hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).armodafinilContraindicated (1)tranylcypromine increases effects of armodafinil by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.asenapineMonitor Closely (1)tranylcypromine, asenapine. 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).atogepantMonitor Closely (1)tranylcypromine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetineContraindicated (1)tranylcypromine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.avapritinibMonitor Closely (1)tranylcypromine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.axitinibMonitor Closely (1)tranylcypromine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.belladonna and opiumSerious - Use Alternative (1)tranylcypromine increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.benzhydrocodone/acetaminophenSerious - Use Alternative (1)tranylcypromine increases toxicity of benzhydrocodone/acetaminophen 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.benzphetamineContraindicated (1)tranylcypromine increases effects of benzphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.benztropineMonitor Closely (1)tranylcypromine, benztropine. Other (see comment). Use Caution/Monitor. Comment: Anti-parkinsonism drugs should be used with caution in patients receiving tranylcypromine since severe reactions have been reported.bretyliumMonitor Closely (1)tranylcypromine increases effects of bretylium by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. Bretylium produces release of catecholamines from nerve endings. This increased catecholamine release is potentiated by MAOIs.brexpiprazoleMonitor Closely (1)tranylcypromine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.brimonidineContraindicated (1)tranylcypromine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.brompheniramineSerious - Use Alternative (1)tranylcypromine increases effects of brompheniramine 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. .buprenorphineSerious - Use Alternative (1)tranylcypromine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.buprenorphine buccalSerious - Use Alternative (1)tranylcypromine increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.buprenorphine subdermal implantMonitor Closely (1)tranylcypromine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.buprenorphine, long-acting injectionMonitor Closely (1)tranylcypromine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Concomitant use could result in life-threatening serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Buprenorphine long-acting injection is not recommended for patients taking MAOIs or within 14 days of stopping such treatment.bupropionContraindicated (1)tranylcypromine and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropionbuspironeContraindicated (2)tranylcypromine and buspirone both increase serotonin levels. Contraindicated. tranylcypromine, buspirone. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.butabarbitalMinor (1)tranylcypromine increases levels of butabarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.butalbitalMinor (1)tranylcypromine increases levels of butalbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.butorphanolSerious - Use Alternative (1)tranylcypromine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.caffeineContraindicated (1)tranylcypromine increases effects of caffeine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.cannabidiolMonitor Closely (1)tranylcypromine will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP2C19 inhibitor.captoprilMonitor Closely (1)tranylcypromine increases effects of captopril by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.carbamazepineContraindicated (1)carbamazepine increases toxicity of tranylcypromine by unknown mechanism. Contraindicated. D/C MAO inhibitor 2 weeks before.carbinoxamineSerious - Use Alternative (1)tranylcypromine increases effects of carbinoxamine 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. .cariprazineMonitor Closely (1)tranylcypromine, cariprazine. 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).celandineMinor (1)celandine increases effects of tranylcypromine by pharmacodynamic synergism. Minor/Significance Unknown. Based on animal studies.cetirizineSerious - Use Alternative (1)tranylcypromine increases effects of cetirizine 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.chlorpheniramineSerious - Use Alternative (1)tranylcypromine increases effects of chlorpheniramine 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. .chlorpromazineMonitor Closely (1)tranylcypromine, chlorpromazine. Other (see comment). Use Caution/Monitor. Comment: Coadministration of MAOI and phenothiazines may lead to additive hypotensive effects.chlorpropamideMonitor Closely (1)tranylcypromine increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor.cilostazolMonitor Closely (1)tranylcypromine increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).citalopramContraindicated (1)tranylcypromine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.clemastineSerious - Use Alternative (1)tranylcypromine increases effects of clemastine 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. .clomipramineContraindicated (1)tranylcypromine and clomipramine both increase serotonin levels. Contraindicated.clozapineMonitor Closely (1)tranylcypromine, clozapine. 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).cocaine topicalSerious - Use Alternative (1)tranylcypromine and cocaine topical both increase serotonin levels. Contraindicated.codeineMonitor Closely (1)tranylcypromine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)tranylcypromine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.cordycepsMinor (1)cordyceps increases effects of tranylcypromine by pharmacodynamic synergism. Minor/Significance Unknown.cyclobenzaprineContraindicated (1)tranylcypromine and cyclobenzaprine both increase serotonin levels. Contraindicated. Do not coadminister cyclobenzaprine with MAOIs or within 14 days of discontinuing an MAOIcyproheptadineContraindicated (1)tranylcypromine, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.desfluraneSerious - Use Alternative (1)tranylcypromine increases levels of desflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.desipramineContraindicated (1)tranylcypromine and desipramine both increase serotonin levels. Contraindicated.desloratadineSerious - Use Alternative (1)tranylcypromine increases effects of desloratadine 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.desvenlafaxineContraindicated (1)tranylcypromine and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugdeutetrabenazineContraindicated (1)tranylcypromine, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.dexchlorpheniramineSerious - Use Alternative (1)tranylcypromine increases effects of dexchlorpheniramine 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. .dexfenfluramineContraindicated (1)tranylcypromine increases effects of dexfenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)tranylcypromine and dexfenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.dexmethylphenidateContraindicated (1)tranylcypromine increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.dextroamphetamineContraindicated (1)tranylcypromine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)tranylcypromine and dextroamphetamine both increase serotonin levels. Avoid or Use Alternate Drug.dextroamphetamine transdermalContraindicated (1)tranylcypromine increases effects of dextroamphetamine transdermal by decreasing metabolism. Contraindicated. MAOIs slows amphetamine metabolism, increasing amphetamine?s effect on norepinephrine release and other monoamines from adrenergic nerve endings causing signs of hypertensive crisis. Do not administer dextroamphetamine during or within 14 days following MAOI administration.Monitor Closely (1)tranylcypromine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextromethorphanContraindicated (1)tranylcypromine and dextromethorphan both increase serotonin levels. Contraindicated.dextromoramideSerious - Use Alternative (1)tranylcypromine increases toxicity of dextromoramide by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.diamorphineSerious - Use Alternative (1)tranylcypromine increases toxicity of diamorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.diazepam intranasalMonitor Closely (2)tranylcypromine will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam. diazepam intranasal, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.diethylpropionContraindicated (1)tranylcypromine increases effects of diethylpropion by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.difenoxin hclMonitor Closely (1)difenoxin hcl, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.Serious - Use Alternative (1)tranylcypromine increases toxicity of difenoxin hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.dihydroergotamineSerious - Use Alternative (1)tranylcypromine and dihydroergotamine both increase serotonin levels. Avoid or Use Alternate Drug.dihydroergotamine intranasalSerious - Use Alternative (1)tranylcypromine and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.diphenhydramineSerious - Use Alternative (1)tranylcypromine increases effects of diphenhydramine 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. .diphenoxylate hclMonitor Closely (1)diphenoxylate hcl, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.Serious - Use Alternative (1)tranylcypromine increases toxicity of diphenoxylate hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.dipipanoneSerious - Use Alternative (1)tranylcypromine increases toxicity of dipipanone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.disulfiramMonitor Closely (1)disulfiram, tranylcypromine. Mechanism: unknown. Use Caution/Monitor. Possible CNS delirium including agitation, visual hallucinations, and disorientation may occur. .dobutamineContraindicated (1)tranylcypromine increases effects of dobutamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.dolasetronSerious - Use Alternative (1)dolasetron, tranylcypromine. Either increases toxicity of the other by