Drug interactions
Methadone + Tranylcypromine
Severity: Contraindicated
Methadone and Tranylcypromine: contraindicated 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
Methadone has serotonergic activity, and with a non-selective MAO inhibitor such as tranylcypromine there is a risk of serotonin syndrome and severe hypertensive or hypotensive reactions, hyperthermia and CNS depression. Fatal reactions have been described with opioid and MAOI combinations.
What this interaction means in plain words
Methadone and Tranylcypromine are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Methadone belongs to Musculoskeletal; Tranylcypromine belongs to Central Nervous System.
Why it happens
MAO inhibition combined with serotonin reuptake inhibition by methadone, leading to serotonin excess, with additive CNS depression.
What to do
Do not combine; allow at least 14 days after stopping tranylcypromine before starting methadone. Use an opioid with no serotonergic activity if analgesia or opioid maintenance is needed.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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References
Other interactions of Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Other interactions of Tranylcypromine
- 5-HTP + Tranylcypromine Contraindicated
- Amitriptyline + Tranylcypromine Contraindicated
- Amoxapine + Tranylcypromine Contraindicated
- Atomoxetine + Tranylcypromine Contraindicated
- Benzphetamine + Tranylcypromine Contraindicated
- Brimonidine + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Methadone with Tranylcypromine?
MediHelp rates the interaction as contraindicated. Methadone and Tranylcypromine are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Methadone has serotonergic activity, and with a non-selective MAO inhibitor such as tranylcypromine there is a risk of serotonin syndrome and severe hypertensive or hypotensive reactions, hyperthermia and CNS depression. Fatal reactions have been described with opioid and MAOI combinations.
How serious is the interaction between Methadone and Tranylcypromine?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not combine; allow at least 14 days after stopping tranylcypromine before starting methadone. Use an opioid with no serotonergic activity if analgesia or opioid maintenance is needed.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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