Interactions between ultiva(remifentanil) and Jumex (selegiline)
selegiline and remifentanil (Major Drug-Drug)
CONTRAINDICATED: Coadministration of monoamine oxidase inhibitors (MAOIs) and phenylpiperidine opioids such as meperidine and fentanyl may rarely produce severe and potentially fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive type. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, rigidity, hypertensive crisis, hypotension, seizures, and coma. Death has occurred in some cases. The exact mechanism is unknown but may be related to excessive serotonergic activity in the CNS (i.e., serotonin syndrome). The interaction is unpredictable and has been reported with meperidine, fentanyl, and alfentanil in combination with various MAOIs including phenelzine, tranylcypromine, moclobemide, and selegiline. Fatal hyperpyrexia and hypertension have been observed in animal studies involving meperidine and phenelzine or furazolidone. In contrast, symptoms of the depressive reaction probably stem from additive CNS depressant effects of the agents and include respiratory depression, hypotension, and coma.
MANAGEMENT: In general, phenylpiperidine opioids are considered contraindicated with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with these opioids. The product labeling for some MAOIs such as rasagiline and selegiline recommends also avoiding methadone and propoxyphene. Although morphine may also have significant additive CNS and respiratory depressant effects, it is generally considered a safer alternative in patients treated with MAOIs.
