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Drug Interactions between duloxetine and phenelzine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

phenelzine DULoxetine

Applies to: phenelzine and duloxetine

CONTRAINDICATED: By inhibiting serotonin metabolism, monoamine oxidase inhibitors (MAOIs) may potentiate the pharmacologic activity of serotonergic agents such as serotonin reuptake inhibitors, 5-HT1 receptor agonists, ergot alkaloids, buspirone, dextromethorphan, and most antidepressants. The result may be an increased risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, serotonergic agents should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with serotonergic agents. A washout period of 5 to 14 days is usually recommended when switching from another antidepressant to an MAOI; however, the individual product labeling should be consulted.

References

  1. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. (1989) "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther, 46, p. 528-36
  3. Sternbach H (1988) "Danger of MAOI therapy after fluoxetine withdrawal." Lancet, 2, p. 850-1
  4. Sovner R, Wolfe J (1988) "Interaction between dextromethorphan and monoamine oxidase inhibitor therapy with isocarboxazid ." N Engl J Med, 319, p. 1671
  5. Bem JL, Peck R (1992) "Dextromethorphan. An overview of safety issues." Drug Saf, 7, p. 190-9
  6. Nierenberg DW, Semprebon M (1993) "The central nervous system serotonin syndrome." Clin Pharmacol Ther, 53, p. 84-8
  7. Graham PM, Potter JM, Paterson J (1982) "Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction." Lancet, 2, p. 440
  8. Spiker DG, Pugh DD (1976) "Combining tricyclic and monoamine oxidase inhibitor antidepressants." Arch Gen Psychiatry, 33, p. 828-30
  9. White K, Pistole T, Boyd JL (1980) "Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study." Am J Psychiatry, 137, p. 1422-5
  10. White K, Simpson G (1981) "Combined MAOI-tricyclic antidepressant treatment: a reevaluation." J Clin Psychopharmacol, 1, p. 264-82
  11. Rivers N, Horner B (1970) "Possible lethal reaction between nardil and dextromethorphan." Can Med Assoc J, 103, p. 85
  12. (2002) "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation
  13. Sternbach H (1991) "The serotonin syndrome." Am J Psychiatry, 148, p. 705-13
  14. Feighner JP, Boyer WF, Tyler DL, Neborsky RJ (1990) "Adverse consequences of fluoxetine-MAOI combination therapy." J Clin Psychiatry, 51, p. 222-5
  15. Graham PM, Ilett KF (1988) "Danger of MAOI therapy after fluoxetine withdrawal." Lancet, 2, p. 1255-6
  16. Bhatara VS, Bandettini FC (1993) "Possible interaction between sertraline and tranylcypromine." Clin Pharm, 12, p. 222-5
  17. Suchowersky O, deVries JD (1990) "Interaction of fluoxetine and selegiline." Can J Psychiatry, 35, p. 571-2
  18. (2001) "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories
  19. Brannan SK, Talley BJ, Bowden CL (1994) "Sertraline and isocarboxazid cause a serotonin syndrome." J Clin Psychopharmacol, 14, p. 144-5
  20. Graber MA, Hoehns TB, Perry PJ (1994) "Sertraline-phenelzine drug interaction: a serotonin syndrome reaction." Ann Pharmacother, 28, p. 732-5
  21. Cetaruk EW, Aaron CK (1994) "Hazards of nonprescription medications." Emerg Med Clin North Am, 12, p. 483-510
  22. Diamond S (1995) "The use of sumatriptan in patients on monoamine oxidase inhibitors." Neurology, 45, p. 1039-40
  23. Phillips SD, Ringo P (1995) "Phenelzine and venlafaxine interaction." Am J Psychiatry, 152, p. 1400-1
  24. Klysner R, Larsen JK, Sorensen P, Hyllested M, Pedersen BD (1995) "Toxic interaction of venlafaxine and isocarboxazide." Lancet, 346, p. 1298-9
  25. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  26. Heisler MA, Guidry JR, Arnecke B (1996) "Serotonin syndrome induced by administration of venlafaxine and phenelzine." Ann Pharmacother, 30, p. 84
  27. De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
  28. Fischer P (1995) "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol, 15, p. 440-2
  29. Corkeron MA (1995) "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust, 163, p. 481-2
  30. Thomas JM, Rubin EH (1984) "Case report of a toxic reaction from a combination of tryptophan and phenelzine." Am J Psychiatry, 141, p. 281-3
  31. Pope HG Jr, Jonas JM, Hudson JI, Kafka MP (1985) "Toxic reactions to the combination of monoamine oxidase inhibitors and tryptophan." Am J Psychiatry, 142, p. 491-2
  32. Alvine G, Black DW, Tsuang D (1990) "Case of delirium secondary to phenelzine/L-tryptophan combination." J Clin Psychiatry, 51, p. 311
  33. Staufenberg EF, Tantam D (1989) "Malignant hyperpyrexia syndrome in combined treatment." Br J Psychiatry, 154, p. 577-8
  34. Levy AB, Bucher P, Votolato N (1985) "Myoclonus, hyperreflexia and diaphoresis in patients on phenelzine- tryptophan combination treatment." Can J Psychiatry, 30, p. 434-6
  35. Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL (1993) "Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings." J Clin Psychopharmacol, 13, p. 312-20
  36. Mills KC (1997) "Serotonin syndrome: A clinical update." Crit Care Clin, 13, p. 763
  37. Gardner DM, Lynd LD (1998) "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother, 32, p. 33-8
  38. Mathew NT, Tietjen GE, Lucker C (1996) "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia, 16, p. 323-7
  39. Weiner LA, Smythe M, Cisek J (1998) "Serotonin syndrome secondary to phenelzine-venlafaxine interaction." Pharmacotherapy, 18, p. 399-403
  40. Diamond S, Pepper BJ, Diamond ML, Freitag FG, Urban GJ, Erdemoglu AK (1998) "Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports." Neurology, 51, p. 274-6
  41. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG (1998) "Serotonin syndrome resulting from drug interactions." Med J Aust, 169, p. 523-5
  42. Brubacher JR, Hoffman RS, Lurin MJ (1996) "Serotonin syndrome from venlafaxine-tranylcypromine interaction." Vet Hum Toxicol, 38, p. 358-61
  43. Miller LG (1998) "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med, 158, p. 2200-11
  44. Martin TG (1996) "Serotonin syndrome." Ann Emerg Med, 28, p. 520-6
  45. Jacob JE, Wagner ML, Sage JI (2003) "Safety of selegiline with cold medications." Ann Pharmacother, 37, p. 438-41
  46. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
  47. (2005) "Product Information. Manerix (moclobemide)." Hoffmann-La Roche Limited
  48. Gillman PK (2005) "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth
  49. Bodner RA, Lynch T, Lewis L, Kahn D (1995) "Serotonin syndrome." Neurology, 45, p. 219-23
  50. Jimenez-Genchi A (2006) "Immediate switching from moclobemide to duloxetine may induce serotonin syndrome." J Clin Psychiatry, 67, p. 1821-1822
  51. (2008) "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories
  52. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
  53. (2011) "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC
  54. (2013) "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals
View all 54 references

