Monoamine oxidase inhibitors MAOIs interactions

Monoamine Oxidase Inhibitors (MAOIs). Controlled trials comparing the M AOl phenelzine to clomipramine or fluoxetine have produced mixed results. Given the limited data regarding any efficacy of MAOIs in the treatment of OCD coupled with their potentially dangerous interactions, we cannot recommend MAOIs in the treatment of OCD until other approaches have been tried. 

Monoamine Oxidase Inhibitors (MAOIs). Early studies also evaluated the effectiveness of the MAOl phenelzine. Phenelzine, relative to TCAs, provided greater benefit for PTSD however, its usefulness is limited by its potential for drug and food interactions. A recent open label study suggests that the reversible MAOI moclobemide might be helpful for PTSD. It is not available in the United States. 

Arguably the first modern class of antidepressants, monoamine oxidase inhibitors (MAOIs) were introduced in the 1950s but are now rarely used in clinical practice because of toxicity and potentially lethal food and drug interactions. Their primary use now is in the treatment of depression unresponsive to other antidepressants. However, MAOIs have also been used historically to treat anxiety states, including social anxiety and panic disorder. In addition, selegiline is used for the treatment of Parkinson s disease (see Chapter 28). 

Because of neurotoxicity and overdose concerns, 2C-B may have potentially dangerous interactions with users taking monoamine oxidase inhibitors (MAOIs). MAOIs are most commonly found in the prescription antidepressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (1-deprenyl), and Aurorex or Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline). 

Drugs and chemicals are known to cause activated interaction. The depressant action of opioid drugs is enhanced by drugs acting on the central nervous system (CNS) such as alcohol, anesthetics, anxiolytics, hypnotics, tricyclic antidepressants, and antipsychotics. Concomitant administration of opioid analgesics and monoamine oxidase inhibitors (MAOIs) should be avoided, or extra care should be taken if such a therapy is inevitable. Fatal reactions are reported when treated along with selegiline. Interactions also are reported with cyclizine, cimetidine, mexiletine, cisapride, metoclopramide, or domperidone. 

Q8 A pregnancy test is necessary because hypertension is a feature of preeclampsia, a serious condition which can occur in pregnancy and which threatens the life of both mother and foetus. Also, many antihypertensive drugs are contraindicated in pregnancy. It is necessary to know whether the patient is taking prescribed medicines or is self-medicating, as some drugs, such as monoamine oxidase inhibitors (MAOIs), can interact with dietary components to cause a very rapid rise in BP. 

Interactions. With nonselective monoamine oxidase inhibitors (MAOI), the monoamine dopamine formed from levodopa is protected from destruction it accumulates and also follows the normal path of conversion to noradrenaline (norepinephrine), by dopamine (J-hydroxylase severe hypertension results. The interaction with the selective MAO-B inhibitor, selegiline, is possibly therapeutic (see below). Tricyclic antidepressants are safe. Levodopa antagonises the effects of antipsychotics (dopamine receptor blockers). Some antihypertensives enhance hypotensive effects of levodopa. Metabolites of dopamine in the urine interfere with some tests for phaeochromocytoma, and in such patients it is best to measure the plasma catecholamines directly. 

All SSRIs have common 5-HT agonistic effects and because of this, SSRIs have common interactions and side effects. SSRIs are potent inhibitors of serotonin reuptake by CNS neurons and may interact with other drugs such as monoamine oxidase inhibitors (MAOIs) or circumstances which cause serotonin release. A minimum 2 weeks wash-out period should be observed between stopping a MAOI and starting an SSRI. Conversely, a MAOI should not be started for at least 1 week after an SSRI has been stopped, 5 weeks after fluoxetine, and 2 weeks for paroxetine and sertraline. Escitalopram and citalopram are hypersensitive to each other. 

Monoamine-oxidase inhibitors (MAOIs) make up the second group and include, isocarboxazid, tranylcypromine and phenelzine, which are now used less commonly due to severe side-effects, especially through a potentially dangerous interaction with foodstuffs. A newer agent, moclobemide (a RIMA, reversible, selective type A monoamine-oxidase inhibitor) is said to give less dangerous interactions with foodstuffs. See monoamine-oxidase inhibitors. 

