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Interactions between Tranylcypromine and Ultane

1 drug interaction and 35 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

tranylcypromine sevoflurane

Applies to: tranylcypromine and Ultane (sevoflurane)
Contraindicated

Anecdotal reports have implicated the concomitant use of general anesthesia and nonselective monoamine oxidase inhibitors (MAOIs) as causing hypotension or hypertension. Analysis of these cases suggests that other contributing factors may have been involved (e.g., meperidine and sympathomimetic agents). The safe administration of general anesthetics to patients taking MAOIs has also been reported.

Management

The makers of MAOIs, both selective and nonselective, consider general anesthesia to be contraindicated in patients treated with MAOIs and recommend discontinuing MAOI therapy 10 to 14 days before elective surgery. However, this precaution is generally no longer considered necessary as long as patients are closely monitored during surgery and any adverse or idiosyncratic reactions are promptly managed.

References (5)
  1. (2001) "Product Information. Nardil (phenelzine)." Parke-Davis
  2. (2001) "Product Information. Parnate (tranylcypromine)." SmithKline Beecham
  3. (2001) "Product Information. Marplan (isocarboxazid)." Roche Laboratories
  4. (2006) "Product Information. Emsam (selegiline)." Bristol-Myers Squibb
  5. (2006) "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA

Food/lifestyle interactions

Major food/lifestyle interactions

Major:

tranylcypromine Food/Lifestyle

Applies to: tranylcypromine
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 (19)
  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

Disease interactions

34 potential interactions Applies to: 22 conditions, including Bipolar Disorder, Heart Failure, Headache, Heart Attack, and Angina.

Alcoholism

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Alcoholism.

The use of monoamine oxidase inhibitors with alcohol or any other CNS depressants is contraindicated.

Angina

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Angina.

Monoamine oxidase inhibitors may have the capacity to suppress anginal pain that would otherwise serve as a warning of myocardial ischemia. Caution is advised in patients with a history of angina or risk of myocardial infarction.

Bipolar Disorder

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Bipolar Disorder.

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a monoamine oxidase inhibitor (MAOI). This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that MAOIs antidepressants are not approved for use in treating bipolar depression.

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Bipolar Disorder.

Monoamine oxidase inhibitor (MAOI) antidepressants may cause excessive stimulation in hyperactive or schizophrenic patients. Symptoms of psychosis may be aggravated in schizophrenia, particularly that with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. Therapy with MAOI antidepressants should be administered cautiously in patients with hyperactive or hyperexcitable personalities, schizophrenia or bipolar disorder.

Carcinoid Syndrome

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Carcinoid Syndrome.

The use of nonspecific monoamine oxidase inhibitors (MAOIs) is contraindicated in patients with carcinoid syndrome. Nonspecific MAOIs inhibit the breakdown of pressor amines, including serotonin, and may exacerbate symptoms of the syndrome.

Cardiovascular Conditions and Disorders

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Cardiovascular Conditions and Disorders.

The use of monoamine oxidase inhibitor (MAOI) antidepressants is contraindicated in patients with cerebrovascular or cardiovascular disease, including hypertension and congestive heart failure. Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have resulted in some cases. MAOI antidepressants are also commonly associated with dose-related orthostatic hypotension, which occurs most frequently in patients with preexisting hypertension but may be minimized with slow, gradual titration. Blood pressure should be monitored closely in all patients who receive MAOI therapy, and patients should be advised to stop taking the medication and seek medical attention immediately if signs and symptoms of a hypertensive reaction occur (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Cardiovascular Conditions and Disorders.

The use of most monoamine oxidase inhibitors (MAOIs) is contraindicated in patients with diagnosed cardiovascular disease, hypertension, or confirmed or suspected cerebrovascular disorders. These drugs can cause hypertensive crises, which sometimes can be fatal, and are characterized by occipital headache, palpitations, neck stiffness or soreness, nausea, sweating, dilated pupils and photophobia. Intracranial bleeding has been reported in some cases in association with the increase in blood pressure.

Normotensive patients receiving therapy with MAOIs need to have monitored their blood pressure frequently to detect any evidence of pressor response and treatment should be discontinued immediately if blood pressure increases or the patient reports symptoms such a headaches or palpitations. Additionally, patients should be advised to avoid foods and drinks with high tyramine content such as cheese, sour cream, beer, liver, bananas and others, as these might trigger an hypertensive crisis.

Cerebral Vascular Disorder

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Cerebral Vascular Disorder.

The use of most monoamine oxidase inhibitors (MAOIs) is contraindicated in patients with diagnosed cardiovascular disease, hypertension, or confirmed or suspected cerebrovascular disorders. These drugs can cause hypertensive crises, which sometimes can be fatal, and are characterized by occipital headache, palpitations, neck stiffness or soreness, nausea, sweating, dilated pupils and photophobia. Intracranial bleeding has been reported in some cases in association with the increase in blood pressure.

