serotonin levels. Avoid or Use Alternate Drug.donepezil transdermalMonitor Closely (1)donepezil transdermal, tranylcypromine. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.dopamineContraindicated (1)tranylcypromine increases effects of dopamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.dopexamineSerious - Use Alternative (1)tranylcypromine increases effects of dopexamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.dosulepinContraindicated (1)tranylcypromine and dosulepin both increase serotonin levels. Contraindicated.doxapramSerious - Use Alternative (1)doxapram increases effects of tranylcypromine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.doxepinContraindicated (1)tranylcypromine and doxepin both increase serotonin levels. Contraindicated.doxepin creamSerious - Use Alternative (1)tranylcypromine increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.doxylamineSerious - Use Alternative (1)tranylcypromine increases effects of doxylamine 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. .duloxetineContraindicated (1)tranylcypromine and duloxetine both increase serotonin levels. Contraindicated.eletriptanSerious - Use Alternative (2)eletriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. tranylcypromine increases levels of eletriptan by decreasing metabolism. Contraindicated.eliglustatContraindicated (1)tranylcypromine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.eluxadolineMonitor Closely (1)tranylcypromine increases levels of eluxadoline by decreasing metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2A6 inhibitors.entacaponeContraindicated (1)entacapone, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Both nonselective MAO inhibitors and entacapone inhibit catecholamine metabolism, leading to increased levels of catecholamines. Potential for dangerously high HR or BP.ephedrineContraindicated (1)tranylcypromine increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.epinephrineContraindicated (1)tranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.epinephrine inhaledContraindicated (1)tranylcypromine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.epinephrine racemicSerious - Use Alternative (1)tranylcypromine increases effects of epinephrine racemic by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.ergotamineSerious - Use Alternative (1)tranylcypromine and ergotamine both increase serotonin levels. Avoid or Use Alternate Drug.escitalopramContraindicated (1)tranylcypromine and escitalopram both increase serotonin levels. Contraindicated.esketamine intranasalMonitor Closely (1)esketamine intranasal, tranylcypromine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with MAO-Is. .etomidateMonitor Closely (1)tranylcypromine increases levels of etomidate by pharmacodynamic synergism. Use Caution/Monitor.fedratinibSerious - Use Alternative (1)tranylcypromine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.fenfluramineContraindicated (2)tranylcypromine increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. fenfluramine, tranylcypromine. Either increases effects of the other by serotonin levels. Contraindicated. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome. Do not use concomitantly or within 14 days of MAOIs.Serious - Use Alternative (1)tranylcypromine and fenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.fentanylContraindicated (1)tranylcypromine increases toxicity of fentanyl by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.fentanyl intranasalContraindicated (1)tranylcypromine increases toxicity of fentanyl intranasal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.fentanyl transdermalContraindicated (1)tranylcypromine increases toxicity of fentanyl transdermal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.fentanyl transmucosalContraindicated (1)tranylcypromine increases toxicity of fentanyl transmucosal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.fexofenadineSerious - Use Alternative (1)tranylcypromine increases effects of fexofenadine 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.fezolinetantContraindicated (1)tranylcypromine will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitorsfinerenoneMonitor Closely (1)tranylcypromine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.flibanserinMonitor Closely (1)tranylcypromine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.fluoxetineContraindicated (1)tranylcypromine and fluoxetine both increase serotonin levels. Contraindicated.fluphenazineMonitor Closely (1)tranylcypromine, fluphenazine. 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).fluvoxamineSerious - Use Alternative (1)fluvoxamine and tranylcypromine both increase serotonin levels. Contraindicated.formoterolSerious - Use Alternative (1)tranylcypromine increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.frovatriptanSerious - Use Alternative (2)frovatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. tranylcypromine increases levels of frovatriptan by decreasing metabolism. Contraindicated.gabapentinMonitor Closely (1)gabapentin, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.gabapentin enacarbilMonitor Closely (1)gabapentin enacarbil, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.ganaxoloneMonitor Closely (1)tranylcypromine and ganaxolone both increase sedation. Use Caution/Monitor.glimepirideMonitor Closely (1)tranylcypromine increases effects of glimepiride by unknown mechanism. Use Caution/Monitor.glipizideMonitor Closely (1)tranylcypromine increases effects of glipizide by unknown mechanism. Use Caution/Monitor.glyburideMonitor Closely (1)tranylcypromine increases effects of glyburide by unknown mechanism. Use Caution/Monitor.granisetronSerious - Use Alternative (1)granisetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.green teaMonitor Closely (1)green tea, tranylcypromine. Other (see comment). Use Caution/Monitor. Comment: Avoid combination or excessive consumption of green tea. Combination may increase risk of cardiac arrhythmias or severe hypertension can occur due to caffeine component of green tea.haloperidolMonitor Closely (1)tranylcypromine, haloperidol. 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).hydralazineMonitor Closely (1)hydralazine, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.hydrocodoneSerious - Use Alternative (1)tranylcypromine increases toxicity of hydrocodone by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.hydromorphoneSerious - Use Alternative (1)tranylcypromine increases toxicity of hydromorphone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.hydroxyzineSerious - Use Alternative (1)tranylcypromine increases effects of hydroxyzine 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.iloperidoneMonitor Closely (1)tranylcypromine, iloperidone. 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).imipramineContraindicated (1)tranylcypromine and imipramine both increase serotonin levels. Contraindicated.indacaterol, inhaledMonitor Closely (1)indacaterol, inhaled, tranylcypromine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with MAO inhibitors. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.insulin aspartMonitor Closely (1)tranylcypromine increases effects of insulin aspart by unknown mechanism. Use Caution/Monitor.insulin degludecMonitor Closely (1)tranylcypromine, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.insulin degludec/insulin aspartMonitor Closely (1)tranylcypromine, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.insulin detemirMonitor Closely (1)tranylcypromine increases effects of insulin detemir by unknown mechanism. Use Caution/Monitor.insulin glargineMonitor Closely (1)tranylcypromine increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.insulin glulisineMonitor Closely (1)tranylcypromine increases effects of insulin glulisine by unknown mechanism. Use Caution/Monitor.insulin inhaledMonitor Closely (1)tranylcypromine, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.insulin lisproMonitor Closely (1)tranylcypromine increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.insulin NPHMonitor Closely (1)tranylcypromine increases effects of insulin NPH by unknown mechanism. Use Caution/Monitor.insulin regular humanMonitor Closely (1)tranylcypromine increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.iobenguane I 131Serious - Use Alternative (1)tranylcypromine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.isavuconazonium sulfateMonitor Closely (1)tranylcypromine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.isocarboxazidContraindicated (1)isocarboxazid and tranylcypromine both increase serotonin levels. Contraindicated.isomethepteneContraindicated (1)tranylcypromine, isometheptene. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Hypertension, V tach.isoniazidSerious - Use Alternative (1)tranylcypromine and isoniazid both increase serotonin levels. Avoid or Use Alternate Drug.isoproterenolContraindicated (1)tranylcypromine increases effects of isoproterenol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.ivacaftorMonitor Closely (1)tranylcypromine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .ketamineSerious - Use Alternative (1)tranylcypromine increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.L-tryptophanSerious - Use Alternative (1)tranylcypromine and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug.lasmiditanMonitor Closely (2)lasmiditan, tranylcypromine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions. tranylcypromine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.lemborexantMonitor Closely (2)tranylcypromine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification. lemborexant, tranylcypromine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.levalbuterolSerious - Use Alternative (1)tranylcypromine increases effects of levalbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.levocetirizineSerious - Use Alternative (1)tranylcypromine increases effects of