Monoamine oxidase inhibitors discontinuation

Switching to or from a monoamine oxidase inhibitor (MAOl) - At least 14 days should elapse between discontinuation of an MAOl and initiation of therapy with mirtazapine. In addition, allow at least 14 days after stopping mirtazapine before starting an MAOl. 

Monoamine oxidase inhibitors (MAOIs) Do not give tetracyclics with MAOIs. Allow a minimum of 14 days to elapse after discontinuation of MAOIs before starting a tetracyclic. 

Maintenance/Continuation/Extended treatment There is no evidence to indicate how long the depressed patient should be treated with nefazodone. However, it is generally agreed that pharmacologic treatment for acute episodes of depression should continue for at least 6 months. Whether the dose of antidepressant needed to induce remission is identical to the dose needed to maintain euthymia is unknown. In clinical trials, more than 250 patients were treated for at least 1 year. Switching to or from a monoamine oxidase inhibitor (MAOi) At least 14 days should elapse between discontinuation of an MAOI and initiation of therapy with nefazodone. In addition, wait at least 7 days after stopping nefazodone before starting an MAOI. 

Hypersensitivity to SSRIs in combination with a monoamine oxidase inhibitor (MAOl), or within 14 days of discontinuing an MAOl administration of thioridazine with fluoxetine or within a minimum of 5 weeks after fluoxetine has been discontinued coadministration of fluvoxamine with cisapride, thioridazine or pimozide concomitant use of thioridazine with paroxetine concomitant use of pimozide with sertraline coadministration of sertraline oral concentrate and disulfiram. 

Patients with marked anxiety, tension, and agitation, because the drug may aggravate these symptoms hypersensitivity to methylphenidate or other components of the product patients with glaucoma, motor tics, or a family history or diagnosis of Tourette s syndrome during treatment with monoamine oxidase inhibitors (MAOIs), and also within a minimum of 14 days following discontinuation of an MAOl (hypertensive crises may result). 

Concurrent treatment with monoamine oxidase inhibitors (MAOIs) and within a minimum of 14 days following discontinuation of an MAOl (hypertensive crisis may result). 

Patients known to be hypersensitive to atomoxetine or other constituents of the product with a monoamine oxidase inhibitor (MAOl) or within 2 weeks after discontinuing an MAOl narrow angle glaucoma (see Warnings). 

Plasma levels of doxepin similar to those achieved during oral therapy may be obtained with topical application the usual drug interactions associated with tricyclic antidepressants may occur. Therefore, monoamine oxidase inhibitors must be discontinued at least 2 weeks prior to the initiation of doxepin cream. Topical application of the cream should be performed four times daily for up to 8 days of therapy. The safety and efficacy of chronic dosing has not been established. Adverse local effects include marked burning and stinging of the treatment site which may necessitate discontinuation of the cream in some patients. Allergic contact dermatitis appears to be frequent, and patients should be monitored for symptoms of hypersensitivity. 

The discovery of the antidepressant effect of medications was coincidental to their use for other disorders. Initial work published in 1952 reported that iproniazid (originally used for the treatment of tuberculosis) could elevate mood. Although the use of iproniazid was discontinued due to toxicity, many other additional medications have been tested and approved for the treatment of depression. These include monoamine oxidase inhibitors, tricyclics, selective serotonin reuptake inhibitors, and a heterogeneous class of atypical drugs. 

Discontinuing selective serotonin reuptake inhibitors (SSRIs) may induce a syndrome wherein the main neuropsychiatric symptoms are dizziness, shock-like sensations, anxiety, irritability, agitation, and insomnia. These symptoms usually develop 1 to 7 days after abrupt or gradual discontinuation. Antidepressant discontinuation may also induce mania, mainly reported with tricyclics and monoamine oxidase inhibitors but also observed with SSRIs. 

Like other SSRIs, sertraline should not be used within 2 weeks of discontinuing monoamine oxidase inhibitors (MAOIs) and MAOIs should not be started for at least 2 weeks after stopping sertraline. 

No dosage adjustment is required in patients with mild to moderate renal impairment however, escitalopram should be used with caution in patients with severe renal impairment. Escitalopram is contraindicated in combination with irreversible monoamine oxidase inhibitors (MAOis), and a period of at least 2 weeks should be allowed between discontinuation of escitaiopram and commencement of an irreversible MAOi and vice versa. Escitaiopram appears to be a well-tolerated and effective antidepressant. 

Psychiatric evaluation of a patient after 6 weeks of treatment with a monoamine oxidase inhibitor (MAOI) shows no improvement. The psychiatrist now writes a prescription for fluoxetine which the patient starts two days after her final dose of the MAOI. Since the MAOIs used as antidepressants continue to exert effects for 2 or more weeks after discontinuance, the most likely result of the administration of fluoxetine now will be to cause (A) A rapid amelioration of her depressive symptoms Electrocardiographic abnormalities Extrapyramidal dysfunction The serotonin syndrome Weight gain... 

El-Ganzouri AR, Ivankovich AD, Braverman B, McCarthy R. Monoamine oxidase inhibitors should they be discontinued preoperatively / / / (1985) 64,592-6. 

Concomitant use of monoamine oxidase inhibitors (MAOls) or within 14 days after their discontinuation is contraindicated as hyperpyretic crisis, seizures, and deaths have occurred in patients receiving cyclobenzaprine (or structurally similar tricyclic antidepressants) and MAOls. 

Dopamine is formed within the brain from both L-dopa and l-3-O-methyldopa, but the latter is probably demethylated first. Administration of either amino acid to man or to animals [487, 494,499] enhances brain levels of dopamine and noradrenaline, and of their O-methylated metabolites, the former effect being further enhanced by monoamine oxidase inhibitors and inhibitors of catechol 0-methyl transferase. Cerebral 3-O-methyldopamine arises by methylation of dopamine rather than by decarboxylation of L-3-O-methyldopa, while the increases in cerebral and urinary homovanillic acid levels after L-dopa arise by oxidative deamination and 3-O-methylation of dopamine formed at the periphery and the neuron. The accumulation of the long-lived amino acid, L-3-O-methyldopa, in the brain, and its slow conversion to dopamine, may well explain why the therapeutic effects of L-dopa in Parkinsonism disappear only slowly upon discontinuation of treatment. Indeed, preliminary studies in man [494] indicate that l-3-O-methyldopa exerts a therapeutic action in Parkinsonism without the com-comitant side effects normally associated with L-dopa therapy. The relevant information regarding the fate and mode of action of L-dopa in the central nervous system is summarised in Figure 5.8. 

Hypersensitivity to cyclobenzaprine concomitant use of monoamine oxidase (MAO) inhibitors or within 14 days after their discontinuation acute recovery phase of Ml and in patients with arrhythmias, heart block, or conduction disturbances or CHF hyperthyroidism. 

Coadministration with a monoamine oxidase (MAO) inhibitor, Wellbutrin, Wellbutrin SR or any medications that contain bupropion current or prior diagnosis of bulimia or anorexia nervosa, seizure disorders patients who have shown an allergic response to bupropion or other ingredients in the formulation patients undergoing abrupt discontinuation of alcohol or sedatives (including benzodiazepines). 

Pharmacologic doses of pyridoxine (vitamin B6 ) enhance the extracerebral metabolism of levodopa and may therefore prevent its therapeutic effect unless a peripheral decarboxylase inhibitor is also taken. Levodopa should not be given to patients taking monoamine oxidase A inhibitors or within 2 weeks of their discontinuance because such a combination can lead to hypertensive crises. 

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