A client taking phenelzine asks which nonprescription cold product must be avoided. Which product should the nurse identify?
1A preservative-free saline nasal spray for nasal dryness
2Plain guaifenesin labeled as a single-ingredient expectorant
3A decongestant containing the sympathomimetic pseudoephedrine✓ Correct answer
4Plain acetaminophen labeled as a single-ingredient analgesic
Explanation
Phenelzine is a nonselective monoamine oxidase inhibitor. Sympathomimetic decongestants such as pseudoephedrine can interact with an MAOI and precipitate severe hypertension or a hypertensive crisis. The client should check combination-product labels and consult the pharmacist or prescriber before using nonprescription medicines. The listed single-ingredient alternatives do not contain a sympathomimetic decongestant.
Clinical reasoning MAO inhibition can markedly amplify the pressor effect of sympathomimetics. Pseudoephedrine can therefore trigger dangerous hypertension in a client taking phenelzine.
Decision rule Screen every cold remedy for hidden decongestants and obtain professional guidance before combining an over-the-counter product with an MAOI.
Scenario 70-year-old male, Parkinson disease on levodopa-carbidopa, evaluated for new severe major depression. New medications considered.
Nonselective monoamine oxidase inhibitor — An antidepressant class that inhibits monoamine metabolism and has important food and medication interactions; phenelzine is an example.
Hypertensive crisis — A severe, potentially life-threatening blood-pressure elevation that can follow an MAOI interaction with a sympathomimetic.
MAOI washout — 14-day drug-free interval required before and after nonselective MAOI use.