Maoi & Advair? Safe?

[PsyJedi548]

Hello, I need some help. Does anyone have experience or knowledge about the use of Maoi while taking the asthma medicine Advair? (Fluticasone propionate / Salmeterol). I’ve read that Salmeterol could potentially cause a bad interaction with maoi, but the dose I’m taking is only 50mcg/ day. Any help would be greatly appreciated. Thank you.

Additionally... Psychonaut Wiki lists black pepper, and coffee as Maoi’s, and I consume them all the time. I can’t see why Harmaline or Harmine would cause an issue for me if those aren’t...

 

[downwardsfromzero]

Fluticasone propionate - Wikipedia

en.wikipedia.org

Clinical pharmacokinetics of salmeterol - PubMed

Salmeterol is an inhaled long-acting selective beta(2)-adrenoceptor agonist that is commercially available as the xinafoate (1-hydroxy-2-naphthoic acid) salt of the racemic mixture of the two optical isomers, (R)- and (S)-, of salmeterol. It acts locally in the lung through action on beta2...

pubmed.ncbi.nlm.nih.gov

Drug Interactions With Oral Inhaled Medications

Objective: To evaluate the potential for drug interactions with oral inhaled medications (OIMs). OIMs include bronchodilators (β-agonists and antimuscarinics), corticosteroids, combination products (2 or more agents combined within a single inhalation ...

www.ncbi.nlm.nih.gov

Long-acting β-agonists (LABAs) include salmeterol, formoterol, arformoterol, indacaterol, and olodaterol. LABAs have a similar drug interaction profile as SABAs with regard to other adrenergic medications, β-blockers, diuretics, MAOIs, and TCAs.10-14 Salmeterol is a substrate of CYP 3A4. The use of strong CYP P450 3A4 inhibitors (ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nelfinavir, saquinavir, ketoconazole, telithromycin) is not recommended with salmeterol as concurrent administration can lead to increased risk of cardiovascular adverse effects.10 Concomitant use of a LABA with xanthine derivatives (aminophylline, theophylline) or steroids (prednisone, methylprednisolone) may potentiate any hypokalemic effect of adrenergic agonists.11,12,14 Drug interaction studies indicate that CYP 450 3A4 and P-gp inhibitors (ketoconazole, erythromycin, verapamil, ritonavir) may decrease the systemic clearance of indacaterol; however, no dose adjustment is required for the 75 µg dose.13 Ketoconazole can also increase the plasma concentration of olodaterol via dual CYP P450 3A4 and Pg inhibition, but clinical studies indicate no dosage adjustment is necessary.14,15

Both are metabolised through cyp3A4 which should show minimal metabolic interactions with the cyp2D6 metabolised harmala alkaloids. Grapefruit would be more of a concern in this instance. Pay attention to the above quoted passage, however. You would need to consult a competent physician to be sure about possible effects on blood potassium and cardiac function, although the cardiac amines are metabolised through subtype MAO-B compared with the tryptamines such as serotonin and DMT which are substrates for MAO-A. Harmala alkaloids affect only the MAO-A system and their effects on MAO-B are minimal.

Black pepper and coffee are not really comparable with harmala alkaloids in terms of MAOI activity. (Personally, I try to avoid coffee if taking harmalas because they inhibit caffeine metabolism and this leads to insomnia and cardiovascular symptoms.) In the second PubMed article linked above, you'll see that it's the irreversible MAOIs that are of more concern. Harmaline and harmine are reversible inhibitors of MAO (RIMAs) and while this makes them less of a concern, you would still be wise to get proper medical advice before proceeding further with this.

 

[PsyJedi548]

Thank you for the well articulated response. It has helped tremendously. I used a paid service online to chat with a doctor, and they said that it would be safe to take Advair with Harmala, and Harmaline. Still, they did not elaborate much as to the reason why. I’m going to see about asking more doctors, but from the information I’ve gathered so far, it looks like this combination could possibly be safe.

 

[Sabnock1990]

Just for future reference, keep in mind that MAOI's are not some touchy substance, they can be mixed with various substances/medicines/supplements just fine, the only substances one should watch out for when it comes to MAOI's are things that raise Serotonin or Noradrenaline levels, or things metabolized by CYP1A2 or CYP2D6, outside of that, chances are it's safe to assume that there will be no negative drug to drug interactions.

 

[downwardsfromzero]

Indeed, that does to a large extent apply to the RIMAs in question here, but it is still standard practice to refer people to a qualified physician when they request what amounts to medical advice. Metabolic profiles vary between people because of genetic and environmental factors and it is worth being aware of one's own specific tendencies. Keywords - cytochrome P450 isotypes; food-drug interactions.

Some people do on occasion notice a reaction with (for example) tyramine-rich foods and harmalas which, if not overtly dangerous, is still at least unpleasant - whereas you, ShamensStamen, report that you don't. That's fine, but each person does need to be aware of how these factors might affect them personally - YMMV.

 

[PsyJedi548]

Update- My primary physician just got back to me saying that there wouldn’t be any dangerous interaction between salmeterol and harmala alkaloids, and that I could proceed, but to make sure I rinse and gargle sufficiently after inhaling the Advair... Also I messaged Hamilton Morris on Instagram, who surprisingly responded saying this...

“I expect it would be OK because beta-carbolines in B. caapi primarily inhibit MAO-A and MAO-B typically only degrades primary amine phenethylamines and salmeterol is a secondary amine. Can you abstain from salmeterol for a day before? You could also buy some peganum harmala or B. caapi and smoke small amounts cautiously to test for an interaction without any DMT present, that’s probably what I would do in your position (in addition to abstaining if possible).”

So there we have it. I will update once I actually do smoke the harmala. Thanks for the help everyone!