Pseudoephedrine Monoamine oxidase inhibitors

As with other sympathomimetic agents, theoretical drug interactions with ephedra alkaloids are possible. Despite this potential, only a handful of adverse drug interactions have been reported. This is especially pertinent when considering the extensive use of both ephedra-containing supplements and ephedrine- or pseudoephedrine-containing OTC products. The most notable interaction exists between nonselective monoamine oxidase inhibitors and ephedra- or ephedrine-containing products. 

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]. 

ASA = aspirin NSAIDs = non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen, and diclofenac CNS stimulants include drugs such as pseudoephedrine, dextroamphetamine, theophylline, and caffeine MAO = monoamine oxidase CNS depressants include drugs such as benzodiazepines, barbiturates, and ethanol SSRIs = selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, and paroxetine. Antidiabetic agents include drugs such as insulin, glipizide, glyburide, and metformin. 

Acrivastine enhances the CNS depressant effects of alcohol and other CNS depressants. Overdosage with pseudoephedrine may cause palpitations, tachycardia, pressor activity, cardiac arrhythmias, or cardiovascular collapse. These agents should not be taken with monoamine oxidase A inhibitor (MAO A inhibitor), such as tranylcypromine. 

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