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Understanding Antidepressant Medications (cont.)

MAOIs Drug or Food Interactions, Side Effects

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:
  • 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

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).]
  • Increased heart rate or blood pressure in people with hyperthyroid conditions
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