Posted by Robert_Burton_1621 on July 20, 2015, at 14:11:11
In reply to Re: Stopping Parnate for surgery? Help! » Uncouth, posted by SLS on July 20, 2015, at 12:59:21
> According to my cursory research, the following anesthesia drugs are compatible with MAOIs. At the very least, your anesthesiologist should research combining propofol with midazolam.
>
>
> - Scott
>
> --------------------------------------------
>
> alfentanil
> atracurium
> codeine
> fentanyl
> hydrocodone
> hydromorphone
> ketamine
> ketorolac
> midazolam
> mivacurium
> morphine
> oxycodone
> phenelphrine
> propofol
> rapacuronium
> remifentanil
> sufentanil
> vecuronium
>Also, my search brought up:
felypressin (octopressin)
buprenorphine
benzodiazepineStahl states (2012 CNS Spect 17.1) that fentanyl is strictly prohibited. Gillman (2005 Brit J Anaesthesia 95.4) concludes that it has "possibly" caused fatalities from serotonin toxicity.
Obviously care must be taken with anesthesia, but I agree with Scott in his advice to suggest that your anesthetist research the possibility of your remaining on parnate. Apparently dangers with anesthesia are the indirectly acting sympatho-mimetic agents which are hardly ever used therapeutically now anyway, and medications which can induce serotonin syndrome like pethadine and tramadol. There used to be something like a default assumption that MAOIs cannot be taken simultanously with anaesthetics. I say "used to be" but what I mean is that many doctors - and psychiatrists - remain burdened by this misapprenehsion. A psychiatrist I saw in 2014 asserted, on my broaching the subject of MAOIs, confidently and without any qualification, that if I were to take MAOIs I would not be able to have any surgery or dental work for the next five years (his estimation of how long I needed treatment).
There have been significant advances in the understanding of MAOIs and interactions. Here's some recent links (their suggestions may be contained in the list Scott produces):
http://bja.oxfordjournals.org/content/95/4/434.full
http://www.ncbi.nlm.nih.gov/pubmed/22938842
http://www.ncbi.nlm.nih.gov/pubmed/23993253
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