Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T21:17:14.377Z Has data issue: false hasContentIssue false
  • English
  • Français

Monoamine Oxidase Inhibitors and Narcotic Analgesics

A Critical Review of the Implications for Treatment

Published online by Cambridge University Press:  02 January 2018

B. Browne  and
S. Linter
B. Browne*
Affiliation:
Newcastle General Hospital (now Consultant Psychiatrist, St Mary's Hospital)
S. Linter
Affiliation:
Newcastle General Hospital
*
St Mary's Hospital, Stannington, Morpeth, NorthumberlandNE616AA
Get access Rights & Permissions [Opens in a new window]

Extract

There has been a recent renewal of interest in the use of monoamine oxidase inhibitors, but the concurrent administration of narcotic analgesics is often a cause for concern. This review clarifies the different types of MAOi/narcotic interactions and offers guidelines for the use of narcotic analgesics in the presence of MAOIs. The MAOI/pethidine interaction has two distinct forms: an excitatory and a depressive form. Pethidine must never be used in the presence of MAOIs because of the risk of a fatal excitatory interaction. Morphine does not cause this excitatory interaction, and is the drug of choice provided an allowance is made for possible potentiation of the depressive narcotic effect. It is inevitable that strong analgesia will occasionally be required as an emergency measure in patients on MAOIs, and insufficient attention is paid in psychiatric textbooks to the two different types of interactions and their therapeutic implications.

Type
Papers
Information
The British Journal of Psychiatry , Volume 151 , Issue 2 , August 1987 , pp. 210 - 212
Copyright
Copyright © Royal College of Psychiatrists, 1987 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Pharmaceutical Association (1976) Evaluation of Drug Interactions. New York: American Pharmaceutical Association.Google Scholar
Barry, B. J. (1979) Adverse effects of MAO inhibitors with narcotics reversed with naloxone. Anaesthetics and Intensive Care, 7, 194.Google ScholarPubMed
British Medical Journal (1976) Editorial. British Medical Journal, ii, 69.Google Scholar
Brown, D. D. & Waldron, D. H. (1962) An unusual reaction to tranylcypromine. Practitioner, 189, 83.Google Scholar
Brown, T. C. K. & Cass, N. M. (1979) Beware – the use of MAO inhibitors is increasing again. Anaesthetics and Intensive Care, 7, 65–68.Google Scholar
Churchill-Davidson, H. C. (1965) Anaesthesia and monoamine oxidase inhibitors. British Medical Journal, 1, 520–523.Google Scholar
Clement, A. J. & Benazon, D. (1962) Reactions to other drugs in patients taking monoamine oxidase inhibitors. The Lancet, ii, 197.CrossRefGoogle Scholar
Cocks, D. P. & Passmore-Rowe, (1962) Dangers of monoamine oxidase inhibitors. British Medical Journal, ii, 1545–1546.Google Scholar
Crammer, J., Barraclough, B. & Heine, B. (1982) The Use of Drugs in Psychiatry. London: Gaskell.Google Scholar
Denton, P. H., Borrelu, V. M. & Edwards, N. V. (1962) Dangers of monoamine oxidase inhibitors. British Medical Journal, ii, 1752.Google Scholar
Meyer, D. & Halfin, V. (1981) Toxicity secondary to meperidine in patients on monoamine oxidase inhibitors. A case report and critical review. Journal of Clinical Psychopharmacology, 1, 319–321.CrossRefGoogle ScholarPubMed
Mendelson, G. (1979) Narcotics and monoamine oxidase inhibitors. Medical Journal of Australia, 1, 400–405.Google Scholar
Mitchell, R. S. (1955) Fatal toxic encephalitis occurring during iproniazid therapy in pulmonary tuberculosis. Annals of Internal Medicine, 42, 417.Google ScholarPubMed
Palmer, H. (1960) Potentiation of pethidine. British Medical Jounud, ii, 944–947.Google Scholar
Papp, C. & Benaim, S. (1958) Toxic effects of iproniazid in a patient with angina. British Medical Journal, ii, 1070.CrossRefGoogle Scholar
Penn, R. G. & Rogers, K. J. (1971) Comparison of the effects of morphine, pethidine and pentazocine in rabbits pre-treated with an MAOI. British Journal of Pharmacology, 42, 485–492.CrossRefGoogle Scholar
Quitkin, F., Rifkin, A. & Klein, D. F. (1979) Monoamine oxidase inhibitors. A review of antidepressant effectiveness. Archives of General Psychiatry, 76, 749–753.Google Scholar
Reid, N. C. R. W. & Jones, D. (1962) Pethidine and phenelzine. British Medical Journal, i, 408.CrossRefGoogle Scholar
Rivers, N. & Homer, B. (1970) Possible lethal reaction between Nardil and dextromethorphan. Canadian Medical Association Journal, 103, 85.Google Scholar
Rogers, K. J. (1971) Role of brain monoamines in the interaction between pethidine and tranylcypromine. European Journal of Pharmacology, 14, 86–93.CrossRefGoogle ScholarPubMed
Rogers, K. J. & Thornton, J. A. (1969) The interaction between monoamine oxidase inhibitors and narcotic analgesics in mice. British Jounud of Pharmacology, 36, 470–480.CrossRefGoogle ScholarPubMed
Sargant, W. (1975) Interactions with monoamine oxidase inhibitors. British Medical Journal, iv, 101.Google Scholar
Shee, J. C. (1960) Dangerous potentiation of pethidine by iproniazid and its treatment. British Medical Journal, ii, 507–509.CrossRefGoogle Scholar
Stock Ley, I. H. (1981) Drug Interactions: A Source Book of Adverse Interactions. Oxford: Blackwell.Google Scholar
Taylor, D. C. (1962) Alarming reaction to pethidine in patients on phenelzine. The Lancet, ii, 401.CrossRefGoogle Scholar
Tyrer, P. J. (1982) Drugs in Psychiatric Practice. London: Butterworth.Google Scholar
Vigram, I. M. (1964) Dangerous potentiation of meperidine hydrochloride by pargyline hydrochloride. Journal of the American Medical Association, 187, 9 S4–955.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.