OBJECT DRUGS
MAO Inhibitors (nonselective):
MAO-B Inhibitors:
- Rasagiline (Azilect)
- Safinamide (Xadago)
- Selegiline (Eldepryl, etc.)
PRECIPITANT DRUGS
Sympathomimetics:
- Amphetamines
- Atomoxetine (Strattera)
- Cocaine
- Diethylpropion (Tenuate, etc.)
- Dopamine
- Ephedrine
- Isometheptene (Midrin)
- Mazindol (Sanorex)
- Metaraminol (Aramine)
- Methylphenidate (Ritalin, etc.)
- Phendimetrazine (Bontril)
- Phentermine (Ionamin, etc.)
- Phenylephrine
- Pseudoephedrine (Sudafed, etc.)
- Tapentadol (Nucynta, etc.)
Comment:
Linezolid is a mild MAO inhibitor, but can produce (usually modest) increases in the pressor response to indirect-acting sympathomimetics such as pseudoephedrine. MAO-B inhibitors theoretically would be unlikely to interact, but some patients on these drugs may develop nonselective MAO inhibition. Rasagiline is metabolized by CYP1A2, so theoretically, patients on CYP1A2 inhibitors may be more likely to develop nonselective MAO inhibition due to rasagiline. (For a list of CYP1A2 inhibitors, see CYP 450 Table at front of book.) Direct acting sympathomimetics such as epinephrine, isoproterenol and norepinephrine do not appear to interact as much with MAO inhibitors, but one should still be alert for increased pressor effects.
Class 2: Use only if Benefit Felt to Outweigh Risk
- Use Alternative:
- Linezolid: Tedizolid (Sivextro) does not appear to be a MAOI to a clinically important degree, so is unlikely to increase the risk of serotonin syndrome. Also, depending on the antibiogram, one could consider alternative antibiotics such as vancomycin or telavancin (Vibativ) for linezolid.
- Monitor: If sympathomimetic drugs are used with linezolid or MAO-B inhibitors, monitor for evidence of hypertension, fever, seizures, or arrhythmias; discontinue the sympathomimetic immediately if any of these findings are present