▶ Nefopam is predicted to increase the risk of serious elevations
in blood pressure when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid.rTheoretical
▶ Opicapone is predicted to increase the risk of elevated blood
pressure when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid.rTheoretical
▶ Opioids are predicted to increase the risk of CNS excitation or
depression when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid.rStudy → Also see TABLE 13
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of neuroleptic malignant
syndrome when given with phenothiazines.rTheoretical →
▶ Pholcodine is predicted to increase the risk of CNS excitation
or depression when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid and for 14 days after stopping
▶ Reboxetine is predicted to increase the risk of a hypertensive
crisis when given with monoamine-oxidase A and B inhibitors,
irreversible. Avoid.rTheoretical
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the exposure to rizatriptan. Avoid and
for 14 days after stopping the MAOI.rTheoretical → Also
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the exposure to sumatriptan. Avoid and
for 14 days after stopping the MAOI.rTheoretical → Also
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of a hypertensive crisis when
given with sympathomimetics, inotropic. Avoid and for 14 days
after stopping the MAOI.rTheoretical
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of a hypertensive crisis when
given with sympathomimetics, vasoconstrictor. Avoid and for
14 days after stopping the MAOI.rStudy
▶ Tetrabenazine is predicted to increase the risk of CNS toxicity
when given with monoamine-oxidase A and B inhibitors,
. Avoid and for 14 days after stopping the MAOI.
▶ Tricyclic antidepressants are predicted to increase the risk of
severe toxic reaction when given with monoamine-oxidase A
and B inhibitors, irreversible. Avoid and for 14 days after
stopping the MAOI.rTheoretical → Also see TABLE 8
p. 1376 → Also see TABLE 13 p. 1378
▶ Tryptophan increases the risk of side-effects when given with
monoamine-oxidase A and B inhibitors, irreversible
Anecdotal → Also see TABLE 13 p. 1378
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the exposure to
Theoretical → Also see TABLE 13 p. 1378
Monoamine-oxidase B inhibitors → see TABLE 6 p. 1376
(bradycardia), TABLE 8 p. 1376 (hypotension), TABLE 13 p. 1378 (serotonin
rasagiline . safinamide . selegiline.
FOOD AND LIFESTYLE Hypertension is predicted to occur when
high-dose selegiline is taken with tyramine-rich foods (such
as mature cheese, salami, pickled herring, Bovril ®, Oxo ®,
Marmite ® or any similar meat or yeast extract or fermented
soya bean extract, and some beers, lagers or wines).
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of severe hypertension when
given with amfetamines. Avoid.rTheoretical → Also see
▶ Safinamide is predicted to increase the risk of severe
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of severe hypertension when
given with beta2 agonists. Avoid.rTheoretical
▶ Safinamide is predicted to increase the risk of severe
hypertension when given with beta2 agonists.rTheoretical
▶ Monoamine-oxidase B inhibitors are predicted to increase the
risk of severe hypertension when given with
Theoretical → Also see TABLE 13 p. 1378
▶ Combined hormonal contraceptives slightly increase the
▶ Combined hormonal contraceptives increase the exposure to
1496 Monoamine-oxidase A and B inhibitors — Monoamine-oxidase B inhibitors BNF 78
▶ Hormone replacement therapy is predicted to increase the
exposure to selegiline. Avoid.oStudy
▶ Monoamine-oxidase B inhibitors are predicted to increase the
effects of levodopa. Adjust dose.nStudy → Also see TABLE 8
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of side-effects when given with
. Avoid and for 14 days after stopping the MAOI.
Theoretical → Also see TABLE 13 p. 1378
▶ Safinamide is predicted to increase the risk of side-effects
when given with linezolid. Avoid and for 1 week after stopping
safinamide, p. 427.rTheoretical → Also see TABLE 13 p. 1378
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of a hypertensive crisis when
given with methylphenidate. Avoid.rTheoretical
slightly increases the exposure to rasagiline.
