The Use of Pethidine and Morphine in the Presence of Monoamine Oxidase Inhibitors

Evans-Prosser, C. D. G.

doi:10.1093/bja/40.4.279

Cited by 28 publications

(7 citation statements)

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“…83 What is the evidence linking MAOI to serotonergic crises? Serotonergic reactions to meperidine have been described for all MAOI, 80,84,85 including moclobemide 81,82 and selegiline. 83 Meperidine blocks neuronal serotonin reuptake, resulting in serotonergic overactivity, agitation, hyper/hypotension, convulsions, hyperthermia, and coma.…”

Section: Is Postoperative Fever An Indication For Hospital Admission?mentioning

confidence: 99%

“…82 However, serotonin concentration must reach a critical level, as evidenced by one patient who reacted to meperidine only after increasing her phenelzine dose 80 and by a randomized, controlled trial, in which 15 patients on MAOI given meperidine and morphine all responded normally. 85 Cocaine also reduces serotonin inactivation and blocks monoamine reuptake. 80,86 A delayed excitatory reaction occurred in a patient on phenelzine 70 min after topical laryngeal cocaine.…”

Section: Is Postoperative Fever An Indication For Hospital Admission?mentioning

confidence: 99%

“…80 Three cases of excessive barbiturate/opioid effects were reported from 1960 to 1970. 80,84 Since then, numerous reports have described uneventful anesthetics using barbiturates and various opioids: remifentanil, 89 alfentanil, 89,90 sufentanil, 91 fentanyl, 80,81 hydromorphone 91 and morphine 80,81,81,85,89 for patients continuing to take MAOI. Other agents including propofol, 90,92 ketamine, 93 midazolam, 92 ketorolac, 92 vecuronium, 92 and atracurium 92 have also been used safely.…”

Section: Do Maoi Interact With Anesthetic Drugs?mentioning

confidence: 99%

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Patient selection in ambulatory anesthesia — An evidence-based review: part II

et al. 2004

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P Pu ur rp po os se e: : This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors.S So ou ur rc ce e: : Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirectacting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided.C Co on nc cl lu us si io on n: : Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management. Objectif : C'est la seconde revue qui évalue la prise en charge de patients, dont les pathologies médicales ont été ciblées, qui doivent subir une anesthésie en chirurgie ambulatoire. Les situations choisies comprennent : le diabète, l'obésité morbide, l'enfant né prématurément, l'enfant atteint d'infection des voies respiratoires supérieures, l'hyperthermie maligne et l'usage d'inhibiteurs de la monoamine-oxydase. Source : Les stratégies de recherche dans Medline et le cadre de l'é-valuation de la preuve clinique sont présentés dans la partie I. Constatations principales : Le diabète n'a pas été relié à des événements indésirables à la suite d'une opération ambulatoire. Le patient très obèse est plus à risque de complications respiratoires péri-opératoires mineures, ce qui n'augmente pas les admissions hospitalières imprévues. L'enfant prématuré est admis en chirurgie ambulatoire si l'âge post-conception est > 60 semaines et si l'hématocrite est > 30 %. L'enfant qui a une infection récente des voies respiratoires supérieures

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Section: Is Postoperative Fever An Indication For Hospital Admission?mentioning

confidence: 99%

Section: Is Postoperative Fever An Indication For Hospital Admission?mentioning

confidence: 99%

Section: Do Maoi Interact With Anesthetic Drugs?mentioning

confidence: 99%

See 1 more Smart Citation

Patient selection in ambulatory anesthesia — An evidence-based review: part II

et al. 2004

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“…In 2 independent studies performed by el-Ganzouri et al as well as by Evans-Prosser, patients who were receiving stable long term MAOI therapy (minimum of 3 weeks) were treated with morphine doses and their responses were monitored. 21,22 In each of these studies investigators monitored blood pressure, pulse, respiration rate, and mental status of all subjects receiving this combination and reported no adverse effects when morphine was administered. 21,22 Additionally, in a case series published by Rastogi et al in 2011, authors describe a patient who was treated with mirtazapine and citalopram who developed serotonin syndrome secondary to increases in his fentanyl patch doses.…”

Section: Human Datamentioning

confidence: 99%

Phenelzine and Morphine Drug-Drug Interaction? A Literature Review

Beechinor

Tyson

Roth

2020

Journal of Pharmacy Practice

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The objectives of this manuscript are to describe a case report of a patient whose phenelzine maintenance therapy was discontinued due to concern for a phenelzine-morphine drug interaction, to review the available literature regarding the potential for this drug-drug interaction, and provide recommendations for this clinical scenario. A PubMed/MEDLINE literature search was conducted and all publications determined to be relevant to this case report were included. Literature describing in vitro data, case reports/human studies, and review articles concerning the interaction between morphine and monoamine oxidase inhibitors (MAOIs) were included. A total of 14 publications pertinent to the potential phenelzine-morphine interaction were included in this review including 5 in vitro studies, 4 human studies, and 6 review articles detailing the drug interaction profile between opioids and antidepressants. Of these publications, only a single case report of a potential drug interaction between morphine and phenelzine was identified. The literature suggesting a drug interaction between morphine and phenelzine is limited. The combination of phenelzine and morphine, with close monitoring for signs and symptoms of serotonin syndrome, is reasonable for patients with appropriate indications for both agents.

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“…Pethidine (Evans-Prosser 1968;Vigran 1964) and possibly dextromethorphan (Bazire 1987) are the only opioid analgesics to have elicited the excitatory response. Both these opioids block the neuronal uptake of serotonin.…”

Section: Maoismentioning

confidence: 99%

Drug Interactions of Clinical Significance with Opioid Analgesics

Maurer

Bartkowski

1993

Drug Safety

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Opioid analgesics and other drugs interact through multiple mechanisms, resulting in pharmacological effects that depend upon the pharmacodynamic action studied, the interacting agents and the route of administration. Many interactions result from induction or inhibition of the hepatic cytochrome P450 mono-oxygenase system. The elimination of opioids is largely dependent on hepatic metabolism, and drug interactions involving this mechanism can therefore be clinically significant. Antibiotics are often used concomitantly with opioids in patients undergoing medical or surgical procedures; the best documented metabolic interactions are with erythromycin and rifampicin (rifampin). Erythromycin increases and rifampicin decreases the effects of opioids. Cimetidine may increase the effects of opioids by increasing their duration of action; there have been no documented cases of interactions with ranitidine. Carbamazepine, phenytoin and the barbiturates can enhance the metabolism of opioids that rely on hepatic metabolism. Other pharmacokinetic interactions include those with benzodiazepines, tricyclic antidepressants, phenothiazines and metoclopramide. Interactions involving pharmacodynamic mechanisms are more common than pharmacokinetic ones. Such interactions are manifested clinically as as a summation (additive or synergistic) of similar or opposing pharmacological effects on the same body system. Idiosyncratic interactions also occur, the mechanisms of which have not been proven to be solely modulated by either pharmacokinetic or pharmacodynamic means. The knowledge of particular opioid-drug interactions, and the causative pharmacokinetic, pharmacodynamic, and idiosyncratic mechanisms, allows for the safer administration of opioid analgesics.

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The Use of Pethidine and Morphine in the Presence of Monoamine Oxidase Inhibitors

Cited by 28 publications

References 0 publications

Patient selection in ambulatory anesthesia — An evidence-based review: part II

Patient selection in ambulatory anesthesia — An evidence-based review: part II

Phenelzine and Morphine Drug-Drug Interaction? A Literature Review

Drug Interactions of Clinical Significance with Opioid Analgesics

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