levocetirizine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.levodopaContraindicated (1)tranylcypromine, levodopa. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.levodopa inhaledContraindicated (1)levodopa inhaled increases effects of tranylcypromine by dopaminergic effects. Contraindicated. Levodopa may enhance risk for acute hypertensive episode if coadministered with nonselective MAOIs. Discontinue use of any nonselective MAO inhibitors at least 2 weeks before initiating levodopa inhaled.levomilnacipranContraindicated (1)tranylcypromine and levomilnacipran both increase serotonin levels. Contraindicated. Do not use MAOIs intended to treat psychiatric disorders with levomilnacipran or within 7 days of stopping levomilnacipran due to an increased risk of serotonin syndromelevorphanolSerious - Use Alternative (1)tranylcypromine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.linezolidSerious - Use Alternative (1)linezolid and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.lisdexamfetamineContraindicated (1)tranylcypromine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Contraindicated. Do not use amphetamines during and within 14 days of discontinuation of monoamine oxidase inhibitors. .lithiumMonitor Closely (1)lithium, tranylcypromine. Mechanism: unknown. Use Caution/Monitor. Risk of malignant hyperpyrexia. Interactions esp. expected w/non selective MAOIs.Serious - Use Alternative (1)tranylcypromine and lithium both increase serotonin levels. Avoid or Use Alternate Drug.lofepramineContraindicated (1)tranylcypromine and lofepramine both increase serotonin levels. Contraindicated.lomitapideMonitor Closely (1)tranylcypromine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.lonafarnibSerious - Use Alternative (1)tranylcypromine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.loratadineSerious - Use Alternative (1)tranylcypromine increases effects of loratadine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.lorcaserinSerious - Use Alternative (1)tranylcypromine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.loxapineMonitor Closely (1)tranylcypromine, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).loxapine inhaledMonitor Closely (1)tranylcypromine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).lsdSerious - Use Alternative (1)tranylcypromine and lsd both increase serotonin levels. Avoid or Use Alternate Drug.lurasidoneMonitor Closely (3)lurasidone, tranylcypromine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity. tranylcypromine, lurasidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity. tranylcypromine, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).maprotilineContraindicated (1)tranylcypromine and maprotiline both increase serotonin levels. Contraindicated.maravirocMonitor Closely (1)maraviroc, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.mavacamtenContraindicated (1)tranylcypromine will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Contraindicated. Strong or moderate CYP2C19 inhibitors may increase mavacamten systemic exposure, resulting in heart failure due to systolic dysfunction. meperidineContraindicated (2)tranylcypromine and meperidine both increase serotonin levels. Contraindicated. tranylcypromine increases toxicity of meperidine by unknown mechanism. Contraindicated.metaproterenolSerious - Use Alternative (1)tranylcypromine increases effects of metaproterenol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.metforminSerious - Use Alternative (1)tranylcypromine will increase the level or effect of metformin by unspecified interaction mechanism. Avoid or Use Alternate Drug.methadoneSerious - Use Alternative (1)tranylcypromine increases toxicity of methadone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.methamphetamineContraindicated (1)tranylcypromine increases effects of methamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.methyldopaSerious - Use Alternative (1)tranylcypromine, methyldopa. Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine inhibits the hypotensive effects of methyldopa. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with methyldopa.methylene blueSerious - Use Alternative (1)methylene blue and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.methylenedioxymethamphetamineContraindicated (1)tranylcypromine increases effects of methylenedioxymethamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.methylphenidateContraindicated (1)tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.methylphenidate transdermalContraindicated (1)methylphenidate transdermal and tranylcypromine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.metoclopramide intranasalSerious - Use Alternative (1)metoclopramide intranasal increases toxicity of tranylcypromine by Other (see comment). Avoid or Use Alternate Drug. Comment: Metoclopramide may enhance the hypertensive effect of monoamine oxidase inhibitors.metrizamideSerious - Use Alternative (1)tranylcypromine, metrizamide. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Do not coadminister because tranylcypromine may lower seizure threshold. D/C MAO inhibitor 24h before admin of metrizamide.midazolam intranasalMonitor Closely (1)tranylcypromine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.midodrineContraindicated (1)tranylcypromine increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.milnacipranContraindicated (1)tranylcypromine and milnacipran both increase serotonin levels. Contraindicated.mirtazapineSerious - Use Alternative (1)tranylcypromine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.modafinilContraindicated (1)tranylcypromine increases effects of modafinil by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.molindoneMonitor Closely (1)tranylcypromine, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).morphineSerious - Use Alternative (2)tranylcypromine and morphine both increase serotonin levels. Avoid or Use Alternate Drug. tranylcypromine increases toxicity of morphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.nalbuphineSerious - Use Alternative (1)tranylcypromine increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.naratriptanSerious - Use Alternative (2)naratriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. tranylcypromine increases levels of naratriptan by decreasing metabolism. Contraindicated.nefazodoneContraindicated (1)tranylcypromine and nefazodone both increase serotonin levels. Contraindicated.netupitant/palonosetronSerious - Use Alternative (1)netupitant/palonosetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.norepinephrineContraindicated (1)tranylcypromine increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.nortriptylineContraindicated (1)tranylcypromine and nortriptyline both increase serotonin levels. Contraindicated.olanzapineMonitor Closely (1)tranylcypromine, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).oliceridineMonitor Closely (2)tranylcypromine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. tranylcypromine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.olodaterol inhaledMonitor Closely (1)tranylcypromine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. MAO inhibitors prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmiasondansetronSerious - Use Alternative (1)ondansetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.opicaponeContraindicated (1)opicapone, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Both nonselective MAO inhibitors and opicapone inhibit catecholamine metabolism, leading to increased levels of catecholamines. Potential for dangerously high HR or BP.opium tinctureMonitor Closely (1)opium tincture, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.Serious - Use Alternative (1)tranylcypromine increases toxicity of opium tincture by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.oxycodoneSerious - Use Alternative (1)tranylcypromine increases toxicity of oxycodone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.oxymetazoline intranasalSerious - Use Alternative (1)tranylcypromine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. MAOIs cause norepinephrine accumulation within adrenergic neurons. Significant hypertension can result if coadministered with alpha1 agonists.oxymetazoline topicalMonitor Closely (1)oxymetazoline topical and tranylcypromine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.oxymorphoneSerious - Use Alternative (1)tranylcypromine increases toxicity of oxymorphone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.ozanimodContraindicated (1)tranylcypromine and ozanimod both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of ozanimod with MAO-B inhibitors may decrease exposure of the active metabolites of ozanimod, which may inhibit MAO. The potential for a clinical interaction with MAO inhibitors has not been studied; however, the increased risk of nonselective MAO inhibition may lead to a hypertensive crisis. Allow at least 14 days to elapse between discontinuing ozanimod and initiating with MAO inhibitors.paliperidoneMonitor Closely (1)tranylcypromine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).palonosetronSerious - Use Alternative (1)palonosetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.panax ginsengMinor (1)panax ginseng increases effects of tranylcypromine by pharmacodynamic synergism. Minor/Significance Unknown.papaveretumSerious - Use Alternative (1)tranylcypromine increases toxicity of papaveretum by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.paroxetineContraindicated (1)tranylcypromine and paroxetine both increase serotonin levels. Contraindicated.pentazocineSerious - Use Alternative (2)tranylcypromine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug. tranylcypromine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.pentobarbitalMinor (1)tranylcypromine increases levels of pentobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.perphenazineMonitor Closely (1)tranylcypromine, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity)