From the Guidelines
For a patient on a monoamine oxidase inhibitor (MAOI) for depression who needs treatment for seasonal allergies, second-generation antihistamines like loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra) are generally safe options. These medications don't have significant interactions with MAOIs and don't cause the sedation or anticholinergic effects that first-generation antihistamines do. The typical adult dose is loratadine 10mg daily, cetirizine 10mg daily, or fexofenadine 180mg daily. It's essential to avoid first-generation antihistamines like diphenhydramine (Benadryl) and decongestants containing pseudoephedrine or phenylephrine, as these can interact with MAOIs and potentially cause dangerous hypertensive crises.
Intranasal corticosteroids like fluticasone (Flonase) or triamcinolone (Nasacort) are also safe options for nasal symptoms and can be used alongside antihistamines, as supported by the 2017 Joint Task Force on Practice Parameters 1. These recommendations prioritize minimizing interactions with MAOIs while effectively managing seasonal allergy symptoms, thus optimizing morbidity, mortality, and quality of life outcomes.
Key considerations include:
- Avoiding first-generation antihistamines and certain decongestants due to potential interactions with MAOIs.
- Using second-generation antihistamines for their safety profile and efficacy in managing allergy symptoms without significant central nervous system effects.
- Considering intranasal corticosteroids as a safe and effective option for nasal symptoms, which can be used in conjunction with antihistamines.
From the Research
Safe Medication Options for Seasonal Allergies with MAOI Treatment
When a patient is on Monoamine Oxidase Inhibitors (MAOIs) for depression and requires treatment for seasonal allergies, it's crucial to choose medications that do not interact adversely with MAOIs.
- The following medications should be avoided due to their potential to elevate blood pressure via sympathomimetic actions or increase serotonin levels:
- Phenylephrine
- Oxymetazoline
- Dextromethorphan
- Chlorpheniramine
- Brompheniramine 2
- Illicit drugs that stimulate the central nervous system, such as ecstasy (MDMA, 3,4-methylenedioxymethamphetamine), should also be avoided as they act as serotonin releasers 2.
- There is no specific mention of safe medications for seasonal allergies in the provided studies. However, the studies emphasize the importance of avoiding certain medications and being aware of potential interactions when prescribing or taking MAOIs 2, 3, 4, 5, 6.
General Considerations for MAOI Treatment
- MAOIs can have significant interactions with various medications, including those used for seasonal allergies, and certain foods, particularly those containing tyramine 2.
- Patient involvement and awareness are crucial in managing MAOI treatment safely, including informing other healthcare providers about MAOI prescriptions and avoiding certain over-the-counter (OTC) medications that could interact with MAOIs 2, 3.