Interactions between zolmitriptan and Matulane (procarbazine)
procarbazine and zolmitriptan (Major Drug-Drug)
CONTRAINDICATED: Monoamine oxidase inhibitors (MAOIs) may significantly elevate the plasma concentrations of certain 5-HT1 receptor agonists (namely rizatriptan, sumatriptan, and zolmitriptan) and their active metabolites by inhibiting their metabolic clearance via monoamine oxidase, subtype A. Clinically, this interaction may result in an increased risk of vasospastic reactions, including coronary artery vasospasm, peripheral vascular ischemia and colonic ischemia, associated with the use of 5-HT1 receptor agonists. Although the pharmacokinetic alterations are observed only with a limited number of 5-HT1 receptor agonists and their metabolites, the possibility of a pharmacodynamic interaction should be considered for all agents in the class, since they exhibit modest 5-HT1A activity. Theoretically, MAOIs may potentiate the serotonergic activity of these agents and increase the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors. The mechanism is inhibition of the breakdown of serotonin by MAOIs.
MANAGEMENT: The concurrent use of certain 5-HT1 receptor agonists and MAOIs or other agents which possess MAOI activity (e.g., furazolidone, procarbazine, selegiline) is considered contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with 5-HT1 receptor agonists. If concurrent therapy is necessary, almotriptan, frovatriptan and naratriptan may be preferred due to the lack of a significant pharmacokinetic interaction with MAOIs. However, the patient should be closely monitored for adverse effects related to excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia.
