Monoamine oxidase (MAO) inhibitors (drug interactions)
Monoamine oxidase (MAO) inhibitors are a class of antidepressant medications that can interact dangerously with various substances. Certain herbal supplements and compounds can lead to severe side effects when taken alongside these drugs. For example, combining MAO inhibitors with ephedra, which contains the stimulant ephedrine, is particularly hazardous and should be avoided entirely, as it can cause rapid and dangerous interactions. Similarly, the herb scotch broom, high in tyramine, poses risks of nausea, sweating, and elevated blood pressure when used with MAO inhibitors.
Other substances like green tea and ginseng may also result in potential adverse effects due to their caffeine content or other interactions, leading to symptoms like tremors or headaches. Additionally, St. John's wort and compounds such as 5-hydroxytryptophan (5-HTP) and S-adenosylmethionine (SAMe) may increase serotonin levels to dangerous levels and could lead to serotonin syndrome. Consequently, it is crucial for individuals considering MAO inhibitors to consult healthcare professionals before combining these medications with any other substances, particularly herbal products, to ensure safe usage.
Monoamine oxidase (MAO) inhibitors (drug interactions)
DEFINITION: A group of antidepressant drugs.
INTERACTIONS: Ephedra, green tea, ginseng, 5-hydroxytryptophan (5-HTP), S-adenosylmethionine (SAMe), St. John’s wort, scotch broom
DRUGS IN THIS FAMILY: Furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine sulfate (Nardil), tranylcypromine sulfate (Parnate), selegiline (Emsam)
Ephedra
Effect: Dangerous Interaction
Because it contains the stimulant ephedrine, combining the herb ephedra with monoamine oxidase (MAO) inhibitors can rapidly produce a severe, dangerous interaction and should be avoided. In the United States, it is illegal to sell products containing ephedra.
Scotch Broom
Effect: Dangerous Interaction
The herb scotch broom contains high levels of tyramine, so it should not be taken with MAO inhibitors. Reactions include nausea, sweating, heart palpitations, and high blood pressure.
Green Tea
Effect: Probable Dangerous Interaction
Because it contains caffeine, green tea should not be combined with MAO inhibitors. In some cases, it may lead to hypertensive crisis.
Ginseng
Effect: Possible Dangerous Interaction
According to one report, the combination of ginseng and the MAO inhibitor phenelzine caused worrisome symptoms. While this may have been caused by caffeine contamination of the ginseng, experts recommend avoiding ginseng-MAO inhibitor combinations. Particularly with the drug phenelzine (Nardil), ginseng consumption may cause tremors, mania, or headache.
St. John’s Wort
Effect: Possible Dangerous Interaction
Because St. John’s wort functions somewhat similarly to SSRI (selective serotonin-reuptake inhibitor) antidepressants, taking St. John's wort with MAO inhibitors may cause a dangerous level of serotonin to occur in the brain. SSRIs and St. John’s wort should not be combined with MAO inhibitors.
5-hydroxytryptophan (5-HTP), S-adenosylmethionine (SAMe)
Effect: Possible Dangerous Interactions
Evidence suggests dangerous interactions are likely to occur when taking SAMe and 5-HTP with MAO inhibitors, such as serotonin syndrome. These should substances should not be combined.
Bibliography
Brinker, F. “Interactions of Pharmaceutical and Botanical Medicines.” Journal of Naturopathic Medicine, vol. 7, 1997, p. 14.
Edinoff, Amber N., et al. “Clinically Relevant Drug Interactions with Monoamine Oxidase Inhibitors.” Health Psychology Research, vol. 10, no. 4, Nov. 2022, p. 39576, doi:10.52965/001c.39576.
Garcia, Eddie. "Monoamine Oxidase Inhibitor Toxicity." Medscape, 25 Oct. 2023, emedicine.medscape.com/article/815695-overview. Accessed 20 Sept. 2024.
Iruela, L. M., et al. “Toxic Interaction of S-Adenosylmethionine and Clomipramine.” American Journal of Psychiatry, vol. 150, 1993, p. 522.
Jones, B. D., and A. M. Runikis. “Interaction of Ginseng with Phenelzine.” Journal of Clinical Psychopharmacology, vol. 7, 1987, pp. 201-02.
Preston, Claire L. Stockley’s Drug Interactions. 12th ed., Pharmaceutical Press, 2021.