Trazodone Pseudoephedrine

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. 

A 35-year old Caucasian man with AIDS and multiple opportunistic infections, including Mycobacterium kansasii and Mycobacterium avium complex (MAC) disease developed moderate to severe primary sensorineural hearing loss after 4—5 months of therapy with oral azithromycin 500 mg/day. Other medications included ethambutol, isoniazid, rifabutin, ciprofloxacin, co-trimoxazole, fluconazole, zidovudine (later switched to stavudine), lamivudine, indinavir, methadone, mod-ified-release oral morphine, pseudoephedrine, diphenhydramine, megestrol acetate, trazodone, sorbitol, salbutamol by metered-dose inhaler and nebulizer, ipratropium, and oral morphine solution as needed. Significant improvement of the hearing impairment was documented 3 weeks after drug withdrawal. 

Clinically important, potentially hazardous interactions with alprazolam, amphetamines, astemizole, clarithromycin, clozapine, desipramine, dexibuprofen, dextroamphetamine, diethylpropion, droperidol, duloxetine, erythromycin, haloperidol, imipramine, isocarboxazid, linezolid, lithium, MAO inhibitors, mazindol, meperidine, methamphetamine, midazolam, moclobemide, nortriptyline, phendimetrazine, phenelzine, phentermine, phenylpropanolamine, phenytoin, pimozide, pseudoephedrine, selegiline, serotonin agonists, sibutramine, St John s wort, sumatriptan, sympathomimetics, tramadol, tranylcypromine, trazodone, tricyclic antidepressants, troleandomycin, tryptophan, zolmitriptan... 

Amphetamines 2-5 days Up to 2 weeks with prolonged or heavy use Many sympathomimetic amines such as pseudoephedrine, ephedra, phenylephrine, fenfluramine, and phentermine may cause positive results. Other drugs such as selegiline, chlorpromazine, trazodone, bupropion, and amantadine may cause false-positive results depending on the assay. 

A single report describes toxicity in a woman treated with trazodone when she took pseudoephedrine. 

An isolated report deseribes a woman who had been taking trazodone 250 mg daily for 2 years who took two doses of a non-preseription medi-eine eontaining pseudoephedrine. Within 6 hours she experieneed dread, anxiety, panie, eonfusion, depersonalisation and the sensation that parts of her body were separating. None of these symptoms had been experieneed in the past when she was taking either preparation alone. The reasons for this reaetion are not understood. This appears to be an isolated ease, and therefore no general eonelusions ean be drawn. 

Weddle RL. Possible trazodone-pseudoephedrine toxicity a case repot. Neurcbehav T[Pg.1229]

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