Skip to main content
PMC home page
British Medical Journal logoLink to British Medical Journal
. 1973 Feb 10;1(5849):311–315. doi: 10.1136/bmj.1.5849.311

Interactions between Sympathomimetic Amines and Antidepressant Agents in Man

A J Boakes, D R Laurence, P C Teoh, F S K Barar, L T Benedikter, B N C Prichard
PMCID: PMC1588195  PMID: 4685619

Abstract

Intravenous infusions of phenylephrine, noradrenaline, adrenaline, and isoprenaline were given to healthy human volunteers after five to seven days on phenelzine, tranylcypromine, or imipramine, and cardiovascular responses were compared with those observed under control conditions. With monoamine oxidase inhibitors there was a 2-2½ fold potentiation of the pressor effect of phenylephrine, but no clinically significant potentiation of cardiovascular effects of noradrenaline, adrenaline, or isoprenaline. With imipramine there was potentiation of the pressor effects of phenylephrine (2-3 fold), noradrenaline (4-8 fold), and adrenaline (2-4 fold); there were dysrhythmias during adrenaline infusions, but no noticeable or consistent changes in response to isoprenaline.

Noradrenaline and adrenaline in amounts contained in local anaesthetics used in dentistry are not likely to be significantly potentiated in otherwise healthy patients receiving monoamine oxidase inhibitors. Hazardous potentiation of their cardiovascular effects might occur in patients receiving tricyclic antidepressants.

Our observations do not indicate that the hazards associated with isoprenaline inhalation by bronchial asthmatics would be increased by coincident therapy with a monoamine oxidase inhibitor or tricyclic antidepressant.

