A 16-year-old client has taken an overdosage of citalopram (Celexa) and is brought to the emergency department. What symptoms would the nurse expect to be present?

• GI upset, confusion, and polyuria are early warning signs of lithium toxicity.
• Severe symptoms such as ataxia and seizures occur in advanced toxicity.
• Continuous monitoring of serum lithium levels and client symptoms is essential to maintain safety.

Monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) are prescribed for patients with depression who do not respond well to other antidepressants. While effective, they require careful monitoring because of their high potential for dangerous food and drug interactions. MAOIs such as tranylcypromine (Parnate) can cause hypertensive crisis when taken with foods high in tyramine. Patient education must emphasize strict dietary restrictions to prevent life-threatening complications.

B. Instruct the patient to avoid beer and cheddar cheese.
Beer, cheddar cheese, and other tyramine-rich foods can precipitate a sudden and dangerous rise in blood pressure. Patients must avoid these foods completely while on MAOIs.

A. Warn the patient about severe hypotension.
MAOIs are more likely to cause orthostatic hypotension rather than severe hypotension, but the greater safety concern is hypertensive crisis due to food-drug interactions.

C. Encourage the patient to take ginseng and ephedra.
Both ginseng and ephedra can dangerously increase blood pressure when combined with MAOIs and should be avoided.

D. Encourage the patient to eat fruit such as bananas.
Bananas contain tyramine (especially overripe ones) and should be avoided to prevent a hypertensive crisis.

Take-Home Points:

• MAOIs require strict dietary restrictions to prevent hypertensive crisis.
• Tyramine-rich foods such as aged cheese, beer, and cured meats must be avoided.
• Nurses must educate patients on drug–food and drug–herb interactions with MAOIs.