▶ Moclobemide is predicted to increase the effects of monoamineoxidase B inhibitors
▶ Moclobemide is predicted to increase the risk of side-effects
when given with safinamide. Avoid and for 1 week after
stopping safinamide.rTheoretical → Also see TABLE 13 p. 1378
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of side-effects when given with
monoamine-oxidase A and B inhibitors, irreversible. Avoid and
for 14 days after stopping the MAOI.rTheoretical → Also
see TABLE 8 p. 1376 → Also see TABLE 13 p. 1378
▶ Safinamide is predicted to increase the risk of side-effects
when given with monoamine-oxidase A and B inhibitors,
. Avoid and for 1 week after stopping safinamide.
Theoretical → Also see TABLE 13 p. 1378
▶ Rasagiline is predicted to increase the risk of side-effects when
given with opioids (pethidine). Avoid and for 14 days after
stopping rasagiline.rTheoretical → Also see TABLE 13 p. 1378
▶ Safinamide is predicted to increase the risk of side-effects
when given with opioids (pethidine). Avoid and for 1 week after
stopping safinamide.rTheoretical → Also see TABLE 13 p. 1378
▶ Selegiline increases the risk of side-effects when given with
opioids (pethidine). Avoid.rAnecdotal → Also see TABLE 13
▶ Quinolones (ciprofloxacin) slightly increase the exposure to
▶ Reboxetine is predicted to increase the risk of a hypertensive
crisis when given with monoamine-oxidase B inhibitors
(rasagiline, selegiline). Avoid.rTheoretical
▶ Monoamine-oxidase B inhibitors are predicted to increase the
risk of a hypertensive crisis when given with
sympathomimetics, inotropic. Avoid.rAnecdotal
▶ Monoamine-oxidase B inhibitors are predicted to increase the
risk of a hypertensive crisis when given with
sympathomimetics, vasoconstrictor. Avoid.rAnecdotal
Monoclonal antibodies → see TABLE 15 p. 1378 (myelosuppression),
TABLE 12 p. 1378 (peripheral neuropathy), TABLE 9 p. 1377 (QT-interval
prolongation), TABLE 4 p. 1375 (antiplatelet effects)
infection (possibly life-threatening) when given with
▶ Tocilizumab is predicted to decrease the exposure to
alprazolam. Monitor and adjust dose.oTheoretical
▶ Blinatumomab is predicted to transiently increase the
exposure to aminophylline. Monitor and adjust dose.o
▶ Sarilumab potentially affects the exposure to aminophylline.
Monitor and adjust dose.oTheoretical
▶ Tocilizumab is predicted to decrease the exposure to
aminophylline. Monitor and adjust dose.oTheoretical
▶ Anakinra is predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
▶ Anthracyclines are predicted to increase the risk of
cardiotoxicity when given with monoclonal antibodies
(trastuzumab, trastuzumab emtansine)
Theoretical → Also see TABLE 15 p. 1378
▶ Antiarrhythmics (dronedarone) increase the risk of neutropenia
when given with brentuximab vedotin. Monitor and adjust
▶ Antiepileptics (carbamazepine) are predicted to decrease the
effects of brentuximab vedotin.rTheoretical
▶ Tocilizumab is predicted to decrease the exposure to
antiepileptics (fosphenytoin, phenytoin). Monitor and adjust
▶ Antifungals, azoles (itraconazole, ketoconazole) increase the risk
of neutropenia when given with brentuximab vedotin. Monitor
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to trastuzumab emtansine.
▶ Brentuximab vedotin increases the risk of pulmonary toxicity
when given with bleomycin. Avoid.rStudy → Also see
▶ Tocilizumab is predicted to decrease the exposure to calcium
channel blockers. Monitor and adjust dose.oTheoretical
▶ Blinatumomab is predicted to transiently increase the
Monitor and adjust dose.oTheoretical
▶ Tocilizumab is predicted to decrease the exposure to
ciclosporin. Monitor and adjust dose.oTheoretical
▶ Cobicistat is predicted to increase the exposure to trastuzumab
▶ Sarilumab potentially decreases the exposure to combined
hormonal contraceptives.rTheoretical
▶ Corticosteroids are predicted to increase the risk of
immunosuppression when given with dinutuximab. Avoid
except in life-threatening situations.rTheoretical
▶ Corticosteroids (betamethasone, deflazacort, dexamethasone,
hydrocortisone, methylprednisolone, prednisolone) are
predicted to decrease the efficacy of monoclonal antibodies
(atezolizumab, ipilimumab, nivolumab, pembrolizumab). Use
with caution or avoid.rTheoretical
▶ Tocilizumab is predicted to decrease the exposure to
corticosteroids (dexamethasone, methylprednisolone). Monitor
▶ Blinatumomab is predicted to transiently increase the
exposure to coumarins (warfarin). Monitor and adjust dose.
