] Uses Deconge tant Action Stimulates a-adren gic rec tors w/ vasoconstriction Dose Adults. 30-60 mg PO q6—8h Peds. 4 mg/kg/24 h PO qid -1- in renal insuff Caution [C, +] Contra Poorly controlled HTN or CAD, w/MAOIs Disp Tabs, caps, Liq SE HTN, insomnia, tach, arrhythmias, nervousness, tremor Interactions T Risk of HTN crisis W/ MAOIs T effects W/BBs, sympathomimetics X effects W/TCAs -1- effect OF methyldopa, reserpine EMS Found in many OTC cough/cold pr >arations use sympathomimetics w/ caution, may T adverse effects OD May cause N/V, HTN, arrhythmias, and Szs symptomatic and supportive... 

Local anesthetic preparations often contain a sympathomimetic drug. Cold medications contain pseudoephedrine or ephedrine-type drugs. All of these would synergize with the increased levels of catecholamines produced by a MAOI. 

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. 

The manufaeturers eontraindieate the use of sympathomimetics (including adrenergic bronchodilators, pseudoephedrine, phenylpropanolamine, adrenaline (epinephrine), noradrenaline (norepinephrine), dopamine, dob-utamine) with linezolid unless there are faeilities available for close observation of the patient and monitoring of blood pressure. Some indirectly-aeting sympathomimetics occur in cough and cold remedies, whieh can be bought without prescription. To keep in line with the manufaeturers recommendations, patients should be told to avoid these preparations. However, it should be said that the evidenee available indicates that blood pressure rises are unlikely to be of the proportions seen with the antidepressant MAOIs, which result in hypertensive crises. Consider also MAOIs or RIMAs + Sympathomimetics Indirectly-acting , p.l 147. 

A very well-documented, serious, and potentially fatal interaction. Patients taking any of the MAOIs should not normally take any sympathomimetic amine with indirect activity. These include ephedrine, isometheptene mucate, mephentermine, metaraminol, phenylpropanolamine and pseudoephedrine. Direct evidence implicating methylephe-drine and pholedrine seems not to have been documented, but on the basis of their known pharmacology their concurrent use with the MAOIs should be avoided. 

The monoamine oxidase inhibitors (MAOIs) work through augmented activity of dopamine, as monoamine oxidase normally degrades norepinephrine and serotonin. The MAOIs are rarely used clinically due to their adverse effects, notably orthostatic hypotension, peripheral edema, myoclonic jerks, weakness, and insomnia. Hypertensive crisis can result when combined with sympathomimetics, including over-the-counter products such as ephe-drine and pseudoephedrine. Further, MAOIs are known to contribute to the serotonin syndrome and use of meperidine must be avoided in such patients. Patients on MAOI need to restrict tyramine-rich foods, as well [1,2]. 

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