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Misc How dangerous are interactions with MAOI's?

R

ross46

Greenlighter
Joined
May 11, 2013
Messages
26
So for most of the medications i've ever taken the leaflet always says something like "do not take with MAOI's or if you have taken one in the last two weeks"

How bad are the reactions if you take something like the drugs below with it? i got told by a doctor that with opiates it might actually kill you. Don't know how true it is so i'm asking you guys.

The meds i've taken are; codeine (Tylenol), tramadol (Ultram), buprenorphine (Transtec), morphine (Oramorph), oxycodone (Percocet), fluoxetine (Zoloft), venafalaxin (Effexor), citalopram (Celexa), amitriptyline (Elavil), quetiapine (Seroquel), olanzapine (Zyprexa), diazepam (Valium), gabapentin (Neurontin) and pregablin (Lyrica). PHEW!

so what would happen with the opiates, benzo's, antidepressants, antipsychotics and anti epilieptics or even weed or alcohol if taken with an MAOI?
 
Very. They need to be avoided at all costs as they can be potentially lethal.
 
What makes the interactions so deadly? I can understand taking a benzo and opiate because it slows down breathing etc but i can't find anything on why they are so lethal?
 
^ Yes
And if you take a MAOI you have to follow a strict diet, because you need the monoamine oxidase to break down monoamines, like tyramine (found in cheese)
 
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Ah, didn't realise it was serotonin syndrome. I've had a mild form of that when they tried me on the venefalaxine and citalopram. Not nice!! which meds would it be that cause hypertensive crisis and why?
 
codeine, morphine, oxycodone, buprenorphine :
Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.
Click to expand...
http://bja.oxfordjournals.org/content/95/4/434.full so there shouldn't be a problem

tramadol is a SSRI, so don't combine it with a MAOI

fluoxetine, venafalaxin, citalopram, amitriptyline are all antidepressants and iirc all act as serotonin reuptake inhibitors, so don't combine with a MAOI

diazepam, gabapentin and pregablin should be fine as far as I know

olanzapine not safe to combine

quetiapine not sure about that one
 
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Ok thanks for all the information

"Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs."

I was told when i was taking the SSRI's and SNRI's that it was the bupe patch that was the culprit for the Serotonin Syndrome? Is this true? or is wiki lying to me? (i know it's not a reliable source but it gives a quick overview). So where you say "do not precipitate serotonin toxicity with MAOIs." is that just MAOI's or does not cause SS full stop?

I'm not taking or planning to take MAOI's just i was curious, but more info on Serotonin Syndrome would be appreciated. looking into it it shows that SGA's can cause SS but does not state Abilify which i might be starting soon. Thankyou!!

Edit: Found this paper, that hypothesises that abilify might stop SS as it binds to 5HT1A and 5HT2A. You guys will understand the implications of that more than me!

http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol24_no1/dnb_vol24_no1_100.pdf
 
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Well, now that you said it I think I remember reading about bupe and oxycodone being linked to serotonine syndrome, but I have to do so more research on it.

Did you read the post about SS in the thread I linked a few posts above ? I think that should answer all your questions.
If not feel free to ask :)
 
Is there a thread on here explaining how the cytochromes work? i know that a lot of drugs use the P450 cytochrome but i haven't found a full on explanation in laymans terms. i'm a mechanical engineer not a biologist/ pharmacologist/ doctor. I noticed that antipsychotics weren't on his list?
 
Cytochromes metabolize substrates, like drugs, so your body can excrete them easier/ because your body thinks that they are dangerous and wants to 'deactivate' them (though sometimes substances are metabolized into much more harmful molecules and sometimes you need the cytochromes to metabolize a prodrug, like codein into an active drug (morphine in this case))
But there are drugs that either enhance or inhibit cytochromes.
So if you take two drugs (A and B), both are metabolized by a certain cytochrome and one (A) inhibits said cytochrome the other drug, B, may accumulate within the body because the cytochromes that should metabolize it are being inhibited by drug A, this could lead to a toxic level of drug B
If you take two drugs (C and D), both are metabolized by a certain cytochrome and one (C) enhances said cytochrome drug D will be metabolized much quicker than normal, this could lead to withdrawal etc.

I hope you understand what I'm trying to say :D
 
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makes sense. But what does the cytochrome actually do to "metabolise" the drug. i saw something about P450 and de-hydogenase? so in the case of dehydrogenase, it uses another chemical in the body (such as NAD(P)H ) with an electrical charge due to it being one electron short to remove the hydrogen atom? Is it similar to respiration where the iron molecule in the haemoglobin is electrically charged so binds with the oxygen or carbon dioxide atom, essentially creating a new molecule?


In the case of codeine, it says that "Codeine is metabolised by O- and N-demethylation". What is the process there? what chemical in the body can substitute a methyl group? and then where does CYP2D6 come into it? Trying to remember A level chemistry and biology!!

is there a thread that already explains this because i can't be the only one who's asked this. I've tried searching but when you type in codeine and morphine it comes up with loads of random threads, even if you put in "codeine demthylation"
 
kleinerkiffer said:
codeine, morphine, oxycodone, buprenorphine : http://bja.oxfordjournals.org/content/95/4/434.full so there shouldn't be a problem

tramadol is a SSRI, so don't combine it with a MAOI

fluoxetine, venafalaxin, citalopram, amitriptyline are all antidepressants and iirc all act as serotonin reuptake inhibitors, so don't combine with a MAOI

diazepam, gabapentin and pregablin should be fine as far as I know

olanzapine not safe to combine

quetiapine not sure about that one
Click to expand...


I think olanzapine and quetiapine would be okay seeing as they are both serotonergic and adrenergic antagonists.
 
Let's not forget about DXM, another lethal interaction.

I'm pretty sure a fellow Bluelighter recently died from a MAOI and DXM interaction.
It may have been an SSRI and DXM interaction though.
Nevertheless, it's still very dangerous.
 
why would a doctor put someone on an MAOI? is it a last resort when other drugs don't work seeing as its so dangerous you even have to change your diet?
 
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