What are examples of MAOIs available in the US?
Examples of oral MAOIs include:
- rasagiline (Azilect),
- selegiline (Eldepryl, Zelapar),
- isocarboxazid (Marplan),
- phenelzine (Nardil), and
- tranylcypromine (Parnate).
Selegiline is also available in a topical patch form called Emsam.
What drugs interact with MAOIs?
MAO inhibitors should be avoided with other antidepressants such as paroxetine fluoxetine, amitriptyline, nortriptyline, bupropion; pain medications like methadone, tramadol, and meperidine; dextromethorphan, St. Johns Wort, cyclobenzaprine, and mirtazapine. Such combinations lead to high serotonin levels which may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. These medications should not be used within 14 days of stopping an MAOI.
MAOIs are not recommended for use with medications like pseudoephedrine, phenylephrine, ephedrine, and phenylpropanolamine. The combination of MAO inhibitors and these drugs can cause an acute hypertensive episode.
Monoamine oxidase also breaks down tyramine, a chemical present in aged cheese, wines, and other aged foods. Since MAOIs inhibit monoamine oxidase, they decrease the breakdown of tyramine from ingested food, thus increasing the level of tyramine in the body. Excessive tyramine can elevate blood pressure and cause a hypertensive crisis. Patients treated with MAOIs should adhere to recommended dietary modifications that reduce the intake of tyramine.
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