What cold medicines should be avoided when taking anti-depressants, specifically Monoamine Oxidase Inhibitors (MAOIs) or Selective Serotonin Reuptake Inhibitors (SSRIs)?

Cold Medicines to Avoid with Antidepressants

Patients taking antidepressants, particularly MAOIs and SSRIs, should avoid decongestants containing sympathomimetics like pseudoephedrine and phenylephrine, as well as cough suppressants containing dextromethorphan, due to risks of hypertensive crisis and serotonin syndrome. 1, 2

Medications to Avoid with MAOIs

Decongestants

• Avoid all sympathomimetic decongestants (pseudoephedrine, phenylephrine, oxymetazoline) as they can cause dangerous hypertensive crisis when combined with MAOIs 1, 3
• These medications are commonly found in over-the-counter cold and sinus products 3

Cough Suppressants

• Avoid dextromethorphan (found in many cough syrups) as it can cause serotonin syndrome when combined with MAOIs 2, 3
• Avoid chlorpheniramine and brompheniramine (antihistamines in many cold products) due to serotonergic effects 3

Other Cold Medicine Ingredients

• Avoid any cold medicine containing stimulants or sympathomimetic agents 1
• Avoid medications with multiple active ingredients as they often contain hidden sympathomimetics or serotonergic compounds 3

Medications to Use with Caution with SSRIs

Cough Suppressants

• Use dextromethorphan with caution as it may increase risk of serotonin syndrome when combined with SSRIs 4
• Monitor for early signs of serotonin syndrome: agitation, confusion, tremor, hyperreflexia 5

Decongestants

• Use sympathomimetic decongestants (pseudoephedrine, phenylephrine) with caution as they may increase blood pressure 1, 6
• Consider lower doses if these must be used 1

Safer Alternatives for Cold Symptoms

For Nasal Congestion

• Saline nasal sprays or rinses are safe alternatives to decongestants 1
• Intranasal corticosteroids (fluticasone, mometasone) are generally safe with antidepressants 1

For Cough

• Simple expectorants like guaifenesin (without dextromethorphan) are generally safe 3
• Honey and non-medicated lozenges may help with cough symptoms 7

For Allergic Symptoms

• Second-generation antihistamines (loratadine, cetirizine) are generally safer than first-generation antihistamines 1
• Avoid first-generation antihistamines (diphenhydramine, chlorpheniramine) with MAOIs 3

Special Considerations

For MAOI Users

• Always consult with a healthcare provider before taking any over-the-counter medication 2, 8
• Inform all healthcare providers about MAOI use, including dentists and emergency providers 3
• Be aware that hypertensive crisis can occur rapidly and requires immediate medical attention 8, 9

For SSRI Users

• While generally safer than MAOIs, still use caution with decongestants and dextromethorphan 4
• The risk of serotonin syndrome increases when multiple serotonergic medications are combined 5

Common Pitfalls to Avoid

• Failing to check all ingredients in multi-symptom cold products, which often contain hidden sympathomimetics or serotonergic agents 3, 7
• Assuming that "natural" or herbal cold remedies are safe with antidepressants 8
• Not allowing adequate washout periods when switching between antidepressants 2
• Using over-the-counter medications without consulting a healthcare provider 2, 3

Remember that the risks of drug interactions are highest with irreversible MAOIs (phenelzine, tranylcypromine), somewhat lower with reversible MAOIs (moclobemide), and lowest (but still present) with SSRIs 8, 7.