Safety and Efficacy of Monoamine Oxidase Inhibitors in Patients Who Use Psychoactive Substances: Potential Drug Interactions and Substance Use Disorder Treatment Data.
CNS drugs January 17, 2026 Gaëlle Rached, Anna Campana, Dimitri Fiani et al. 1 citation
Monoamine oxidase inhibitors (MAOIs) can be used safely in some patients who use psychoactive substances, but certain combinations pose potentially fatal risks. This narrative review of 219 publications found that combining MAOIs with amphetamines, the empathogen MDMA, opioids with strong serotonergic reuptake inhibition (e.g., meperidine, tramadol), or alcoholic beverages high in tyramine can lead to serotonin toxicity, hypertensive emergencies, or death. In contrast, MAOI treatment of patients who use low-tyramine alcohol, caffeine, cannabis, nicotine, sedatives, and some classic hallucinogens can likely be managed with careful monitoring. No robust human data support MAOIs as effective treatments for substance use disorders themselves.