Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Key Features ++ Potential food or drug interactions can occur during therapeutic use Ingestion of tyramine-containing foods (eg, aged cheese and red wines) or any sympathomimetic drug may cause a severe hypertensive reaction Severe or fatal hyperthermia (serotonin syndrome) May occur when monoamine oxidase inhibitors (MAOIs) are given with serotonin-enhancing drugs (eg, meperidine, fluoxetine, paroxetine, fluvoxamine, venlafaxine, tryptophan, dextromethorphan, tramadol) Can also occur with moclobemide (an MAOI not available in the United States) and linezolid, which has MAOI properties Can also occur with selective serotonin reuptake inhibitors (SSRIs) in large doses or in combination with other SSRIs, even in the absence of an MAOI or meperidine ++ Clinical Findings ++ Acute overdose Ataxia, excitement, hypertension, and tachycardia Several hours later: hypotension, convulsions, and hyperthermia Food or drug hypertensive reaction Hypertension Tachycardia Headache Possible intracranial hemorrhage Serotonin syndrome Fever Agitation Delirium Diaphoresis Hyperreflexia Clonus (spontaneous, inducible, ocular) Hyperthermia (can be life-threatening) ++ Diagnosis ++ Serum drug levels are not available nor useful Generally not detected on urine toxicology screens ++ Treatment ++ Acute overdose Administer activated charcoal, 60–100 g orally or via gastric tube, mixed in aqueous slurry if ingestion is within 1 Treat hypotension with fluids and positioning, but avoid use of pressor agents if possible Treat severe hypertension with nitroprusside, phentolamine, or other rapid-acting vasodilators Serotonin syndrome Cyproheptadine, 4 mg orally (or by gastric tube) every hour for three or four doses, or chlorpromazine 25 mg intravenously, can be effective Observe patients for at least 24 h because hyperthermia may be delayed (see Hyperthermia) GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options