Which pairing is correct regarding nortriptyline and MAOI?

Which pairing is correct regarding nortriptyline and MAOI?

• A. Nortriptyline should not be used with MAOI
• B. Nortriptyline is safe with MAOI
• C. Nortriptyline has no interactions with MAOI
• D. Nortriptyline requires a 1-year washout with MAOI

Answer: (A)

The main concept is that combining a monoamine oxidase inhibitor (MAOI) with a tricyclic antidepressant (TCA) like nortriptyline can unleash dangerous levels of brain monoamines. MAOIs block the enzyme that breaks down norepinephrine, serotonin, and dopamine, while TCAs like nortriptyline prevent the reuptake of norepinephrine and serotonin, increasing their synaptic levels even more. Together, they can cause a dangerous hypertensive crisis, rapid heart rate, hyperthermia, and even serotonin syndrome. Because of these severe risks, using nortriptyline with an MAOI is contraindicated; they should not be used together. If a switch is necessary, a washout period is required, but it is not a year. In practice, a careful, typically multi-day to a couple-week washout is advised depending on the specific MAOI and patient factors, to allow the MAOI effects to diminish before starting the TCA, and vice versa. This ensures that the risk of dangerous monoamine surge is minimized.

The main concept is that combining a monoamine oxidase inhibitor (MAOI) with a tricyclic antidepressant (TCA) like nortriptyline can unleash dangerous levels of brain monoamines. MAOIs block the enzyme that breaks down norepinephrine, serotonin, and dopamine, while TCAs like nortriptyline prevent the reuptake of norepinephrine and serotonin, increasing their synaptic levels even more. Together, they can cause a dangerous hypertensive crisis, rapid heart rate, hyperthermia, and even serotonin syndrome. Because of these severe risks, using nortriptyline with an MAOI is contraindicated; they should not be used together.

If a switch is necessary, a washout period is required, but it is not a year. In practice, a careful, typically multi-day to a couple-week washout is advised depending on the specific MAOI and patient factors, to allow the MAOI effects to diminish before starting the TCA, and vice versa. This ensures that the risk of dangerous monoamine surge is minimized.