▶ Sarilumab potentially affects the exposure to coumarins
(warfarin). Monitor and adjust dose.rTheoretical
▶ Tocilizumab is predicted to decrease the exposure to coumarins
(warfarin). Monitor and adjust dose.oTheoretical
▶ Tocilizumab is predicted to decrease the exposure to diazepam.
Monitor and adjust dose.oTheoretical
▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are
predicted to increase the risk of neutropenia when given with
brentuximab vedotin. Monitor and adjust dose.rStudy
▶ HIV-protease inhibitors are predicted to increase the exposure
to trastuzumab emtansine. Avoid.rTheoretical
▶ Idelalisib is predicted to increase the exposure to trastuzumab
emtansine. Avoid.rTheoretical → Also see TABLE 15 p. 1378
▶ Immunoglobulins are predicted to alter the effects of
dinutuximab. Avoid.rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
monoclonal antibodies. Public Health England advises avoid
(refer to Green Book).rTheoretical
BNF 78 Monoamine-oxidase B inhibitors — Monoclonal antibodies 1497
Monoclonal antibodies (continued)
▶ Macrolides (clarithromycin) increase the risk of neutropenia
when given with brentuximab vedotin. Monitor and adjust
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to trastuzumab emtansine. Avoid.rTheoretical
▶ Tocilizumab is predicted to decrease the exposure to
midazolam. Monitor and adjust dose.oTheoretical
decreases the effects of brentuximab vedotin.
▶ Sarilumab potentially affects the exposure to sirolimus.
Monitor and adjust dose.oTheoretical
▶ Sarilumab is predicted to decrease the exposure to statins
(atorvastatin, simvastatin).oStudy
▶ Tocilizumab is predicted to decrease the exposure to statins
. Monitor and adjust dose.o ▶ Sarilumab potentially affects the exposure to tacrolimus.
Monitor and adjust dose.oTheoretical
▶ Blinatumomab is predicted to transiently increase the
Monitor and adjust dose.oTheoretical
▶ Tocilizumab is predicted to decrease the exposure to
theophylline. Monitor and adjust dose.oTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Clopidogrel is predicted to moderately increase the exposure
▶ Enzalutamide is predicted to decrease the exposure to
▶ Fibrates (gemfibrozil) are predicted to moderately increase the
exposure to montelukast.oStudy
▶ Leflunomide is predicted to increase the exposure to
▶ Mitotane is predicted to decrease the exposure to montelukast.
▶ Opicapone is predicted to increase the exposure to
▶ Rifampicin is predicted to decrease the exposure to
▶ Teriflunomide is predicted to increase the exposure to
Moxisylyte → see TABLE 8 p. 1376 (hypotension)
Moxonidine → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS
▶ Tricyclic antidepressants are predicted to decrease the effects
of moxonidine. Avoid.oTheoretical → Also see TABLE 8
Mycophenolate → see TABLE 15 p. 1378 (myelosuppression)
▶ Mycophenolate is predicted to increase the risk of
haematological toxicity when given with
▶ Mycophenolate is predicted to increase the risk of
haematological toxicity when given with
Theoretical → Also see TABLE 15 p. 1378
ganciclovir.o ▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
mycophenolate. Public Health England advises avoid (refer to
▶ Rifampicin decreases the concentration of mycophenolate.
Monitor and adjust dose.rStudy
▶ Mycophenolate is predicted to increase the risk of
haematological toxicity when given with
▶ Mycophenolate is predicted to increase the risk of
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