or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).phendimetrazineContraindicated (1)tranylcypromine increases effects of phendimetrazine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenelzineContraindicated (1)phenelzine and tranylcypromine both increase serotonin levels. Contraindicated.phenobarbitalMinor (1)tranylcypromine increases levels of phenobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.phentermineContraindicated (1)tranylcypromine increases effects of phentermine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenylephrineContraindicated (1)tranylcypromine increases effects of phenylephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenylephrine ophthalmicMonitor Closely (1)tranylcypromine 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)tranylcypromine increases effects of phenylephrine PO by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.pimavanserinMonitor Closely (1)tranylcypromine, pimavanserin. 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).pimozideMonitor Closely (1)tranylcypromine, pimozide. 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).pirbuterolSerious - Use Alternative (1)tranylcypromine increases effects of pirbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.pirfenidoneSerious - Use Alternative (1)tranylcypromine will increase the level or effect of pirfenidone by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid; coadministration of pirfenidone and moderate CYP1A2 inhibitors result in moderately increased exposure to pirfenidone; if unable to avoid, decrease dose of moderate CYP1A2 inhibitorpleurisy rootMinor (1)pleurisy root decreases effects of tranylcypromine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.pregabalinMonitor Closely (1)pregabalin, 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.primidoneMinor (1)tranylcypromine increases levels of primidone by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.procarbazineContraindicated (1)procarbazine and tranylcypromine 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)tranylcypromine increases effects of promethazine 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. Combination of tranylcypromine and promethazine may result in additive hypotensive effects.propofolSerious - Use Alternative (1)tranylcypromine increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.propylhexedrineContraindicated (1)tranylcypromine increases effects of propylhexedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.protriptylineContraindicated (1)tranylcypromine and protriptyline both increase serotonin levels. Contraindicated.pseudoephedrineContraindicated (1)tranylcypromine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.quetiapineMonitor Closely (1)tranylcypromine, quetiapine. 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).rasagilineContraindicated (1)rasagiline and tranylcypromine both increase serotonin levels. Contraindicated. 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 tranylcypromine by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.remimazolamMonitor Closely (1)remimazolam, tranylcypromine. 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.risperidoneMonitor Closely (1)tranylcypromine, risperidone. 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).rizatriptanSerious - Use Alternative (2)rizatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated. tranylcypromine increases levels of rizatriptan by decreasing metabolism. Contraindicated.ruxolitinibMinor (1)tranylcypromine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ruxolitinib topicalMinor (1)tranylcypromine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.safinamideContraindicated (1)tranylcypromine, 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)tranylcypromine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.SAMeSerious - Use Alternative (1)tranylcypromine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.secobarbitalMinor (1)tranylcypromine increases levels of secobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.selegilineContraindicated (1)selegiline and tranylcypromine both increase serotonin levels. Contraindicated.selegiline transdermalContraindicated (1)selegiline transdermal and tranylcypromine both increase serotonin levels. Contraindicated.serdexmethylphenidate/dexmethylphenidateContraindicated (1)tranylcypromine increases effects of serdexmethylphenidate/dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.sertralineContraindicated (1)tranylcypromine and sertraline both increase serotonin levels. Contraindicated.sevofluraneSerious - Use Alternative (1)tranylcypromine increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.solriamfetolContraindicated (1)tranylcypromine 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)tranylcypromine and St John's Wort both increase serotonin levels. Contraindicated.sufentanilSerious - Use Alternative (1)tranylcypromine 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)tranylcypromine 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)tranylcypromine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.sulfamethoxazoleMinor (1)tranylcypromine increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sulfisoxazoleMinor (1)tranylcypromine increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sumatriptanSerious - Use Alternative (2)sumatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated. tranylcypromine increases levels of sumatriptan by decreasing metabolism. Contraindicated.sumatriptan intranasalSerious - Use Alternative (2)sumatriptan intranasal and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated. tranylcypromine increases levels of sumatriptan intranasal by decreasing metabolism. Contraindicated.tamsulosinMonitor Closely (1)tranylcypromine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadolMonitor Closely (1)tranylcypromine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)tranylcypromine increases toxicity of tapentadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.tazemetostatMonitor Closely (1)tranylcypromine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tedizolidSerious - Use Alternative (1)tedizolid, tranylcypromine. 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)tranylcypromine increases effects of terbutaline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.tetrabenazineContraindicated (1)tetrabenazine, tranylcypromine. 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.thiothixeneMonitor Closely (1)tranylcypromine, thiothixene. 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).tinidazoleMonitor Closely (1)tranylcypromine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tolazamideMonitor Closely (1)tranylcypromine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.tolbutamideMonitor Closely (1)tranylcypromine increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor.tolcaponeContraindicated (1)tolcapone, tranylcypromine. 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)tranylcypromine and tramadol both increase serotonin levels. Avoid or Use Alternate Drug. tranylcypromine increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.trazodoneContraindicated (1)tranylcypromine and trazodone both increase serotonin levels. Contraindicated.trifluoperazineMonitor Closely (1)tranylcypromine, trifluoperazine. 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).trihexyphenidylMonitor Closely (1)tranylcypromine, trihexyphenidyl. 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.trimipramineContraindicated (1)tranylcypromine and trimipramine both increase serotonin levels. Contraindicated.tyramineContraindicated (1)tranylcypromine 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)tranylcypromine 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)tranylcypromine, 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 tranylcypromine both increase sedation. Use Caution/Monitor.venlafaxineContraindicated (1)tranylcypromine and venlafaxine both increase serotonin levels. Contraindicated.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)tranylcypromine 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)tranylcypromine, 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)tranylcypromine increases toxicity of vortioxetine by serotonin levels. Contraindicated.warfarinMonitor Closely (1)tranylcypromine will increase the level or effect of warfarin by Other (see comment). Use Caution/Monitor. Warfarin's less potent R-enantiomer is metabolized in part by CYP3A4 (and also CYP1A2 and CYP2C19). Monitor INR more frequently if coadministered with inhibitors of these isoenzymes and adjust warfarin dose if needed. xylometazolineContraindicated (1)tranylcypromine increases effects of xylometazoline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.yohimbeMonitor Closely (1)yohimbe increases effects of tranylcypromine by pharmacodynamic synergism. Use Caution/Monitor.yohimbineContraindicated (1)tranylcypromine increases effects of yohimbine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.ziprasidoneMonitor Closely (1)tranylcypromine, ziprasidone. 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).zolmitriptanSerious - Use Alternative (2)zolmitriptan and tranylcypromine both