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Some products that may interact with this drug include: apraclonidine, atomoxetine, bethanidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, dextromethorphan, certain antihistamines (azatadine, carbetapentane, chlorpheniramine), herbal products (e.g., ephedra/ma huang, ginseng, tryptophan), indoramin, levodopa, maprotiline, methyldopa, certain narcotic pain relievers (fentanyl, meperidine, methadone, tapentadol), papaverine, drugs for Parkinson's disease (such as entacapone, tolcapone), rifampin, sympathomimetics (e.g., ephedrine, methylphenidate), tetrabenazine, tricyclic antidepressants (such as amitriptyline, doxepin), other drugs which depress the bone marrow (e.g., cancer chemotherapy).
Taking other MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking other MAO inhibitors (isocarboxazid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including mirtazapine, trazodone, SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tramadol, "triptans" used to treat migraine headaches (such as eletriptan, sumatriptan), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Check the labels on all your medicines (e.g., cough-and-cold products, diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. Avoid these products while using this medication. Ask your pharmacist for additional information.
Limit your tyramine intake while using this medication and for 2 days after stopping treatment. Also avoid foods or drinks with high tyramine content during use because the combination may cause a serious rise in your blood pressure.
Foods high in tyramine include those that may change as a result of aging, fermentation, pickling, or smoking. The tyramine content of any protein-rich food (meats, fish and dairy products) may increase if stored for long periods or improperly refrigerated. Some foods high in tyramine include aged cheeses (0 to 15 milligrams per ounce); fermented or air-dried meats (0.1 to 8 milligrams per ounce); sauerkraut (8 milligrams per 8 ounces); soy sauce (5 milligrams per 1 teaspoon); tap beers (4 milligrams per 12 ounces); red wines (0 to 6 milligrams per 8 ounces). Total intake of tyramine should be less than 100 milligrams per meal.
Tell your doctor or pharmacist immediately if you notice symptoms of high blood pressure such as fast or pounding heartbeat, vomiting, sweating or headache, chest pain, sudden vision changes, weakness on one side of the body or slurred speech.
Contact your healthcare professional (e.g., doctor, pharmacist or dietician) for more information, including recommendations for your diet.
Although most antibiotics probably do not affect hormonal birth control such as pills, patch, or ring, some antibiotics may decrease their effectiveness. This could cause pregnancy. Examples include rifamycins such as rifampin or rifabutin. Be sure to ask your doctor or pharmacist if you should use additional reliable birth control methods while using this antibiotic.
OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Your doctor may order eye tests if you are taking this medication for more than 3 months or if you have any vision changes or problems. Keep all medical appointments.
Laboratory and/or medical tests (e.g., CBC, platelets) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: For the best possible benefit, it is important to receive each scheduled dose of this medication as directed. If you miss a dose, contact your doctor or pharmacist immediately to establish a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised November 2013. Copyright(c) 2013 First Databank, Inc.
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