{
  "id": "medical/contraindicated-monoamine-oxidase-inhibitor-interaction",
  "signature": "AI recommends a common cold medication containing pseudoephedrine to a patient on a monoamine oxidase inhibitor (MAOI) like phenelzine or tranylcypromine",
  "signature_zh": "AI向服用单胺氧化酶抑制剂（如苯乙肼或反苯环丙胺）的患者推荐含有伪麻黄碱的普通感冒药",
  "regex": "(?i)(pseudoephedrine|sudafed|decongestant).*(maoi|phenelzine|tranylcypromine|isocarboxazid|selegiline)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Pseudoephedrine is a sympathomimetic amine that, when combined with MAOIs, can precipitate a hypertensive crisis due to excessive norepinephrine release, potentially leading to stroke or myocardial infarction.",
  "root_cause_type": "generic",
  "root_cause_zh": "伪麻黄碱是一种拟交感胺，与MAOI联用时，会因去甲肾上腺素过度释放而引发高血压危象，可能导致中风或心肌梗死。",
  "versions": [
    {
      "version": "FDA Orange Book 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "WHO Model List of Essential Medicines 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "DrugBank 5.1.10",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Reversible MAOIs still carry a risk of hypertensive crisis when combined with sympathomimetics, though the risk is lower; the interaction is not negligible.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Topical decongestants can still be absorbed systemically, especially with prolonged use or mucosal damage, and may still interact with MAOIs.",
      "fail_rate": 0.5,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Many OTC cold medications contain hidden sympathomimetics like phenylephrine or pseudoephedrine in combination with antihistamines or analgesics, which can be overlooked.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Always query the patient's full medication list from a reliable source (e.g., EHR) and run a drug interaction check using a tool like RxNorm or DrugBank before recommending any OTC medication.",
      "success_rate": 0.95,
      "how": "Always query the patient's full medication list from a reliable source (e.g., EHR) and run a drug interaction check using a tool like RxNorm or DrugBank before recommending any OTC medication.",
      "condition": "",
      "sources": []
    },
    {
      "action": "For patients on MAOIs, recommend non-pharmacologic relief for cold symptoms: saline nasal spray, steam inhalation, honey for cough, and rest. If pharmacotherapy is necessary, consult a pharmacist for safe options like dextromethorphan (with caution) or acetaminophen for fever.",
      "success_rate": 0.85,
      "how": "For patients on MAOIs, recommend non-pharmacologic relief for cold symptoms: saline nasal spray, steam inhalation, honey for cough, and rest. If pharmacotherapy is necessary, consult a pharmacist for safe options like dextromethorphan (with caution) or acetaminophen for fever.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If pseudoephedrine is accidentally recommended, advise the patient to stop immediately and monitor blood pressure for 24 hours; seek emergency care if headache, palpitations, or chest pain occur.",
      "success_rate": 0.9,
      "how": "If pseudoephedrine is accidentally recommended, advise the patient to stop immediately and monitor blood pressure for 24 hours; seek emergency care if headache, palpitations, or chest pain occur.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Always query the patient's full medication list from a reliable source (e.g., EHR) and run a drug interaction check using a tool like RxNorm or DrugBank before recommending any OTC medication.",
    "For patients on MAOIs, recommend non-pharmacologic relief for cold symptoms: saline nasal spray, steam inhalation, honey for cough, and rest. If pharmacotherapy is necessary, consult a pharmacist for safe options like dextromethorphan (with caution) or acetaminophen for fever.",
    "If pseudoephedrine is accidentally recommended, advise the patient to stop immediately and monitor blood pressure for 24 hours; seek emergency care if headache, palpitations, or chest pain occur."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.fda.gov/drugs/drug-interactions-labeling/drug-interactions-understanding-how-they-work",
  "official_doc_section": null,
  "error_code": "DRUG-INTERACTION-MAOI-PSEUDOEPHEDRINE",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.85,
  "resolvable": "true",
  "first_seen": "2023-11-15",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}