Because of the very toxic and sometimes fatal reactions (similar to or the same as serotonin
syndrome) that have very occasionally occurred in patients taking both
MAOIs and tricyclic antidepressants, concurrent use is regarded as contra- indicated.
Avoid concurrent use. Tricyclic antidepressants should not be started for 2 weeks after treatment with
MAOIs has been stopped (3 weeks if starting clomipramine or imipramine), and an MAOI should not be started until at least 7 to 14 days after a tricyclic or related antidepressant has been stopped (3 weeks in the case of clomipramine or imipramine). If concurrent use is thought necessary it has been suggested that it should only be undertaken by those well aware of the problems and who can undertake adequate supervision.