Non-selective, irreversible MAOIs. May increase QTc interval w/ pimozide. Risk of serotonin syndrome w/ reversible, selective MAO-A inhibitor (moclobemide), selegiline, serotonergic products (eg, tramadol, sumatriptan & other triptans). May lower seizure threshold w/ antidepressants (eg, tricyclics, SSRIs), neuroleptics (phenothiazines, thioxanthenes, butyrophenones), mefloquine, bupropion & tramadol. May enhance effects w/ lithium or tryptophan. Increased incidence of adverse reactions w/ St. John's wort (Hypericum perforatum
). May alter anticoagulant effects w/ oral anticoagulants. Increased bleeding tendencies w/ NSAIDs. Alcohol. Increased plasma conc w/ omeprazole & cimetidine, CYP2C19 inhibitors (eg, omeprazole, fluoxetine, fluvoxamine, lansoprazole, ticlopidine). Drugs that metabolize CYP2D6 enzyme, have narrow therapeutic index eg, flecainide, propafenone & metoprolol or CNS-acting drugs eg, antidepressants (desipramine, clomipramine & nortryptyline) or antipsychotic (risperidone, thioridazine & haloperidol).