Antidepressants, Monoamine Oxidase (MAO) Inhibitor (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For monoamine oxidase (MAO) inhibitors, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to any MAO inhibitor. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet - Dangerous reactions such as sudden high blood pressure may result when MAO inhibitors are taken with certain foods or drinks. The following foods should be avoided:

• Foods that have a high tyramine content (most common in foods that are aged or fermented to increase their flavor), such as cheeses; fava or broad bean pods; yeast or meat extracts; smoked or pickled meat, poultry, or fish; fermented sausage (bologna, pepperoni, salami, summer sausage) or other fermented meat; sauerkraut; or any overripe fruit. If a list of these foods and beverages is not given to you, ask your health care professional to provide one.
• Alcoholic beverages or alcohol-free or reduced-alcohol beer and wine.
• Large amounts of caffeine-containing food or beverages such as coffee, tea, cola, or chocolate.

Pregnancy - A limited study in pregnant women showed an increased risk of birth defects when these medicines were taken during the first 3 months of pregnancy. In animal studies, MAO inhibitors caused a slowing of growth and increased excitability in the newborn when very large doses were given to the mother during pregnancy.

Breast-feeding - Tranylcypromine passes into the breast milk; it is not known whether isocarboxazid or phenelzine passes into breast milk. Problems in nursing babies have not been reported.

Children - Studies on these medicines have been done only in adult patients, and there is no specific information comparing use of MAO inhibitors in children with use in other age groups. However, animal studies have shown that these medicines may slow growth in the young. Therefore, be sure to discuss with your doctor the use of these medicines in children.

Older adults - Dizziness or lightheadedness may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to these effects of MAO inhibitors.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking MAO inhibitors, it is especially important that your health care professional know if you are taking any of the following:

• Amphetamines or
• Antihypertensives (high blood pressure medicine) or
• Appetite suppressants (diet pills) or
• Cyclobenzaprine (e.g., Flexeril) or
• Fluoxetine (e.g., Prozac) or
• Levodopa (e.g., Dopar, Larodopa) or
• Maprotiline (e.g., Ludiomil) or
• Medicine for asthma or other breathing problems or
• Medicines for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays) or
• Meperidine (e.g., Demerol) or
• Methylphenidate (e.g., Ritalin) or
• Monoamine oxidase (MAO) inhibitors, other, including furazolidone (e.g., Furoxone), procarbazine (e.g., Matulane), or selegiline (e.g., Eldepryl), or
• Paroxetine (e.g., Paxil), or
• Sertraline (e.g., Zoloft), or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) - Using these medicines while you are taking or within 2 weeks of taking MAO inhibitors may cause serious side effects such as sudden rise in body temperature, extremely high blood pressure, severe convulsions, and death; however, sometimes certain of these medicines may be used with MAO inhibitors under close supervision by your doctor

• Antidiabetics, oral (diabetes medicine you take by mouth) or
• Insulin - MAO inhibitors may change the amount of antidiabetic medicine you need to take

• Bupropion (e.g., Wellbutrin) - Using bupropion while you are taking or within 2 weeks of taking MAO inhibitors may cause serious side effects such as seizures

• Buspirone (e.g., BuSpar) - Use with MAO inhibitors may cause high blood pressure

• Carbamazepine (e.g., Tegretol) - Use with MAO inhibitors may increase seizures

• Central nervous system (CNS) depressants (medicines that cause drowsiness) - Using these medicines with MAO inhibitors may increase the CNS and other depressant effects

• Cocaine - Cocaine use by persons taking MAO inhibitors, including furazolidone and procarbazine, may cause a severe increase in blood pressure

• Dextromethorphan - Use with MAO inhibitors may cause excitement, high blood pressure, and fever

• Trazodone or
• Tryptophan used as a food supplement or a sleep aid - Use of these medicines by persons taking MAO inhibitors, including furazolidone and procarbazine, may cause mental confusion, excitement, shivering, trouble in breathing, or fever

Other medical problems - The presence of other medical problems may affect the use of MAO inhibitors. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse - Drinking alcohol while you are taking an MAO inhibitor may cause serious side effects

• Angina (chest pain) or
• Headaches (severe or frequent) - These conditions may interfere with warning signs of serious side effects of MAO inhibitors

• Asthma or bronchitis - Some medicines used to treat these conditions may cause serious side effects when used while you are taking an MAO inhibitor

• Diabetes mellitus (sugar diabetes) - These medicines may change the amount of insulin or oral antidiabetic medication that you need

• Epilepsy - Seizures may occur more often

• Heart or blood vessel disease or
• Liver disease or
• Mental illness (or history of) or
• Parkinson's disease or
• Recent heart attack or stroke - MAO inhibitors may make the condition worse

• High blood pressure - Condition may be affected by these medicines

• Kidney disease - Higher blood levels of MAO inhibitors may occur, which increases the chance of side effects

• Overactive thyroid or
• Pheochromocytoma (PCC) - Serious side effects may occur