Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction

Summary In spite of intensive therap-v, an otherwise fit 34-year-old man died following the hyperpyrexial reaction 10 an interaction between tranylcypromine and clomipramine. There was no evidence of drug overdose. but severe disseminated intravasciilar coagulation developed which provedfatal. Key words Interaction, drug; tranylcypromine, clomipramine. Hyperthermia. Combinations of tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) have been used for many years in the treatment of refractory depression.' In the 1960s there were many reportsz.3 of severe adverse reactions to the combination, which included some fatalities. These occurred in particular when imipramine was added after MA01 therapy had been established. This type of combination therapy was reviewed by Goldberg and Thorn- ton,4 who considered that the risks can be mini- mised if certain precautions are taken and that the results can be worthwhile. We report the case of a man who died follow- ing administration of a combination of clom- ipramine and tranylcypromine. At least four previous deaths due to combinations of clom- ipramine and MAOIs have been noted.5