Fri July 25/2008

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Monoamine Oxidase Inhibitors (MAOIs)

Monoamine Oxidase Inhibitors are often used in cases of severe depression, especially those associated with lethargy and poor motivation. They are also used in cases where treatment resistance is seen (possibly also combined with lithium and/or L-tryptophan). Anxiety states can be treated with MAOIs, and they are sometimes helpful in borderline personality disorder.

In association with mood stabilizers, MAOIs are given to those with bipolar disorder. They are also prescribed in certain cases of atypical depression. Dosage needs to be adequate (e.g. phenelzine 75–90 mg/day).

Monoamine Oxidase Inhibitors are characterized by rapid absorption, but toxic levels can occur in the slow acetylators. The half-life is not as important as the time taken to replace stores of MAO after irreversible blockade.

Stringent dietary restrictions are necessary in patients taking traditional MAOIs, as naturally occurring monoamines (such as tyramine in cheese) and sympathomimetics in cough and cold medicines can interact with MAOIs to produce a fatally catastrophic hypertension.

Side Effects of Monoamine Oxidase Inhibitors

Hypertensive crisis occurs with tyramine-containing foods and some drugs. Tyramine normally inactivated in the gut by MAO acts by releasing NE

Symptoms - flushing, headache, increased BP, rarely CVA

Foods – e.g. cheese, yoghurt, yeast extracts, meat, alcohol, broad beans, pickled herrings.

Problematic Interactions of Monoamine Oxidase Inhibitors

  • Tyramine
  • Sympathomimetics (include cold remedies)
  • Other antidepressants
  • Pethidine
  • Alcohol, barbiturates, anesthetics: CNS depression
  • Insulin: impared blood glucose control

Examples of Monoamine Oxidase Inhibitors

  • Phenelzine
  • Isocarboxazid
  • Tranylcypromine
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