Carbamazepine/Monoamine Oxidase Inhibitors Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Very Serious. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Both of these medicines can increase the level of serotonin in your body.

What might happen:

High serotonin levels may cause changes in body temperature, blood pressure and behavior, leading to a medical condition called Serotonin Syndrome. Serotonin Syndrome may be life threatening.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together.If you experience muscle twitching, tremors, shivering or stiffness, fever, heavy sweating, heart palpitations, restlessness, confusion, agitation, trouble with coordination, or severe diarrhea contact your doctor right away.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Ketter TA, Post RM, Parekh PI, Worthington K. Addition of monoamine oxidase inhibitors to carbamazepine: preliminary evidence of safety and antidepressant efficacy in treatment-resistant depression. J Clin Psychiatry 1995 Oct;56(10):471-5.
  • 2.Tegretol (carbamazepine) US prescribing information. Novartis Pharmaceuticals Corporation September, 2023.
  • 3.Parnate (tranylcypromine sulfate) US prescribing information. GlaxoSmithKline January 4, 2018.
  • 4.Emsam (selegline) US prescribing information. Somerset July, 2017.
  • 5.Barklage NE, Jefferson JW, Margolis D. Do monoamine oxidase inhibitors alter carbamazepine blood levels?. J Clin Psychiatry 1992 Jul;53(7):258.
  • 6.Lydiard RB, White D, Harvey B, Taylor A. Lack of pharmacokinetic interaction between tranylcypromine and carbamazepine. J Clin Psychopharmacol 1987 Oct;7(5):360.
  • 7.Joffe RT, Post RM, Uhde TW. Lack of pharmacokinetic interaction of carbamazepine with tranylcypromine. Arch Gen Psychiatry 1985 Jul; 42(7):738.
  • 8.Anonymous. From the Food and Drug Administration. JAMA 2000 Apr 5; 283(13):1679.
  • 9.Ramsay RR, Dunford C, Gillman PK. Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction. Br J Pharmacol 2007 Nov;152(6):946-51.
  • 10.Peter C, Hongwan D, Kupfer A, Lauterburg BH. Pharmacokinetics and organ distribution of intravenous and oral methylene blue. Eur J Clin Pharmacol 2000 Jun;56(3):247-50.
  • 11.Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005 Mar 17; 352(11):1112-20.
  • 12.Surmaitis RM, Nappe TM, Cook MD. Serotonin syndrome associated with therapeutic metaxalone in a patient with cirrhosis. Am J Emerg Med 2016 Feb;34(2):346.e5-6.
  • 13.Skelaxin (metaxalone) US prescribing information. Pfizer Laboratories Div Pfizer Inc. January, 2024.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.