The ephedra alkaloids are all sympathomimetic amines, which means that a host of drug interactions are theoretically possible. In fact, only a handful of adverse drug interactions have been reported in the peer-reviewed literature. The most important of these involve the monoamine oxidase inhibitors (MAOI). Irreversible, nonselective MAOIs have been reported to adversely interact with indirectly acting sympathomimetic amines present in many cough and cold medicine. In controlled trials with individuals taking moclobemide, ephedrine s effects on pulse and blood pressure were potentiated, but only at higher doses than those currently provided in health supplements (137). Ephe-drine-MAOI interaction may, on occasion, be severe enough to mimic pheo-... 

When explaining possible medication and/or food interactions, for example the importance of avoiding alcohol with certain drugs such metronidazole or cheese with monoamine oxidase inhibitors (MAOIs). 

MAOI and SSRI are acronyms for two types of antidepression medication. MAOI stands for monoamine oxidase inhibitor. MAOIs must be prescribed and used with caution because they tend to dangerously interact with other types of drugs.Today, other forms of antidepressants are usually prescribed for depression patients first. If those medicines do not work, MAOIs are sometimes used with caution. People taking MAOIs have to restrict their diets and watch what other drugs and medicines they take in order to prevent interactions. SSRI, an antidepressant that is more commonly used, stands for selective serotonin reuptake inhibitor.They are generally able to be tolerated by more people and can be used for more minor depressive illnesses. 

Monoamine oxidase inhibitors (MAOIs) Phenelzine, tranylcypromine, and moclobemide have no clinically significant interactions with carbamazepine. 

AUC, area under the curve, Cmax, maximum concentration MAOI, monoamine oxidase inhibitor TCA, tricyclic antidepressant. Recommended first-line drug interaction search engines Lexi-Comp, Inc Lexi-Comp Online, http //online.lexi.com and Thomson MICROMEDEX Healthcare Series https //www.thomsonhc.com. 

The monoamine oxidase inhibitors are associated with a number of undesirable side effects including weight gain, postural hypotension, sexual dysfunction, and insomnia. The most serious side effect is the risk of tyramine-re-lated hypertensive crisis, often referred to as the "cheese effect," which can be fatal. To avoid this situation patients taking MAOIs must limit their tyramine intake, and the restrictive diet required to accomplish this leads to low patient compliance. A similar interaction occurs when switching patients from MAOI to SSRI therapy, and a minimum 2-week washout period before commencement of SSRI therapy is essential to allow MAO levels to return to normal. The therapeutic effects of the TCAs derive from their inhibition of serotonin and norepinephrine uptake, al-... 

Antidepressants are considered to have additive effects, therefore combined use is not recommended. Inhibitors of serotonin reuptake by CNS neurons may interact with other drugs or circumstances which cause serotonin release. The enhancement of the serotonergic effects may produce a life-threatening serotonin syndrome. Drugs which can increase the serotonin level when taken in combination with SSRIs include TCAs, MAOIs, reversible inhibitors of monoamine oxidase, carbamazepine, lithium, or serotoneric substances. These drugs should not be coadministered with SSRIs and they may increase the risks of developing a serotonin syndrome. 

Monoamine oxidases (both MAO-A and MAO-B) also exist in peripheral tissue, specifically the gastrointestinal tract (GIT). In the GIT, they inhibit the first-pass metabolism of exogenous tyramine. Because of this property, treatment with non-selective irreversible MAOIs can result in the accumulation of tyramine and have the potential to precipitate a dangerous hypertensive crisis, the so-called cheese effect. This effect may occur more frequently in elderly than in younger patients, because the cardiovascular systems of the elderly are already compromised by age. Selective MAO-B inhibitors and reversible MAO-A inhibitors are free from this potentially fatal interaction. 

Some of the newer and more recently developed drugs with MAO inhibitory activity (see Table 32.1 , (below)) interact to a lesser extent than the older MAOIs. This is because they are largely selective. One group of these selective inhibitors targets MAO-A, and are relatively rapidly reversible inhibition of this enzyme is responsible for the antidepressant effect. These selective MAO-A inhibitors (moclobemide, toloxatone) have been given the acronym RIMAs (Reversible Inhibitors of Monoamine oxidase A). They leave MAO-B largely uninhibited so that there is still a metabolic pathway available for the breakdown of amines, such as... 

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