Risk of serotonin syndrome — selegiline (MAO-B inhibitor) + tramadol (serotonin reuptake inhibitor)
Management: Do not combine. Allow 14-day washout from selegiline before starting tramadol.
Fluoxetine
contraindicatedRisk of serotonin syndrome — MAO inhibitor + SSRI combination is absolutely contraindicated
Management: Never combine. Allow 14-day washout from selegiline and 5-week washout from fluoxetine.
Sertraline
contraindicatedSSRI + MAO inhibitor: high risk of fatal serotonin syndrome
Management: Absolutely contraindicated. Allow 14-day washout from selegiline before starting any SSRI.
Meperidine (Pethidine)
contraindicatedMeperidine + MAO inhibitor: potentially fatal serotonergic crisis with hyperthermia, rigidity, seizures, cardiovascular collapse.
Management: ABSOLUTE CONTRAINDICATION. Never combine meperidine with any MAO inhibitor. Use alternative opioid (morphine, hydromorphone).
Clomipramine
contraindicatedTCA (serotonin reuptake inhibitor) + MAO inhibitor: serotonin syndrome.
Management: NEVER combine. Allow 2-week washout between agents.
Two MAO inhibitors (linezolid: reversible MAO-A; selegiline: irreversible MAO-B, with MAO-A activity at high doses): risk of hypertensive crisis and serotonin syndrome.
Management: NEVER combine. Allow 2-week washout of selegiline before linezolid.
Paroxetine
contraindicatedSSRI + MAO inhibitor: serotonin syndrome — hyperthermia, seizures, rigidity, death.
Management: NEVER combine. Allow 2-week washout of paroxetine before selegiline.
Dextromethorphan
contraindicatedDXM has serotonergic properties + selegiline is MAO inhibitor. Risk of serotonin syndrome.
Management: NEVER combine. Use alternative antitussive.
Fluvoxamine
contraindicatedSSRI + MAO inhibitor: serotonin syndrome — potentially fatal.
Management: NEVER combine. Allow 2-week washout of either before starting the other.
Imipramine
contraindicatedTCA (serotonin/norepinephrine reuptake inhibitor) + MAO inhibitor: serotonin syndrome.
Management: NEVER combine. Allow 2-week washout between agents.
TCA + MAO inhibitor: serotonin syndrome.
Management: NEVER combine. Allow 2-week washout between agents.
Ephedrine releases stored norepinephrine + selegiline inhibits MAO breakdown of catecholamines: massive catecholamine surge causing severe hypertension, hyperthermia, seizures.
Management: NEVER combine. Allow 2-week washout of selegiline before ephedrine.
Phenylpropanolamine
contraindicatedPPA releases norepinephrine + MAO inhibitor prevents catecholamine breakdown: hypertensive crisis.
Management: NEVER combine. Use alternative urinary incontinence therapy (estriol, DES) with selegiline.
Pseudoephedrine
contraindicatedSympathomimetic + MAO inhibitor: severe hypertensive crisis and potentially fatal cardiovascular collapse.
Management: NEVER combine.