Drug interactions
Isocarboxazid + Levorphanol
Severity: Major
Isocarboxazid and Levorphanol: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining a nonselective MAO inhibitor with the opioid levorphanol can provoke unpredictable and severe reactions. These include serotonin toxicity (agitation, hyperthermia, clonus) or opioid overdose effects such as profound sedation, respiratory depression and hypotension. Fatal outcomes have been reported with MAOI-opioid combinations.
What this interaction means in plain words
Isocarboxazid and Levorphanol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Probable additive serotonergic activity and impaired opioid metabolism or enhanced CNS depression with MAO inhibition; the exact mechanism for levorphanol is not firmly established.
What to do
Avoid levorphanol during isocarboxazid therapy and for 14 days after stopping the MAOI; choose a non-serotonergic analgesic alternative. If an opioid is unavoidable, use small test doses with close monitoring of blood pressure, temperature, mental status and respiration.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Isocarboxazid
- 5-HTP + Isocarboxazid Contraindicated
- Amitriptyline + Isocarboxazid Contraindicated
- Amobarbital + Isocarboxazid Contraindicated
- Amoxapine + Isocarboxazid Contraindicated
- Apraclonidine + Isocarboxazid Contraindicated
- Atomoxetine + Isocarboxazid Contraindicated
Frequently asked questions
Can I take Isocarboxazid with Levorphanol?
MediHelp rates the interaction as major. Isocarboxazid and Levorphanol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining a nonselective MAO inhibitor with the opioid levorphanol can provoke unpredictable and severe reactions. These include serotonin toxicity (agitation, hyperthermia, clonus) or opioid overdose effects such as profound sedation, respiratory depression and hypotension. Fatal outcomes have been reported with MAOI-opioid combinations.
How serious is the interaction between Isocarboxazid and Levorphanol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid levorphanol during isocarboxazid therapy and for 14 days after stopping the MAOI; choose a non-serotonergic analgesic alternative. If an opioid is unavoidable, use small test doses with close monitoring of blood pressure, temperature, mental status and respiration.
What other medicines interact with Isocarboxazid?
MediHelp also lists interactions of Isocarboxazid with, for example, 5-HTP, Amitriptyline, Amobarbital. The full list is on the Isocarboxazid page.
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