Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Tell the doctor what medications are currently being taken because many drugs interact with MAOIs. Do not take any nonprescription or herbal medications without first consulting the doctor or pharmacist. The following are examples of interactions, but they do not represent a complete list.
The risk for serotonin syndrome may be increased by SSRIs, TCAs, atomoxetine (Strattera), duloxetine
(Cymbalta), dextromethorphan (in many cough syrups), dexfenfluramine, 5-HT1 agonists
[such as sumatriptan
(Imitrex) or zolmitriptan
(Zomig)], venlafaxine (Effexor), St. John's wort, or ginkgo. Serotonin syndrome is a serious side effect and may be fatal. Symptoms include fever, muscle stiffness, and changes in mental status such as confusion or hallucinations.
The risk of neuroleptic malignant syndrome (restlessness, sweating, fever, confusion, and muscle stiffness) may increase with lithium
(Eskalith, Lithobid) and tramadol (Ultram).
Morphine, meperidine (Demerol), and other narcotic pain relievers may cause hypotension and depress the central nervous system and respirations.
The following drugs may increase the risk of
hypertensive crisis when taken with MAOIs or within
two weeks of stopping MAOIs:
MAOIs may increase side effects of the following drugs:
bupropion (Wellbutrin,
Wellbutrin SR, Wellbutrin XL, Zyban) - Increases risk of seizures, agitation, and psychotic changes
Antidiabetic agents - Increases risk for low blood sugar levels, depression, and seizures
mirtazapine (Remeron) - May increase risk for seizures
carbamazepine
(Tegretol) - May result in high blood pressure, fever, and seizures
Do not eat foods high in tyramine, dopamine, or tryptophan while taking MAOIs or for
two weeks after discontinuing MAOIs. Tyramine, dopamine, and tryptophan are chemicals that can interact with MAOIs and cause hypertensive crisis, which is an extremely dangerous side effect. Foods high in these chemicals should be avoided. They include the following:
Dairy products
Cheese, particularly Blue, Camembert, Cheddar, Emmenthaler, Stilton, and Swiss, which contain very high amounts of tyramine
Yogurt
Meat and fish products
Anchovies
Beef or chicken liver
Other meats or fish that have not been refrigerated, are fermented, or are spoiled
Caviar
Fermented sausages such as bologna, pepperoni, salami, and summer sausage
Game meat
Meats prepared with tenderizer
Herring
Shrimp paste
Alcoholic beverages
Beer
Red wine, especially Chianti
Sherry
Distilled spirits and liqueurs
Fruits and vegetables
Fruits such as bananas, raspberries, dried fruits, and overripe fruits (especially avocados and figs)
Bean cure, miso soup, sauerkraut, soy sauce, and yeast extracts (such as Marmite)
Foods containing other chemicals that increase blood pressure
Broad beans (fava beans)
Caffeine containing beverages such as coffee, tea, and cola
Side Effects:This is NOT a complete list of side effects reported with MAOIs. A doctor, health care provider, or pharmacist can discuss a more complete list of side effects.
Hypertensive crisis (Hypertensive crisis is the most serious reaction and involves dramatic increases in blood pressure and requires immediate care from the doctor. The hypertensive crisis usually occurs within several hours after ingestion of a drug or food that interacts with MAOIs. Hypertensive crisis can be fatal. Symptoms include severe headache, rapid heart rate, chest pain, neck stiffness, nausea, vomiting, sweating [may include a fever or cold, clammy skin], dilated pupils, and eye sensitivity to light.)
Manic episodes in persons with bipolar disorder
[If not combined with a mood-stabilizing drug, MAOIs may induce manic episodes in individuals with bipolar disorder
(manic depression).]
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