Normotensive patients receiving therapy with MAOIs need to have monitored their blood pressure frequently to detect any evidence of pressor response and treatment should be discontinued immediately if blood pressure increases or the patient reports symptoms such a headaches or palpitations. Additionally, patients should be advised to avoid foods and drinks with high tyramine content such as cheese, sour cream, beer, liver, bananas and others, as these might trigger an hypertensive crisis.

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Cerebral Vascular Disorder.

The use of monoamine oxidase inhibitor (MAOI) antidepressants is contraindicated in patients with cerebrovascular or cardiovascular disease, including hypertension and congestive heart failure. Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have resulted in some cases. MAOI antidepressants are also commonly associated with dose-related orthostatic hypotension, which occurs most frequently in patients with preexisting hypertension but may be minimized with slow, gradual titration. Blood pressure should be monitored closely in all patients who receive MAOI therapy, and patients should be advised to stop taking the medication and seek medical attention immediately if signs and symptoms of a hypertensive reaction occur (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

Diabetes Mellitus

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Diabetes Mellitus.

Monoamine oxidase inhibitors can increase the sensitivity to insulin, and have contributed to hypoglycemic episodes in patients with diabetes. Caution should be used when prescribing in diabetic patients.

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Diabetes Mellitus.

There is conflicting evidence regarding whether monoamine oxidase inhibitors (MAOIs) affect glucose metabolism or potentiate oral hypoglycemic agents. Therapy with MAOIs should be administered cautiously in patients with diabetes.

Headache

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Headache.

The use of monoamine oxidase inhibitor (MAOI) antidepressants is contraindicated in patients with a history of headaches. Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have resulted in some cases. Since headache may often be the first symptom of a hypertensive reaction during MAOI therapy, use of these agents is not recommended in patients who experience frequent or severe headaches. MAOIs should be withdrawn promptly if headaches develop during treatment.

Heart Attack

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Heart Attack.

Monoamine oxidase inhibitors may have the capacity to suppress anginal pain that would otherwise serve as a warning of myocardial ischemia. Caution is advised in patients with a history of angina or risk of myocardial infarction.

Heart Failure

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Heart Failure.

The use of most monoamine oxidase inhibitors (MAOIs) is contraindicated in patients with diagnosed cardiovascular disease, hypertension, or confirmed or suspected cerebrovascular disorders. These drugs can cause hypertensive crises, which sometimes can be fatal, and are characterized by occipital headache, palpitations, neck stiffness or soreness, nausea, sweating, dilated pupils and photophobia. Intracranial bleeding has been reported in some cases in association with the increase in blood pressure.

Normotensive patients receiving therapy with MAOIs need to have monitored their blood pressure frequently to detect any evidence of pressor response and treatment should be discontinued immediately if blood pressure increases or the patient reports symptoms such a headaches or palpitations. Additionally, patients should be advised to avoid foods and drinks with high tyramine content such as cheese, sour cream, beer, liver, bananas and others, as these might trigger an hypertensive crisis.

Hyperkalemia

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Hyperkalemia.

The use of inhaled anesthetic agents has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients during the postoperative period. Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable. Early and aggressive intervention to treat the hyperkalemia and resistant arrhythmias is recommended; as is subsequent evaluation for latent neuromuscular disease. Caution and close monitoring is recommended when using this agent in these patients.

Hyperthyroidism

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Hyperthyroidism.

Nonspecific monoamine oxidase inhibitors (MAOIs) inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have resulted in some cases. Therapy with nonspecific MAOIs should be administered cautiously in patients with hyperthyroidism, since these patients have an increased sensitivity to pressor amines. Blood pressure should be monitored closely during therapy, and patients should be advised to stop taking the medication and seek medical attention immediately if signs and symptoms of a hypertensive reaction occur (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

Hypotension

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Hypotension.

The use of monoamine oxidase inhibitor (MAOI) antidepressants is contraindicated in patients with cerebrovascular or cardiovascular disease, including hypertension and congestive heart failure. Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have resulted in some cases. MAOI antidepressants are also commonly associated with dose-related orthostatic hypotension, which occurs most frequently in patients with preexisting hypertension but may be minimized with slow, gradual titration. Blood pressure should be monitored closely in all patients who receive MAOI therapy, and patients should be advised to stop taking the medication and seek medical attention immediately if signs and symptoms of a hypertensive reaction occur (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Hypotension.

Hypotension has been observed during therapy with monoamine oxidase inhibitors. These drugs should be used with caution, especially in patients with tendency towards hypotension or taking other drugs known to cause hypotension.

Liver Disease

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Liver Disease.

The use of monoamine oxidase inhibitor (MAOI) antidepressants is contraindicated in patients with abnormal liver function tests or a history of liver disease. A low incidence of altered liver function or hepatocellular jaundice has been reported in association with the use of MAOI antidepressants. Periodic monitoring of liver function tests is recommended during prolonged and/or high-dose therapy.

