# AI recommends a common cold medication containing pseudoephedrine to a patient on a monoamine oxidase inhibitor (MAOI) like phenelzine or tranylcypromine

- **ID:** `medical/contraindicated-monoamine-oxidase-inhibitor-interaction`
- **Domain:** medical
- **Category:** data_error
- **Error Code:** `DRUG-INTERACTION-MAOI-PSEUDOEPHEDRINE`
- **Verification:** ai_generated
- **Fix Rate:** 85%

## 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.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| FDA Orange Book 2024 | active | — | — |
| WHO Model List of Essential Medicines 2023 | active | — | — |
| DrugBank 5.1.10 | active | — | — |

## Workarounds

1. **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.** (95% success)
   ```
   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.
   ```
2. **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.** (85% success)
   ```
   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.
   ```
3. **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.** (90% success)
   ```
   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.
   ```

## Dead Ends

- **** — Reversible MAOIs still carry a risk of hypertensive crisis when combined with sympathomimetics, though the risk is lower; the interaction is not negligible. (70% fail)
- **** — Topical decongestants can still be absorbed systemically, especially with prolonged use or mucosal damage, and may still interact with MAOIs. (50% fail)
- **** — Many OTC cold medications contain hidden sympathomimetics like phenylephrine or pseudoephedrine in combination with antihistamines or analgesics, which can be overlooked. (80% fail)