Which vasoconstrictor used in local anesthetics is contraindicated with concomitant MAO inhibitor therapy?

Phenylephrine is contraindicated in patients undergoing therapy with monoamine oxidase (MAO) inhibitors due to its potential to cause significant hypertensive reactions. MAO inhibitors can affect the metabolism of certain catecholamines, leading to an exaggerated response when vasoconstrictors such as phenylephrine are used. This results from the inhibition of monoamine oxidase, which normally helps break down excess monoamines, including norepinephrine and phenylephrine. When combined, they can lead to an excessive increase in blood pressure.

Additionally, phenylephrine is a selective alpha-1 adrenergic agonist, primarily causing vasoconstriction without significant beta-adrenergic activity. This specificity can further heighten the risk of hypertensive crises in patients with altered catecholamine metabolism due to MAO inhibitors.

While norepinephrine and epinephrine can also interact with MAO inhibitors, their mechanisms and effects differ. Epinephrine has both alpha and beta effects, primarily impacting heart rate and bronchodilation in addition to vasoconstriction, which alters its risk profile in the presence of MAO inhibitors. Levonordefrin, while also considered a vasoconstrictor, is used less frequently and has a somewhat different