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Liver Disease.

The use of monoamine oxidase inhibitors is contraindicated in patients with a history of liver disease or in those with abnormal liver function tests.

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Liver Disease.

In a multicenter study to compare the safety of sevoflurane and isoflurane in patients with mild to moderate hepatic impairment, sevoflurane patients had prolonged terminal disposition of fluoride, as evidenced by longer inorganic fluoride half-life than patients with normal hepatic function. Results of evaluations of laboratory parameters (e.g., ALT, AST, alkaline phosphatase, and total bilirubin, etc.), as well as investigator-reported incidence of adverse events relating to liver function, demonstrate that sevoflurane can be administered to patients with normal or mild-to-moderately impaired hepatic function. The use of this agent in patients with severe hepatic dysfunction has not been investigated. Clinical judgment should be exercised when sevoflurane is used in patients with underlying hepatic conditions or under treatment with drugs known to cause hepatic dysfunction.

Malignant Hyperthermia

Major:

Ultane

The sevoflurane in Ultane has a major potential interaction with Malignant Hyperthermia.

The use of sevoflurane is contraindicated in patients with known or suspected susceptibility to malignant hyperthermia.

Mania

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Mania.

Monoamine oxidase inhibitor (MAOI) antidepressants may cause excessive stimulation in hyperactive or schizophrenic patients. Symptoms of psychosis may be aggravated in schizophrenia, particularly that with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. Therapy with MAOI antidepressants should be administered cautiously in patients with hyperactive or hyperexcitable personalities, schizophrenia or bipolar disorder.

Parkinsonism

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Parkinsonism.

Nonspecific monoamine oxidase inhibitors (MAOIs) may increase the frequency and severity of signs and symptoms associated with parkinsonian syndrome. Therapy with nonspecific MAOIs should be administered cautiously in patients with this disorder.

Pheochromocytoma

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Pheochromocytoma.

The use of most monoamine oxidase inhibitors (MAOIs) is contraindicated in patients with pheochromocytoma, as such tumors secrete pressor substances whose metabolism may be inhibited by these drugs.

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Pheochromocytoma.

The use of nonspecific monoamine oxidase inhibitors (MAOIs) is contraindicated in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas, that secrete pressor substances. Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have resulted in some cases.

Pseudotumor Cerebri

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Pseudotumor Cerebri.

Studies comparing sevoflurane to isoflurane for maintenance of anesthesia during neurosurgical procedures found no difference between sevoflurane and isoflurane with regard to recovery from anesthesia. In patients at risk for elevations of intracranial pressure (ICP), sevoflurane should be administered cautiously in conjunction with ICP-reducing maneuvers such as hyperventilation.

Renal Dysfunction

Major:

tranylcypromine

Tranylcypromine has a major potential interaction with Renal Dysfunction.

The use of monoamine oxidase inhibitor (MAOI) antidepressants is contraindicated in patients with severe renal dysfunction. These drugs may accumulate in plasma when renal function is impaired.

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Renal Dysfunction.

Monoamine oxidase inhibitors should be used with caution in patients with renal impairment as there is a possibility of cumulative effects in such patients. Dose selection should be cautious, usually starting at the low end of the dosing range.

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Renal Dysfunction.

Limited data are available on the use of oral sevoflurane in patients with renal insufficiency. Sevoflurane may be associated with glycosuria and proteinuria when used for long procedures at low flow rates. Caution is advised when using sevoflurane in these patients as the safety has not been fully established.

Schizophrenia

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Schizophrenia.

Monoamine oxidase inhibitor (MAOI) antidepressants may cause excessive stimulation in hyperactive or schizophrenic patients. Symptoms of psychosis may be aggravated in schizophrenia, particularly that with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. Therapy with MAOI antidepressants should be administered cautiously in patients with hyperactive or hyperexcitable personalities, schizophrenia or bipolar disorder.

Seizures

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Seizures.

Monoamine oxidase inhibitor (MAOI) antidepressants may have variable effects on seizure threshold. Decreased seizure frequency as well as increased frequency have been reported. Therapy with MAOI antidepressants should be administered cautiously in patients with a history of seizures.

Moderate:

tranylcypromine

Tranylcypromine has a moderate potential interaction with Seizures.

Monoamine oxidase inhibitors have shown a variable effect on the convulsive threshold. Caution should be used when treating patients with epilepsy.

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Seizures.

The use of sevoflurane has been associated with seizures. The majority of cases were in children and young adults, most of whom had no medical history of seizures. Seizures have occurred during, or soon after sevoflurane induction, during emergence, and during post-operative recovery up to a day following anesthesia. Caution and clinical judgment should be exercised when using sevoflurane in patients who may be at risk for seizures.

More resources

tranylcypromine

A total of 551 drugs are known to interact with tranylcypromine.

Ultane

A total of 361 drugs are known to interact with Ultane.

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.