Drug interactions
Isocarboxazid + Nalbuphine
Severity: Major
Isocarboxazid and Nalbuphine: major interaction.
Last updated Sources: US FDA label
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 an MAO inhibitor with an opioid analgesic can cause unpredictable reactions, including profound hypotension, hyperthermia, marked sedation, respiratory depression and occasionally death. Nalbuphine has weak serotonergic activity, so excitatory serotonin-toxicity-type reactions are less likely than with other opioids but cannot be excluded.
What this interaction means in plain words
Isocarboxazid and Nalbuphine 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.
Isocarboxazid belongs to Central Nervous System; Nalbuphine belongs to Musculoskeletal.
Why it happens
Irreversible MAO inhibition may potentiate opioid CNS and cardiovascular depression and may contribute to serotonergic toxicity; the exact mechanism is not fully established.
What to do
Avoid nalbuphine during and for 14 days after stopping isocarboxazid; choose a non-opioid or alternative analgesic. If unavoidable, use a reduced starting dose with careful titration and monitor 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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Isocarboxazid and Nalbuphine, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
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 Nalbuphine?
MediHelp rates the interaction as major. Isocarboxazid and Nalbuphine 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 an MAO inhibitor with an opioid analgesic can cause unpredictable reactions, including profound hypotension, hyperthermia, marked sedation, respiratory depression and occasionally death. Nalbuphine has weak serotonergic activity, so excitatory serotonin-toxicity-type reactions are less likely than with other opioids but cannot be excluded.
How serious is the interaction between Isocarboxazid and Nalbuphine?
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 nalbuphine during and for 14 days after stopping isocarboxazid; choose a non-opioid or alternative analgesic. If unavoidable, use a reduced starting dose with careful titration and monitor blood pressure, temperature, mental status and respiration.
What other medicines interact with Nalbuphine?
MediHelp also lists interactions of Nalbuphine with, for example, Alvimopan, Olanzapine / samidorphan, Alprazolam. The full list is on the Nalbuphine page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
