BNF for Children 2011-2012

706 Appendix 1: Interactions BNFC 2011–2012Appendix 1: InteractionsMAOIsNote For interactions of reversible MAO-A inhibitors(RIMAs) see Moclobemide, and for interactions of MAO-Binhibitors see Rasagiline and Selegiline; the antibacterialLinezolid is a reversible, non-selective MAO inhibitorACE Inhibitors: MAOIs possibly enhance hypotensiveeffect of ACE inhibitorsAdrenergic Neurone Blockers: enhanced hypotensiveeffect when MAOIs given with adrenergic neuroneblockers. Alcohol: MAOIs interact with tyramine found in somebeverages containing .alcohol and some dealcoholisedbeverages (hypertensive crisis)—if no tyramine,enhanced hypotensive effectAlpha 2 -adrenoceptor Stimulants: avoidance ofMAOIs advised by manufacturer of apraclonidine andbrimonidine. Alpha-blockers: avoidance of MAOIs advised bymanufacturer of .indoramin; enhanced hypotensiveeffect when MAOIs given with alpha-blockers. Analgesics: CNS excitation or depression (hypertensionor hypotension) when MAOIs given with.pethidine—avoid concomitant use and for 2 weeksafter stopping MAOIs; possible increased serotonergiceffects and increased risk of convulsions whenMAOIs given with .tramadol—some manufacturersadvise avoid concomitant use and for 2 weeks afterstopping MAOIs; avoidance of MAOIs advised bymanufacturer of .nefopam; possible CNS excitationor depression (hypertension or hypotension) whenMAOIs given with .opioid analgesics—some manufacturersadvise avoid concomitant use and for 2weeks after stopping MAOIsAngiotensin-II Receptor Antagonists: MAOIs possiblyenhance hypotensive effect of angiotensin-II receptorantagonists. Antidepressants: increased risk of hypertension andCNS excitation when MAOIs given with .reboxetine(MAOIs should not be started until 1 week afterstopping reboxetine, avoid reboxetine for 2 weeksafter stopping MAOIs); after stopping MAOIs do notstart .citalopram, .escitalopram, .fluvoxamine,.paroxetine or .sertraline for 2 weeks, also MAOIsshould not be started until at least 1 week afterstopping citalopram, escitalopram, fluvoxamine,paroxetine or sertraline; after stopping MAOIs do notstart .fluoxetine for 2 weeks, also MAOIs should notbe started until at least 5 weeks after stoppingfluoxetine; after stopping MAOIs do not start.duloxetine for 2 weeks, also MAOIs should not bestarted until at least 5 days after stopping duloxetine;enhanced CNS effects and toxicity when MAOIsgiven with .venlafaxine (venlafaxine should not bestarted until 2 weeks after stopping MAOIs, avoidMAOIs for 1 week after stopping venlafaxine);increased risk of hypertension and CNS excitationwhen MAOIs given with other .MAOIs (avoid for atleast 2 weeks after stopping previous MAOIs andthen start at a reduced dose); after stopping MAOIsdo not start .moclobemide for at least 1 week;MAOIs increase CNS effects of .SSRIs (risk of serioustoxicity); after stopping MAOIs do not start.mirtazapine for 2 weeks, also MAOIs should not bestarted until at least 2 weeks after stopping mirtazapine;after stopping MAOIs do not start .tricyclicrelatedantidepressants for 2 weeks, also MAOIsshould not be started until at least 1–2 weeks afterstopping tricyclic-related antidepressants; increasedrisk of hypertension and CNS excitation when MAOIsgiven with .tricyclics, tricyclics should not be starteduntil 2 weeks after stopping MAOIs (3 weeks ifstarting clomipramine or imipramine), also MAOIsshould not be started for at least 1–2 weeks afterstopping tricyclics (3 weeks in the case of clomipramineor imipramine); CNS excitation and confusionwhen MAOIs given with .tryptophan (reduce dose oftryptophan)Antidiabetics: MAOIs possibly enhance hypoglycaemiceffect of antidiabetics; MAOIs enhance hypo-MAOIsAntidiabetics (continued)glycaemic effect of insulin, metformin and sulfonylureas. Antiepileptics: MAOIs possibly antagonise anticonvulsanteffect of antiepileptics (convulsivethreshold lowered); avoidance for 2 weeks afterstopping MAOIs advised by manufacturer of.carbamazepine, also antagonism of anticonvulsanteffectAntihistamines: avoidance of promethazine for 2weeks after stopping MAOIs advised by manufacturerof promethazine; increased antimuscarinic andsedative effects when MAOIs given with antihistamines. Antimalarials: avoidance of antidepressants advised bymanufacturer of .artemether/lumefantrineAntimuscarinics: increased risk of antimuscarinic sideeffectswhen MAOIs given with antimuscarinics. Antipsychotics: CNS effects of MAOIs possiblyincreased by .clozapineAnxiolytics and Hypnotics: avoidance of MAOIsadvised by manufacturer of buspirone; manufacturerof tranylcypromine advises avoid buspirone for 10days after stopping tranylcypromine. Atomoxetine: after stopping MAOIs do not start.atomoxetine for 2 weeks, also MAOIs should not bestarted until at least 2 weeks after stopping atomoxetine;possible increased risk of convulsions whenantidepressants given with atomoxetineBeta-blockers: enhanced hypotensive effect whenMAOIs given with beta-blockers. Bupropion: avoidance of bupropion for 2 weeks afterstopping MAOIs advised by manufacturer of.bupropionCalcium-channel Blockers: enhanced hypotensiveeffect when MAOIs given with calcium-channelblockersClonidine: enhanced hypotensive effect when MAOIsgiven with clonidineDiazoxide: enhanced hypotensive effect when MAOIsgiven with diazoxideDiuretics: enhanced hypotensive effect when MAOIsgiven with diuretics. Dopaminergics: avoid concomitant use of non-selectiveMAOIs with .entacapone; risk of hypertensivecrisis when MAOIs given with .levodopa, avoidlevodopa for at least 2 weeks after stopping MAOIs;risk of hypertensive crisis when MAOIs given with.rasagiline, avoid MAOIs for at least 2 weeks afterstopping rasagiline; enhanced hypotensive effectwhen MAOIs given with .selegiline—manufacturerof selegiline advises avoid concomitant use; avoidconcomitant use of MAOIs with tolcaponeDoxapram: MAOIs enhance effects of doxapramHistamine: avoidance of MAOIs advised by manufacturerof histamine. 5HT 1 Agonists: risk of CNS toxicity when MAOIs givenwith .rizatriptan or .sumatriptan (avoid rizatriptan orsumatriptan for 2 weeks after MAOIs); increased riskof CNS toxicity when MAOIs given with.zolmitriptan. Methyldopa: avoidance of MAOIs advised by manufacturerof .methyldopaMoxonidine: enhanced hypotensive effect whenMAOIs given with moxonidineMuscle Relaxants: phenelzine enhances effects ofsuxamethoniumNicorandil: enhanced hypotensive effect when MAOIsgiven with nicorandilNitrates: enhanced hypotensive effect when MAOIsgiven with nitratesPholcodine: avoidance of pholcodine for 2 weeks afterstopping MAOIs advised by manufacturer of pholcodine. Sympathomimetics: risk of hypertensive crisis whenMAOIs given with .sympathomimetics; risk ofhypertensive crisis when MAOIs given with.methylphenidate, some manufacturers advise