Family Nurse Practitioner Exam

Which medication should be avoided by patients taking MAOIs due to potential serious reactions?

1. Alprazolam (Xanax)

2. Fluoxetine (Prozac)

3. Erythromycin (E-mycin)

4. Amoxicillin (Amoxil)

The correct answer is: Fluoxetine (Prozac)

Patients taking monoamine oxidase inhibitors (MAOIs) need to be cautious about many medications due to the risk of serious interactions. Fluoxetine, which is classified as a selective serotonin reuptake inhibitor (SSRI), can lead to a potentially life-threatening condition known as serotonin syndrome when taken in conjunction with MAOIs. This interaction arises because SSRIs increase serotonin levels in the brain, while MAOIs inhibit the breakdown of serotonin. When these two types of medications are combined, excessive serotonin can accumulate, leading to symptoms such as agitation, confusion, rapid heart rate, and even severe outcomes like seizures and coma. In contrast, the other medications listed—alprazolam, erythromycin, and amoxicillin—do not carry the same level of risk when used with MAOIs. Alprazolam, a benzodiazepine, may be used cautiously, but it does not have the same interactions as fluoxetine. Erythromycin, an antibiotic, and amoxicillin, another antibiotic, are not known to cause interactions that would lead to serotonin syndrome or similar serious reactions in the context of MAOI therapy. Therefore, fluoxetine is specifically singled out as a medication to avoid due to its significant potential for interaction with