Possible Interaction: Antidepressive Agents and Epinephrine

“Many antidepressant drugs inhibit the neuronal uptake of norepinephrine, serotonin, epinephrine and/or dopamine.”

“This might precipitate a hypertensive episode of a dangerous nature, for … investigations have shown that noradrenaline and, to a lesser degree, adrenaline may produce a significant rise in blood pressure if given intravenously to volunteers who were at the same time receiving an antidepressant agent of the tricyclic type.'”

“Patients at higher risk for serious adverse effects from epinephrine are those with comorbidities such as underlying heart disease and those taking monoamine oxidase inhibitors, tricyclic antidepressants , antiarrhythmics, and cocaine [8].”

“Adding epinephrine , however, introduces the possibility of a drug interaction with tricyclic antidepressants and nonselective /gb-blockers.”

“ Antidepressants enhance monoamine, such as serotonin, nor adrenaline and dopamine neurotransmission by blockade of monoamine transporter or monoamine oxydase.”

“ Epinephrine added to local anaesthetics may cause local vasodilation if administered to patients concurrently being treated with cyclic antidepressants , and the combination imposes the risk of severe hypertension and arrhythmias.”

“Epinephrine may precipitate myocardial ischemia, tachyarrhythmias, hypertensive crisis, … edema, digitalis toxicity, and cardiac arrest.5 Antidepressants , anesthetics, sympathomimetics, bretylium, … phosphodiesterase inhibitors potentiate epinephrine's arrhythmogenic effect.50 Until definitive data are available, our clinical experience suggests that all patients should receive at least one dose of epinephrine 1 mg.”

“This might precipitate a hypertensive episode of a dangerous nature, for … investigations have shown that noradrenaline and, to a lesser degree, adrenaline may produce a significant rise in blood pressure if given intravenously to volunteers who were at the same time receiving an antidepressant agent of the tricyclic type.'”

“However, antidepressant treatment alone was ineffective whereas the combination of antidepressant treatment and exercise resulted in an enlargement of both adrenal cortices.”