DANGEROUS MONOAMINE-OXIDASE INHIBITOR INTERACTIONS ARE STILL OCCURRING IN THE 1990S

The clinical course is described of a 28-year-old woman who was severe ly ill following ingestion of a Do-Do tablet (which consists of ephedr ine, caffeine and theophylline), 24 h after discontinuing phenelzine t reatment. Signs and symptoms were delayed for 8 h after which she deve loped encephalopathy, neuromuscular irritability, hypotension, sinus t achycardia, rhabdomyolysis and hyperthermia. Her illness was complicat ed by pneumonia and adult respiratory distress syndrome (ARDS). The ma nagement of monoamine oxidase inhibitor (MAOI) toxicity, which can ari se from interactions and overdoses, is discussed. It should be remembe red that, despite the increase in use of alternative and safer antidep ressants, MAOI interactions still occur and unless they are managed ap propriately, are potentially fatal. Patients need to be warned that re strictions apply for up to 2 weeks after stopping the medication, and doctors need to be aware that serious interactions can occur in this t ime period.