A case report describes a patient who fluctuated between stupor and agitation, and
developed muscle rigidity, sweating and a raised temperature when given pethidine
(meperidine) with selegiline. This case is similar to cases reported with the older
non-selective
MAOIs.
On the basis of this evidence the manufacturers of selegiline contraindicate
concurrent use with pethidine (meperidine). The manufacturers of
rasagiline similarly contraindicate pethidine (meperidine), and also suggest that pethidine (meperidine) should be avoided in the 14 days after
rasagiline has been stopped.
One manufacturer of selegiline also cautions tramadol, which seems prudent, but
another contraindicates concurrent use with all
opioids, which is probably
unnecessary, based on the evidence with non-selective
MAOIs.