Safety concerns with MAOIs

Consider these issues and discuss them with your doctor before taking an MAOI:

• Antidepressants and pregnancy. Some antidepressants may harm your child if you take them during pregnancy or while breast-feeding. If you're considering getting pregnant, talk to your doctor or mental health provider about the possible dangers of certain antidepressants. Don't stop taking your medication without contacting your doctor first.
• Food and beverage interactions. MAOIs can cause dangerous interactions with certain foods and beverages. You'll need to avoid foods containing high levels of tyramine ? an amino acid that regulates blood pressure ? such as aged cheeses, sauerkraut, cured meats, draft beer and fermented soy products (for example, soy sauce, miso and tofu). The interaction of tyramine with MAOIs can cause dangerously high blood pressure. Ask your doctor for a complete list of dietary restrictions, including alcohol restrictions.
• Drug interactions. MAOIs can cause serious reactions when you take them with certain medications, such as other antidepressants, certain pain drugs, certain cold and allergy medications, and some herbal supplements. Always check with your doctor or pharmacist before taking any other prescription or over-the-counter medication, herbs or other supplements while you're taking an MAOI.
• Serotonin syndrome. Rarely, an MAOI can cause dangerously high levels of serotonin, known as serotonin syndrome. It most often occurs when two medications that raise serotonin are combined. These include, for example, other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort.
  • Signs and symptoms of serotonin syndrome include anxiety, agitation, high fever, sweating, confusion, tremors, restlessness, lack of coordination, major changes in blood pressure, and rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.