From the Guidelines
Medications that increase blood pressure, particularly those that affect norepinephrine levels, such as sympathomimetic antihypertensives like pseudoephedrine, phenylephrine, and ephedrine, are contraindicated when taking MAOIs (Monoamine Oxidase Inhibitors) due to the risk of hypertensive crisis 1. When considering hypertension management in patients taking MAOIs, it's crucial to avoid medications that can interact dangerously with MAOIs.
- Sympathomimetic antihypertensives should be avoided because they can increase norepinephrine levels, potentially leading to hypertensive crisis when combined with MAOIs.
- Other medications to avoid include those containing reserpine and alpha-methyldopa, as they can also affect norepinephrine storage and interact with MAOIs.
- Beta-blockers should be used with caution, as they may enhance the hypotensive effects of MAOIs. Some key points to consider when managing hypertension in patients taking MAOIs include:
- Avoiding tyramine-containing foods, as they can cause a hypertensive crisis when taken with MAOIs 1.
- Considering alternative agents for hypertension management, such as calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers, which can be used under close medical supervision with careful dose adjustments to avoid excessive blood pressure reduction.
- Being aware of other substances that may cause elevated blood pressure, such as alcohol, amphetamines, and certain herbal supplements, and advising patients to limit or avoid their use 1.
From the FDA Drug Label
Warnings Do not use if you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression, psychiatric or emotional conditions, or Parkinson’s disease), or for 2 weeks after stopping the MAOI drug. While taking an MAOI, the hypertension medication pseudoephedrine is contraindicated 2.
From the Research
Hypertension Medication Contraindicated with MAOI
- The following medications can elevate blood pressure via sympathomimetic actions and should be avoided when taking MAOI:
- Phenylephrine
- Oxymetazoline 3
- MAOIs can negatively interact with both sympathomimetic and serotonergic drugs, leading to life-threatening blood pressure elevations or serotonin syndrome 3, 4, 5
- Patients on MAOI should avoid certain medications, including those that can increase serotonin levels or elevate blood pressure 3, 6, 7
- It is crucial for patients to inform their healthcare providers about their MAOI prescription to avoid adverse interactions with other medications 3, 7