Which opioid is contraindicated within 14 days of use of an monoamine oxidase inhibitor?
Tapentadol is contraindicated within 14 days of an MAOI. While use of MAOIs for depression is now uncommon, the antibiotic linezolid has MAOI activity. Serotonin syndrome is one reason for this concern. However, the larger concern with the combination is additive norepinephrine activity that has led to adverse cardiovascular effects. Tapentadol has minimal serotonergic activity, and therefore serotonin syndrome is only a theoretical concern with its use. Meperidine is also contraindicated within 14 days of an MAOI, though its use is rare and its chronic use should be nonexistent due to the issues with the normeperidine metabolite mentioned earlier. Note that tramadol and methadone also should not be used within 14 days of an MAOI due to their reuptake blockade of norepinephrine.