Full text

PDF
314

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AXELROD J. Metabolism of epinephrine and other sympathomimetic amines. Physiol Rev. 1959 Oct;39:751–776. doi: 10.1152/physrev.1959.39.4.751. [DOI] [PubMed] [Google Scholar]
  2. Aellig W. H., O'Neil R., Laurence D. R., Verrill P. J. Cardiac effects of adrenaline and felypressin as vasoconstrictors in local anaesthesia for oral surgery under diazepam sedation. Br J Anaesth. 1970 Feb;42(2):174–176. doi: 10.1093/bja/42.2.174. [DOI] [PubMed] [Google Scholar]
  3. Alexanderson B., Evans D. A., Sjöqvist F. Steady-state plasma levels of nortriptyline in twins: influence of genetic factors and drug therapy. Br Med J. 1969 Dec 27;4(5686):764–768. doi: 10.1136/bmj.4.5686.764. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boakes A. J., Laurence D. R., Lovel K. W., O'Neil R., Verrill P. J. Adverse reactions to local anaesthetic-vasoconstrictor preparations. A study of the cardiovascular responses to Xylestesin and Hostacain-with-Noradrenaline. Br Dent J. 1972 Aug 15;133(4):137–140. doi: 10.1038/sj.bdj.4802884. [DOI] [PubMed] [Google Scholar]
  5. Clark B., Thompson J. W., Widdrington G. Analysis of the inhibition of pethidine N-demethylation by monoamine oxidase inhibitors and some other drugs with special reference to drug interactions in man. Br J Pharmacol. 1972 Jan;44(1):89–99. doi: 10.1111/j.1476-5381.1972.tb07241.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Costa E., Boullin D. J., Hammer W., Vogel W., Brodie B. B. Interactions of drugs with adrenergic neurons. Pharmacol Rev. 1966 Mar;18(1):577–597. [PubMed] [Google Scholar]
  7. Coull D. C., Crooks J., Dingwall-Fordyce I., Scott A. M., Wier R. D. Amitriptyline and cardiac disease. Risk of sudden death identified by monitoring system. Lancet. 1970 Sep 19;2(7673):590–591. doi: 10.1016/s0140-6736(70)90169-8. [DOI] [PubMed] [Google Scholar]
  8. Cuthbert M. F., Greenberg M. P., Morley S. W. Cough and cold remedies: a potential danger to patients on monoamine oxidase inhibitors. Br Med J. 1969 Feb 15;1(5641):404–406. doi: 10.1136/bmj.1.5641.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cuthbert M. F., Vere D. W. Potentiation of the cardiovascular effects of some catecholamines by a monoamine oxidase inhibitor. Br J Pharmacol. 1971 Oct;43(2):471P–472P. [PMC free article] [PubMed] [Google Scholar]
  10. Drug interactions. Drug Ther Bull. 1967 Nov 10;5(23):89–92. [PubMed] [Google Scholar]
  11. EBLE J. N. A STUDY OF THE MECHANISMS OF THE MODIFYING ACTIONS OF COCAINE, EPHEDRINE AND IMIPRAMINE ON THE CARDIOVASCULAR RESPONSE TO NOREPINEPHRINE AND EPINEPHRINE. J Pharmacol Exp Ther. 1964 Apr;144:76–82. [PubMed] [Google Scholar]
  12. Eble J. N., Gowdey C. W., Vane J. R. Blood concentration of noradrenaline in the dog after intravenous administration and the effects of desipramine. Nature. 1971 May 21;231(5299):181–182. doi: 10.1038/231181a0. [DOI] [PubMed] [Google Scholar]
  13. Elis J., Laurence D. R., Mattie H., Prichard B. N. Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure. Br Med J. 1967 Apr 8;2(5544):75–78. doi: 10.1136/bmj.2.5544.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Fischbach R., Harrer G., Harrer H. Verstärkung der Noradrenalin-Wirkung durch Psychopharmaka beim Menschen. Arzneimittelforschung. 1966 Feb;16(2):263–265. [PubMed] [Google Scholar]
  15. HARRER G., HARRER H., FISCHBACH R. DIE BEEINFLUSSUNG PHARMAKODYNAMISCHER KREISLAUFBELASTUNGEN DURCH ANTIDEPRESSIVA. Wien Med Wochenschr. 1964 Oct 17;114:717–726. [PubMed] [Google Scholar]
  16. HORWITZ D., GOLDBERG L. I., SJOERDSMA A. Increased blood pressure responses to dopamine and norepinephrine produced by monoamine oxidase inhibitors in man. J Lab Clin Med. 1960 Nov;56:747–753. [PubMed] [Google Scholar]
  17. Hunter K. R., Boakes A. J., Laurence D. R., Stern G. M. Monoamine oxidase inhibitors and L-dopa. Br Med J. 1970 Aug 15;3(5719):388–388. doi: 10.1136/bmj.3.5719.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Marley E., Blackwell B. Interactions of monoamine oxidase inhibitors, amines, and foodstuffs. Adv Pharmacol Chemother. 1970;8:185–349. doi: 10.1016/s1054-3589(08)60597-9. [DOI] [PubMed] [Google Scholar]
  19. Moir D. C., Cornwell W. B., Dingwall-Fordyce I., Crooks J., O'Malley K., Turnbull M. J., Weir R. D. Cardiotoxicity of amitriptyline. Lancet. 1972 Sep 16;2(7777):561–564. doi: 10.1016/s0140-6736(72)91958-7. [DOI] [PubMed] [Google Scholar]
  20. Prescott L. F. Pharmacokinetic drug interactions. Lancet. 1969 Dec 6;2(7632):1239–1243. doi: 10.1016/s0140-6736(69)90766-1. [DOI] [PubMed] [Google Scholar]
  21. ROSE G. A., HOLLAND W. W., CROWLEY E. A. A SPHYGMOMANOMETER FOR EPIDEMIOLOGISTS. Lancet. 1964 Feb 8;1(7328):296–300. doi: 10.1016/s0140-6736(64)92408-0. [DOI] [PubMed] [Google Scholar]
  22. Rand M. J., Trinker F. R. The mechanism of the augmentation of responses to indirectly acting sympathomimetic amines by monoamine oxidase inhibitors. Br J Pharmacol Chemother. 1968 Jun;33(2):287–303. doi: 10.1111/j.1476-5381.1968.tb00990.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. SIGG E. B., OSBORNE M., KOROL B. CARDIOVASCULAR EFFECTS OF IMIPRAMINE. J Pharmacol Exp Ther. 1963 Aug;141:237–243. [PubMed] [Google Scholar]
  24. SPECTOR S. Monoamine oxidase in control of brain serotonin and norepinephrine content. Ann N Y Acad Sci. 1963 Jul 8;107:856–864. doi: 10.1111/j.1749-6632.1963.tb13329.x. [DOI] [PubMed] [Google Scholar]
  25. Svedmyr N. The influence of a tricyclic antidepressive agent (protriptyline) on some of the circulatory effects of noradrenaline and adrenaline in man. Life Sci. 1968 Jan 1;7(1):77–84. doi: 10.1016/0024-3205(68)90364-0. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES