MAO inhibitors should not be used with -

Ans. is 'b' i.e., Pethidine o Nonselective MAO inhibitors interact with many food constituents and drugs : 1-Cheese reaction o Ceain varieties of cheese, beer, wines, picked meat and fish, yeast extract contain large quantities of tyramine, dopa. o In MAO inhibited patients these indirectly acting sympathomimetic amines escape degradation in the intestinal wall and liver --> reaching into systemic circulation they displace large amount of NA from adrenergic nerve endings Hypeensive crisis, cerebrovascular accidents. This can be treated by Lv. injection of a rapidly acting a-blocker eg, phentolamine. Prazosin and chlorpromazine are alternative. 2. Reserpine, guanethidine, tricyclic antidepressant. o Rise in BP and body temprature can occur when these drugs are given with MAO inhibits --> due to their initial NA releasing or uptake inhibiting action. 3. Levodopa Excitement and hypeension occur due to increase V" of DA that is produced from levodopa. 4. Antiparkinsonism anticholinergic Symptoms of atropine poisoning occur. 5. Brabiturates, opoids, alcohol, antihistamininc o Action of these drugs is intensified and prolonged. 6. Pethidine o High fever, sweating, excitation, delirium, convulsion and respiratory depression occur. o This is due to excess production of norpethidine (normally it is minor metabolites). o MAO inhibitors inhibit hydrolysis but not detmethylation more norpethidine is produced. 7. SSRIs o MAO inhibitors produce serotonine syndrome when given with SSRIs.