MAOIs + Ginseng - Drug Interactions

Clinical evidence,mechanism, importance and management

A 64-year-old woman taking phenelzine developed headache,insomnia, and tremulousness on two occasions after taking ginseng (See reference number 1). Three years later, she experienced same symptoms and an increase in depression 72 hrs after starting to take ginseng capsules (See reference number 2). Another depressed woman taking ginseng and bee pollen experienced a relief of her depression and became active and extremely optimistic when she was started on phenelzine 45mg daily,but this was accompanied by insomnia, irritability, headaches and vague visual hallucinations. When phenelzine was stopped and then re-started in absence of ginseng and bee pollen, her depression was not relieved (See reference number 3). It seems unlikely that bee pollen had any part to play in these reactions and suspicion therefore falls on ginseng. It would seem that psychoactive effects of ginsenosides from ginseng and MAOI were somehow additive. Ginseng has stimulant effects,but its adverse effects include insomnia, nervousness, hypertension and euphoria. These two cases once again illustrate that herbal medicines are not necessarily problem-free if combined with orthodox drugs.

Shader RI,Greenblatt DJ. Phenelzine and the dream machine—ramblings and reflections. J Clin Psychopharmacol (1985) 5, 65.

Shader RI,Greenblatt DJ. Bees, ginseng and MAOIs revisited. J Clin Psychopharmacol (1988) 8, 235.

Jones BD,Runikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol (1987) 7, 201–2.