cause norepinephrine accumulation within adrenergic neurons. Significant hypertension can result if coadministered with alpha1 agonists.oxymetazoline topicalMonitor Closely (1)oxymetazoline topical and isocarboxazid both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.oxymorphoneSerious - Use Alternative (1)isocarboxazid 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)isocarboxazid 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.palonosetronSerious - Use Alternative (1)palonosetron, isocarboxazid. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.panax ginsengMinor (1)panax ginseng increases effects of isocarboxazid by pharmacodynamic synergism. Minor/Significance Unknown.papaveretumSerious - Use Alternative (1)isocarboxazid 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)isocarboxazid and paroxetine both increase serotonin levels. Contraindicated.pentazocineSerious - Use Alternative (2)isocarboxazid and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug. isocarboxazid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.pentobarbitalSerious - Use Alternative (1)isocarboxazid, pentobarbital. Other (see comment). Contraindicated. Comment: CNS depressants such as barbiturates should not be used in combination with isocarboxazid.Minor (1)isocarboxazid increases levels of pentobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.perphenazineSerious - Use Alternative (1)isocarboxazid, perphenazine. Other (see comment). Contraindicated. Comment: Concurrent use may prolong or intensify the hypotensive, anticholinergic, or sedative effects of isocarboxazid or perphenazine.phendimetrazineContraindicated (1)isocarboxazid increases effects of phendimetrazine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenelzineContraindicated (1)isocarboxazid and phenelzine both increase serotonin levels. Contraindicated.phenobarbitalSerious - Use Alternative (1)isocarboxazid, phenobarbital. Other (see comment). Avoid or Use Alternate Drug. Comment: CNS depressants such as barbiturates should not be used in combination with isocarboxazid.Minor (1)isocarboxazid increases levels of phenobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.phentermineContraindicated (1)isocarboxazid increases effects of phentermine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenylephrineContraindicated (1)isocarboxazid increases effects of phenylephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenylephrine ophthalmicMonitor Closely (1)isocarboxazid increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.phenylephrine POContraindicated (1)isocarboxazid increases effects of phenylephrine PO by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.pirbuterolSerious - Use Alternative (1)isocarboxazid increases effects of pirbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.pleurisy rootMinor (1)pleurisy root decreases effects of isocarboxazid by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.pregabalinMonitor Closely (1)pregabalin, isocarboxazid. 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.primidoneMinor (1)isocarboxazid increases levels of primidone by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.procarbazineContraindicated (1)isocarboxazid and procarbazine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.promethazineSerious - Use Alternative (1)isocarboxazid increases effects of promethazine by Other (see comment). Avoid or Use Alternate Drug. Comment: Isocarboxazid 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. .propofolSerious - Use Alternative (1)isocarboxazid increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.propylhexedrineContraindicated (1)isocarboxazid increases effects of propylhexedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.protriptylineContraindicated (1)isocarboxazid and protriptyline both increase serotonin levels. Contraindicated.pseudoephedrineContraindicated (1)isocarboxazid increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.rasagilineContraindicated (1)rasagiline and isocarboxazid both increase serotonin levels. Contraindicated. Increased risk of hypertensive crisis. At least 14 days should elapse between discontinuation of rasagiline and initiation of another MAOI or discontinuation of another MAOI and initiation of rasagiline.remifentanilMonitor Closely (1)remifentanil increases toxicity of isocarboxazid by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.remimazolamMonitor Closely (1)remimazolam, isocarboxazid. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.rizatriptanSerious - Use Alternative (2)rizatriptan and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug. isocarboxazid increases levels of rizatriptan by decreasing metabolism. Contraindicated.safinamideContraindicated (1)isocarboxazid, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration increases risk of nonselective MAO inhibition, that may lead to hypertensive crisis. At least 14 days should elapse between discontinuating safinamide and initiating MAOIs.salmeterolSerious - Use Alternative (1)isocarboxazid increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.SAMeSerious - Use Alternative (1)isocarboxazid and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.secobarbitalSerious - Use Alternative (1)isocarboxazid, secobarbital. Other (see comment). Contraindicated. Comment: CNS depressants such as barbiturates should not be used in combination with isocarboxazid.Minor (1)isocarboxazid increases levels of secobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.selegilineContraindicated (1)selegiline and isocarboxazid both increase serotonin levels. Contraindicated.selegiline transdermalContraindicated (1)selegiline transdermal and isocarboxazid both increase serotonin levels. Contraindicated.serdexmethylphenidate/dexmethylphenidateContraindicated (1)isocarboxazid increases effects of serdexmethylphenidate/dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.sertralineContraindicated (1)isocarboxazid and sertraline both increase serotonin levels. Contraindicated.sevofluraneSerious - Use Alternative (1)isocarboxazid increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.solriamfetolContraindicated (1)isocarboxazid will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.St John's WortContraindicated (1)isocarboxazid and St John's Wort both increase serotonin levels. Contraindicated.sufentanilSerious - Use Alternative (1)isocarboxazid increases toxicity of sufentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.sufentanil SLSerious - Use Alternative (1)isocarboxazid increases toxicity of sufentanil SL 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.sulfadiazineMinor (1)isocarboxazid increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.sulfamethoxazoleMinor (1)isocarboxazid increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sulfisoxazoleMinor (1)isocarboxazid increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sumatriptanSerious - Use Alternative (2)sumatriptan and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug. isocarboxazid increases levels of sumatriptan by decreasing metabolism. Contraindicated.sumatriptan intranasalSerious - Use Alternative (2)sumatriptan intranasal and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug. isocarboxazid increases levels of sumatriptan intranasal by decreasing metabolism. Contraindicated.tapentadolMonitor Closely (1)isocarboxazid and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)isocarboxazid increases toxicity of tapentadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.tedizolidSerious - Use Alternative (1)tedizolid, isocarboxazid. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Interaction with MAOIs were not studied in clinical trials; drugs within the same class(eg linezolid) are contraindicated with MAOIs.terbutalineSerious - Use Alternative (1)isocarboxazid increases effects of terbutaline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.tetrabenazineContraindicated (1)tetrabenazine, isocarboxazid. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.tolazamideMonitor Closely (1)isocarboxazid increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.tolbutamideMonitor Closely (1)isocarboxazid increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor.tolcaponeContraindicated (1)tolcapone, isocarboxazid. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Both nonselective MAO inhibitors and tolcapone inhibit catecholamine metabolism, leading to increased levels of catecholamines. Potential for dangerously high HR or BP.tramadolSerious - Use Alternative (2)isocarboxazid and tramadol both increase serotonin levels. Avoid or Use Alternate Drug. isocarboxazid increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.tranylcypromineContraindicated (1)isocarboxazid and tranylcypromine both increase serotonin levels. Contraindicated.trazodoneContraindicated (1)isocarboxazid and trazodone both increase serotonin levels. Contraindicated.trimipramineContraindicated (1)isocarboxazid and trimipramine both increase serotonin levels. Contraindicated.tyramineContraindicated (1)isocarboxazid increases effects of tyramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Tyramine containing foods include cheese, red wine, caviar, herring, canned figs, fermented meats, fava beans, yeast extracts, miso, avocado.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)isocarboxazid and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedvalbenazineSerious - Use Alternative (1)isocarboxazid, valbenazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of valbenazine with MAOIs may increase monoamine neurotransmitter concentration in synapses, potentially increasing risk of serotonin syndrome or attenuating valbenazine effect.valerianMonitor Closely (1)valerian and isocarboxazid both increase sedation. Use Caution/Monitor.venlafaxineContraindicated (1)isocarboxazid and venlafaxine both increase serotonin levels. Contraindicated.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)isocarboxazid and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedvilazodoneContraindicated (1)isocarboxazid, vilazodone. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration with MAO-A inhibitors are contraindicated. Do not prescribe vilazodone within 14 days of discontinuing or starting an MAO inhibitor.vortioxetineContraindicated (1)isocarboxazid, vortioxetine. Either increases effects of the other by serotonin levels. Contraindicated.xylometazolineContraindicated (1)isocarboxazid increases effects of xylometazoline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.yohimbeMonitor Closely (1)yohimbe increases effects of isocarboxazid by pharmacodynamic synergism. Use Caution/Monitor.yohimbineContraindicated (1)isocarboxazid increases effects of yohimbine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.zolmitriptanSerious - Use Alternative (2)zolmitriptan and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug. isocarboxazid increases levels of zolmitriptan by decreasing metabolism. Contraindicated. Frequency Not Defined Common Orthostatic hypotension Dizziness Drowsiness Fatigue Headache Hyperreflexia Sleep disturbance Weakness Tremor Constipation Dry mouth Less Common Confusion Decreased memory Paresthesia Anorexia Nausea Vomiting Impotence Urinary frequency or retention Nystagmus Uncommon Edema Anxiety Hypomania Irritation Hypermetabolic syndrome (hyperpyrexia, tachycardia, tachypnea, incr CPK, acidosis) SIADH Arthralgia Rare Risk of hypertensive crisis (usually due to drug interaction) Ataxia Seizure Jaundice Visual disturbance Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not approved for use in pediatric patientsContraindications Hypersensitivity Pheochromocytoma, CHF, CVD, severe renal impairment Confirmed or suspected cerebrovascular defect or any patient with cardiovascular disease, hypertension, or history of headache Schizophrenia History of liver disease or abnormal liver function tests Concurrent administration with MAO inhibitors or dibenzazepine derivatives; sympathomimetics (including amphetamines); some central nervous system depressants (including narcotics and alcohol); antihypertensive, diuretic, antihistaminic, sedative or anesthetic drugs, bupropion (within 14 days of isocarboxazid discontinuation), buspirone (<10 days of isocarboxazid discontinuation), dextromethorphan, cheese or other foods with a high tyramine content; or excessive quantities of caffeine Use with SSRIs (<14 days of discontinuing isocarboxazid; wait 5 weeks between discontinuation of fluoxetine and initiation of