Monamine A oxidase inhibitors (MAOI) are not commonly used, and when they are it is usually third line therapy (after SSRIs and tricyclics). This stems from the rather serious and lethal side effects that can occur if patients do not follow a tyramine free diet. Irreversible MAOIs include isocarboxazid, phenelzine, and tranylcypromine. classic comedies medications have been used to treat "atypical" depression, phobic anxiety, panic disorder, obsessive-compulsive disorder, and chronic dysthymia.
dosing
Because of their short half-life, twice daily dosing is necessary. Dosages are usually given in the morning and mid-day to avoid overstimulation and insomnia.
interactions & cautions
MAOIs can interact with sympathomimetic agents or dopaminergic agonists to precipitate a hypertensive crisis. The treatment for hypotensive crisis involves discontinuing the monoamine oxidase inhibitor and then slowly administering phentolamine. Beta-blockers should not be used to treat a hypertensive crisis because beta blockade allows for unrestrained alpha adrenergic stimulation which would exacerbate the situation.
When combined with SSRIs, MAOIs may give rise to serotonin syndrome.
MAOIs can precipitate mania.
dietary restrictions
Dietary restrictions must be strictly observed to avoid hypertensive crisis. Even after her medication has been stop the dietary restrictions must be observed for at least 10 days. This is not a complete list of foods that must be avoided, but just several of the more common items. Patients must avoid all matured or aged cheeses, broad bean pods, concentrated yeast extracts, pickled herring, packaged soup (especially miso), aged and smoked meats, soy sauce, draft beer, and spoiled meat, poultry, or fish. It is important for patients to ensure that all food is fresh and stored properly and is consumed relatively soon after purchase. Even under refrigeration items can show an increase in tyramine content after several days.
side effects
The most common side effects of MAOIs include orthostatic hypotension, dizziness, headache, sedation, insomnia or hypersomnia, trimmer, and hyperreflexia.
pregnancy
There no controlled studies of MAOIs during pregnancy in humans and they are considered a class C risk. A male eyes should be avoided during the first trimester of pregnancy because of an increased incidence of birth defects.
MBOI
With a less poetic acronym, selegiline was introduced into the market as a new transdermal preparation, marketed as EMSAM. Selegiline is a monoamine B oxidase inhibitor. Because the transdermal preparation leads to sustained plasma concentrations of the parent compound, the amount of drug delivered to the brain is increased. The patch should be placed on dry intact skin on the upper torso, upper side, or outer surface of the upper arm every 24 hours. The smallest patch administers 6 mg of selegiline every 24 hours and has been found to be effective in major depressive disorder and avoids the need for dietary restrictions. Dosage increases, up to a maximum dose of 12 mg every 24 hours, should be made at intervals of no less than two weeks.
Selegiline has significant drug interactions with carbamazepine or oxcarbazepine, both of which lead to increased selegiline levels. There's also a risk of serotonin syndrome when any SSRI is administered and possibly the same is true with St. John's wort. Sympathomimetics, including amphetamine,
pseudoephedrine etc., are associated with in increased risk of hypertensive crisis.