Caffeine and MAOIs (General): Interaction Overview
MAO inhibitors block monoamine oxidase, preventing metabolism of dopamine, serotonin, and norepinephrine.
Mechanism of Interaction
MAO inhibitors block monoamine oxidase, preventing metabolism of dopamine, serotonin, and norepinephrine. Caffeine stimulates catecholamine release. Combined, unmetabolized norepinephrine accumulates rapidly, potentially causing hypertensive crisis — severe elevated blood pressure, headache, palpitations, and in severe cases, stroke. This interaction is most severe with irreversible MAOIs (phenelzine, tranylcypromine) and less pronounced with reversible MAOIs (moclobemide) or MAO-B selective inhibitors (selegiline at low doses).
Recommendation
Avoid caffeine on irreversible MAOI therapy. Exercise extreme caution with reversible MAOIs. If on low-dose selegiline (MAO-B selective at <10mg), standard caffeine doses may be tolerable but monitor blood pressure. Consult your prescribing psychiatrist.
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