▶ 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

p. 1378

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of neuroleptic malignant

syndrome when given with phenothiazines.rTheoretical →

Also see TABLE 8 p. 1376

▶ 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

the MAOI.rTheoretical

▶ 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

see TABLE 13 p. 1378

▶ 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

see TABLE 13 p. 1378

▶ 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,

irreversible

r

. Avoid and for 14 days after stopping the MAOI.

Theoretical

▶ Tolcapone is predicted to increase the effects of monoamineoxidase A and B inhibitors, irreversible. Avoid.rTheoretical

▶ 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

.r

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the exposure to

Theoretical → Also see TABLE 13 p. 1378

zolmitriptan.r

Monoamine-oxidase B inhibitors → see TABLE 6 p. 1376

(bradycardia), TABLE 8 p. 1376 (hypotension), TABLE 13 p. 1378 (serotonin

syndrome)

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

TABLE 13 p. 1378

▶ Safinamide is predicted to increase the risk of severe

Theoretical

hypertension when given with

→ Also see TABLE 13 p. 1378

amfetamines.r

▶ 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

o

bupropion. Avoid.

Theoretical → Also see TABLE 13 p. 1378

▶ Combined hormonal contraceptives slightly increase the

exposure to rasagiline.oStudy

▶ Combined hormonal contraceptives increase the exposure to

selegiline. Avoid.rStudy

1496 Monoamine-oxidase A and B inhibitors — Monoamine-oxidase B inhibitors BNF 78

Interactions | Appendix 1

A1

▶ 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

p. 1376

▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are

predicted to increase the risk of side-effects when given with

linezolid

r

. 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

▶ Mexiletine

o

slightly increases the exposure to rasagiline.

Study

▶ Moclobemide is predicted to increase the effects of monoamineoxidase B inhibitors

Theoretical → Also see

(rasagiline, selegiline)

TABLE 13 p. 1378

. Avoid.r

▶ 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,

irreversible

r

. 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

p. 1378

▶ Quinolones (ciprofloxacin) slightly increase the exposure to

rasagiline.oStudy

▶ 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)

adalimumab . alemtuzumab . atezolizumab . avelumab . basiliximab . belimumab . bevacizumab . blinatumomab . brentuximab vedotin . brodalumab . canakinumab . certolizumab pegol . cetuximab . daratumumab . dinutuximab . dupilumab . durvalumab . eculizumab . elotuzumab . golimumab . guselkumab .infliximab . inotuzumab ozogamicin .ipilimumab .ixekizumab . natalizumab . necitumumab . nivolumab . obinutuzumab . ocrelizumab . olaratumab . panitumumab . pembrolizumab . pertuzumab . ramucirumab .rituximab . sarilumab . secukinumab . siltuximab . tildrakizumab .tocilizumab .trastuzumab .trastuzumab emtansine . ustekinumab .vedolizumab. ▶ Abatacept is predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

golimumab. Avoid.rTheoretical

▶ Tocilizumab is predicted to decrease the exposure to

alprazolam. Monitor and adjust dose.oTheoretical

▶ Blinatumomab is predicted to transiently increase the

Theoretical

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

golimumab. Avoid.rTheoretical

▶ Anthracyclines are predicted to increase the risk of

cardiotoxicity when given with monoclonal antibodies

(trastuzumab, trastuzumab emtansine)

Theoretical → Also see TABLE 15 p. 1378

. Avoid.r

▶ Antiarrhythmics (dronedarone) increase the risk of neutropenia

when given with brentuximab vedotin. Monitor and adjust

dose.rTheoretical

▶ 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

dose.oTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole) increase the risk

of neutropenia when given with brentuximab vedotin. Monitor

and adjust dose.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to trastuzumab emtansine.

Avoid.rTheoretical

▶ Brentuximab vedotin increases the risk of pulmonary toxicity

when given with bleomycin. Avoid.rStudy → Also see

TABLE 15 p. 1378

▶ Tocilizumab is predicted to decrease the exposure to calcium

channel blockers. Monitor and adjust dose.oTheoretical

▶ Blinatumomab is predicted to transiently increase the

Theoretical

exposure to ciclosporin. Monitor and adjust dose.o ▶ Sarilumab potentially affects the exposure to ciclosporin.

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

emtansine. Avoid.rTheoretical

▶ 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

and adjust dose.oTheoretical

▶ Blinatumomab is predicted to transiently increase the

o

exposure to coumarins (warfarin). Monitor and adjust dose.

Theoretical

▶ 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

Interactions | Appendix 1

A1

Monoclonal antibodies (continued)

▶ Macrolides (clarithromycin) increase the risk of neutropenia

when given with brentuximab vedotin. Monitor and adjust

dose.rTheoretical

▶ 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

▶ Rifampicin

r

decreases the effects of brentuximab vedotin.

Study

▶ 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

(atorvastatin, simvastatin)

Study

. Monitor and adjust dose.o ▶ Sarilumab potentially affects the exposure to tacrolimus.

Monitor and adjust dose.oTheoretical

▶ Blinatumomab is predicted to transiently increase the

Theoretical

exposure to theophylline. Monitor and adjust dose.o ▶ Sarilumab potentially affects the exposure to theophylline.

Monitor and adjust dose.oTheoretical

▶ Tocilizumab is predicted to decrease the exposure to

theophylline. Monitor and adjust dose.oTheoretical

Montelukast

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to montelukast.nStudy

▶ Clopidogrel is predicted to moderately increase the exposure

to montelukast.oStudy

▶ Enzalutamide is predicted to decrease the exposure to

montelukast.nStudy

▶ Fibrates (gemfibrozil) are predicted to moderately increase the

exposure to montelukast.oStudy

▶ Leflunomide is predicted to increase the exposure to

montelukast.oTheoretical

▶ Mitotane is predicted to decrease the exposure to montelukast.

nStudy

▶ Opicapone is predicted to increase the exposure to

montelukast. Avoid.oStudy

▶ Rifampicin is predicted to decrease the exposure to

montelukast.nStudy

▶ Teriflunomide is predicted to increase the exposure to

montelukast.oTheoretical

Morphine → see opioids

Moxifloxacin → see quinolones

Moxisylyte → see TABLE 8 p. 1376 (hypotension)

Moxonidine → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS

depressant effects)

▶ Tricyclic antidepressants are predicted to decrease the effects

of moxonidine. Avoid.oTheoretical → Also see TABLE 8

p. 1376

Mycophenolate → see TABLE 15 p. 1378 (myelosuppression)

▶ Mycophenolate is predicted to increase the risk of

haematological toxicity when given with

Theoretical

aciclovir.o ▶ Antacids

Study

decrease the exposure to mycophenolate.o ▶ Antifungals, azoles (isavuconazole) increase the exposure to

mycophenolate.oStudy

▶ 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

Green Book).rTheoretical

▶ Rifampicin decreases the concentration of mycophenolate.

Monitor and adjust dose.rStudy

▶ Mycophenolate is predicted to increase the risk of

haematological toxicity when given with

Theoretical

valaciclovir.o

▶ Mycophenolate is predicted to increase the risk of

haematological toxicity when given with

o

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