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Drug and food interactions

Major

phenelzine food

Applies to: phenelzine

CONTRAINDICATED: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase inhibitors (MAOIs). The mechanism is inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of MAOIs. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: In general, patients treated with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine) should avoid consumption of products that contain large amounts of amines and protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, salamis, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, sauerkraut, yogurt, papaya products, meat tenderizers, fava bean pods, protein extracts, yeast extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. At least 14 days should elapse following discontinuation of MAOI therapy before these foods may be consumed. Specially designed reference materials and dietary consultation are recommended so that an appropriate and safe diet can be planned. Patients should be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Patients should also be counseled not to use MAOIs with alcohol, and to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them.

References

  1. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  2. Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
  3. Nuessle WF, Norman FC, Miller HE (1965) "Pickled herring and tranylcypromine reaction." JAMA, 192, p. 142-3
  4. Sweet RA, Liebowitz MR, Holt CS, Heimberg RG (1991) "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol, 11, p. 331-2
  5. Walker JI, Davidson J, Zung WWK (1984) "Patient compliance with MAO Inhibitor therapy." J Clin Psychiatry, 45, p. 78-80
  6. Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
  7. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  8. Maxwell MB (1980) "Reexamining the dietary restrictions with procarbazine (an MAOI)." Cancer Nurs, 3, p. 451-7
  9. (2001) "Product Information. Matulane (procarbazine)." Roche Laboratories
  10. De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
  11. Zetin M, Plon L, DeAntonio M (1987) "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry, 48, p. 499
  12. Domino EF, Selden EM (1984) "Red wine and reactions." J Clin Psychopharmacol, 4, p. 173-4
  13. Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D (1994) "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol, 14, p. 5-14
  14. Pohl R, Balon R, Berchou R (1988) "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry, 145, p. 651
  15. (2001) "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation
  16. (2001) "Product Information. Nardil (phenelzine)." Parke-Davis
  17. (2001) "Product Information. Marplan (isocarboxazid)." Roche Laboratories
  18. (2001) "Product Information. Zyvox (linezolid)." Pharmacia and Upjohn
  19. Martin TG (1996) "Serotonin syndrome." Ann Emerg Med, 28, p. 520-6
View all 19 references

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Moderate

DULoxetine food

Applies to: duloxetine

GENERALLY AVOID: Use of duloxetine in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Duloxetine alone can increase serum transaminase levels. In clinical trials, 0.3% of patients discontinued duloxetine due to liver transaminase elevations. The median time to detection was about two months. Three duloxetine-treated patients had liver injury as manifested by transaminase and bilirubin elevations, with evidence of obstruction. Substantial intercurrent ethanol use was present in each of these cases, which may have contributed to the abnormalities observed. Duloxetine does not appear to enhance the central nervous system effects of alcohol. When duloxetine and ethanol were administered several hours apart so that peak concentrations of each would coincide, duloxetine did not increase the impairment of mental and motor skills caused by alcohol.

MANAGEMENT: Due to the risk of liver injury, patients prescribed duloxetine should be counseled to avoid excessive use of alcohol. Duloxetine should generally not be prescribed to patients with substantial alcohol use.

References

  1. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

  • duloxetine
  • phenelzine

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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