NIALAMIDE SHOULD BE ADMINISTERED WITH CAUTION TO PATIENTS RECEIVING DISULFIRAM, CAN CAUSE EPILEPSY & DEATH. CONCOMITANT USE OF NIALAMIDE AND OTHER PSYCHOTROPIC AGENTS IS GENERALLY NOT RECOMMENDED BECAUSE OF POSSIBLE POTENTIATING EFFECTS.
NIALAMIDE SHOULD NOT BE ADMINISTERED IN COMBINATION WITH ANY OF THE FOLLOWING: MAO INHIBITORS OR DIBENZAZEPINE DERIVATIVES; SYMPATHOMIMETICS (INCLUDING AMPHETAMINES); SOME CENTRAL NERVOUS SYSTEM DEPRESSANTS (INCLUDING NARCOTICS AND ALCOHOL); ANTIHYPERTENSIVE, DIURETIC, ANTIHISTAMINIC, SEDATIVE OR ANESTHETIC DRUGS, BUPROPRION HCL, BUSPIRONE HCL, DEXTROMETHORPHAN, CHEESE OR OTHER FOODS WITH A HIGH TYRAMINE CONTENT; OR EXCESSIVE QUANTITIES OF CAFFEINE.
SHOULD NOT BE ADMINISTERED TOGETHER WITH, OR IN CLOSE PROXIMITY TO, OTHER MAO INHIBITORS OR DIBENZAZEPINE-RELATED ENTITIES. HYPERTENSIVE CRISES, SEVERE CONVULSIVE SEIZURES, COMA, OR CIRCULATORY COLLAPSE MAY OCCUR. THE CONCURRENT ADMINISTRATION OF A MAO INHIBITOR AND BUPROPRION HYDROCHLORIDE IS CONTRAINDICATED.
SHOULD NOT BE ADMINISTERED IN COMBINATION WITH ANY SSRI. THERE HAVE BEEN REPORTS OF SERIOUS, SOMETIMES FATAL, REACTIONS (INCLUDING HYPERTHERMIA, RIGIDITY, MYOCLONUS, AUTONOMIC INSTABILITY WITH POSSIBLE RAPID FLUCTUATIONS OF VITAL SIGNS. BUSPIRONE
NIALAMIDE SHOULD NOT BE USED IN COMBINATION WITH BUSPIRONE HCL
NIALAMIDE SHOULD NOT BE ADMINISTERED IN COMBINATION WITH SYMPATHOMIMETICS, INCLUDING AMPHETAMINES, OR WITH OVER-THE-COUNTER DRUGS SUCH AS COLD, HAY FEVER, OR WEIGHT-REDUCING PREPARATIONS THAT CONTAIN VASOCONSTRICTORS. USE OF SYMPATHOMIMETICS AND COMPOUNDS SUCH AS GUANETHIDINE, METHYLDOPA, METHYLPHENIDATE, RESERPINE, EPINEPHRINE, NOREPINEPHRINE, PHENYLALANINE, DOPAMINE, LEVODOPA, TYROSINE, AND TRYPTOPHAN WITH NIALAMIDE MAY PRECIPITATE HYPERTENSION, HEADACHE. THE COMBINATION OF MAO INHIBITORS AND TRYPTOPHAN CAN CAUSE BEHAVIORAL AND NEUROLOGIC SYMPTOMS, INCLUDING DISORIENTATION, CONFUSION, AMNESIA, DELIRIUM, AGITATION, HYPOMANIC SIGNS, ATAXIA, MYOCLONUS, HYPERREFLEXIA, SHIVERING, OCULAR OSCILLATIONS, AND BABINSKI SIGNS. DEXTROMETHORPHAN CAUSE BRIEF EPISODES OF PSYCHOSIS OR BIZARRE BEHAVIOR.
CHEESE OR OTHER FOODS WITH A HIGH TYRAMINE CONTENT
HYPERTENSIVE CRISES HAVE SOMETIMES OCCURRED DURING NIALAMIDE THERAPY AFTER INGESTION OF FOODS WITH A HIGH TYRAMINE CONTENT. IN GENERAL, PATIENTS SHOULD AVOID PROTEIN FOODS IN WHICH AGING OR PROTEIN BREAKDOWN IS USED TO INCREASE FLAVOR. IN PARTICULAR, PATIENTS SHOULD BE INSTRUCTED NOT TO TAKE FOODS SUCH AS CHEESE (PARTICULARLY STRONG OR AGED VARIETIES), SOUR CREAM, CHIANTI WINE, SHERRY, BEER (INCLUDING NON-ALCOHOLIC BEER), LIQUEURS, PICKLED HERRING, ANCHOVIES, CAVIAR, LIVER, CANNED FIGS, RAISINS, BANANAS OR AVOCADOS (PARTICULARLY IF OVERRIPE), CHOCOLATE, SOY SAUCE, SAUERKRAUT, THE PODS OF BROAD BEANS (FAVA BEANS), YEAST EXTRACTS, YOGURT, MEAT EXTRACTS, SMOKED FOOD, MEAT PREPARED WITH TENDERIZERS, OR DRY SAUSAGE.
SHOULD NOT UNDERGO ELECTIVE SURGERY REQUIRING GENERAL ANESTHESIA. ALSO, THEY SHOULD NOT BE GIVEN COCAINE OR LOCAL ANESTHESIA CONTAINING SYMPATHOMIMETIC VASOCONSTRICTORS.
NIALAMIDE SHOULD NOT BE USED IN COMBINATION WITH SOME CENTRAL NERVOUS SYSTEM DEPRESSANTS, SUCH AS NARCOTICS, BARBITURATES, OR ALCOHOL.
NIALAMIDE SHOULD NOT BE USED IN COMBINATION WITH ANTIHYPERTENSIVE AGENTS, INCLUDING THIAZIDE DIURETICS. A MARKED POTENTIATING EFFECT ON THESE DRUGS HAS BEEN REPORTED, RESULTING IN HYPOTENSION.
EXCESSIVE USE OF CAFFEINE IN ANY FORM SHOULD BE AVOIDED IN PATIENTS RECEIVING NIALAMIDE.