MAOIs SSRIs

Uses Acute migraine Action S otonin 5-HTi rec tor antagonist Dose 1—2.5 mg PO once r eat PRN in 4 h 5 mg/24 h max -1- in mild renal/hepatic insuff, take w/ fluids Caution [C, M] Contra Sev e renal/hepatic impair, avoid w/ angina, ischemic heart Dz, uncontrolled HTN, cerebrovascular synds, CTgot use Disp Tabs SE Dizziness, sedation, GI upset, paresthesias, ECG changes, coronary vasospasm, arrhythmias Interactions T Effects W/ MAOIs, SSRIs T effects OF CTgot drugs X effects W7 nicotine EMS May T PR or CyT int val, monitor ECG OD May cause profound HTN and cardiac ischemia symptomatic and supportive... 

A preliminary investigation has shown that sertraline therapy can be an effective treatment for social phobia. In this study, 80% were considered responders with all measures of social anxiety and avoidance, depression, and social functioning showing a statistically significant change from baseline to endpoint ( 84). Versiani s review of the literature led to a ranking of drug efficacy for social phobia classic MAOIs > SSRIs > BZDs > RIMAs ( 84a). 

Limited data exist to support drug management in phobic disorders. Behavioral techniques, especially for specific phobic conditions, are currently the treatment of choice. MAOIs, SSRIs, clonidine, and alprazolam may benefit some patients. Figure 12-3 summarizes the management strategy we would recommend. 

Rapid onset of action and favorable side effect profiles are advantages that some BZDs have in comparison with TCAs, MAOIs, SSRIs, and other antipanic drug therapies. Not all patients respond to therapy with BZDs, however. Also, BZDs lack therapeutic efficacy in treating patients with major depression, a frequent complication of PD. Furthermore, abrupt discontinuation of BZDs produces withdrawal symptoms (see Chapter 12). Nevertheless, familiarity with the assets and liabilities of each BZD prescribed for PD enhances the art of antipanic pharmacotherapy and its efficacy. The latter is important because, compared with other antipanic drugs, BZDs have advantages for PD therapy that are offset by their disadvantages as listed in Table 13-1 (18). 

MAOIs SSRIs t risk of serotonin syndrome >- For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome Additive inhibitory on serotonin reuptake Avoid co-administration. MAOIs should not be started for at least 1 week after stopping SSRIs (2 weeks after sertraline, S weeks after fluoxetine). Conversely, SSRIs should not be started for at least 2 weeks after stopping MAOIs... 

ANTI EPILEPTICS 1. ANTIMALARIALS -chloroquine, mefloquine 2. ANTIDEPRESSANTS-MAOIs, SSRIs, TCAs 3. ANTIPSYCHOTICS t risk of seizures These drugs lower seizure threshold Care with co-administration. Watch for t fit frequency warn patient of this risk when starting these drugs and take suitable precautions. Consider increasing dose of antiepileptic... 

Direct information about the concurrent use of isoniazid and SSRIs seems to be limited, but the case reports cited here would suggest that the combination of isoniazid and these SSRIs is normally without problems. However, also be aware that one report suggests the possibility of an inerease in adverse effects with the combination of SSRIs and isoniazid. In fheory isoniazid could interact with the SSRIs because it has some weak MAO inhibitory activity. However, isoniazid rarely interacts like the MAOIs. This is because isoniazid seems to lack activity on mitochondrial MAO even though it has activity on plasma MAO. Therefore no adverse MAOI/SSRI interaction would usually be expected. 

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