Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction

Contraindicated combinations (see section 4.3)
• Non-selective MAO inhibitors Paroxysmal hypertension, hyperthermia possibly fatal. Due to the long duration of action of MAOIs, this interaction is still possible 15 days after discontinuation of the MAOI.

Inadvisable combinations (see section 4.4)
• Dopaminergic ergot alkaloids (bromocriptine, cabergoline, lisuride, pergolide): Risk of vasoconstriction and/or hypertensive crisis.

•   Vasoconstrictor ergot alkaloids (dihydroergotamine, ergotamine, methylergometrine, methylsergide):
Risk of vasoconstriction and/or hypertensive crisis.

• Tricyclic antidepressants (e.g. imipramine):
Paroxysmal hypertension with possibility of arrhythmias (inhibition of adrenaline or noradrenaline entry in sympathetic fibers).

• Noradrenergic-serotoninergic antidepressants (minalcipram, venlafaxine): Paroxysmal hypertension with possibility of arrhythmias (inhibition of adrenaline or noradrenaline entry in sympathetic fibers).

• Selective type A MAO inhibitors
Risk of vasoconstriction and/or hypertensive crisis.

• Linezolid:
Risk of vasoconstriction and/or hypertensive crisis.

• Guanethidine and related products:
Substantial increase in blood pressure (hyperreactivity linked to the reduction in sympathetic tone and/or to the inhibition of adrenaline or noradrenaline entry in sympathetic fibers). If the combination cannot be avoided, use with caution lower doses of sympathomimetic agents.

• Cardiac glycosides, quinidine:
Increased risk of arrhythmias.

• Sibutramine:
Paroxysmal hypertension with possibility of arrhythmias (inhibition of adrenaline or noradrenaline entry in sympathetic fibers).
•   Halogenated volatile anaesthetics (desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane):
Risk of perioperative hypertensive crisis and arrhythmia.

Combinations requiring precautions for use:
• Oxytocic agents:
The effect of presso-active sympathomimetic amines is potentiated. Thus, some oxytocic agents may cause severe persistent hypertension and strokes can occur during post-partum period.