MAO Inhibitors Drug List: Types, Uses, and Key Warnings You Should Know

Monoamine oxidase inhibitors, also known as MAO inhibitors or MAOIs, function by impeding the activity of monoamine oxidase enzymes in the brain.

These enzymes are responsible for the degradation of neurotransmitters like dopamine, norepinephrine, and serotonin. While historically linked to depression due to low levels of these neurotransmitters, their deficiency might not solely explain depression. MAOIs elevate the levels of these neurotransmitters by inhibiting the actions of monoamine oxidase enzymes.

Typically reserved for cases where standard antidepressants have failed, MAOIs pose a higher risk of drug interactions compared to conventional antidepressants. Additionally, they can interact adversely with specific foods such as aged cheeses and cured meats.

Key Facts: Understanding MAO Inhibitors (MAOIs)

1. What Are MAO Inhibitors?

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs that treat mental health conditions by blocking the enzyme monoamine oxidase, which breaks down mood-regulating neurotransmitters like serotonin, dopamine, and norepinephrine.

2. Common MAOI Drugs Listed:

The article lists several widely known MAOI medications, including phenelzine, tranylcypromine, and isocarboxazid, which are often used when other antidepressants fail.

3. When Are They Prescribed?

MAOIs are generally reserved for treatment-resistant depression, panic disorders, or atypical depression due to their potential for serious food and drug interactions.

4. Dangerous Interactions:

Taking MAOIs with certain foods (like aged cheese and cured meats) or drugs (like SSRIs or decongestants) can lead to life-threatening conditions such as hypertensive crisis or serotonin syndrome.

5. Use with Caution:

Patients on MAOIs require close monitoring, strict dietary restrictions, and careful drug management. They’re not typically first-line antidepressants due to these complexities.

How do MAOIs work?

The monoamine oxidase enzyme naturally occurs in the body and is responsible for breaking down, or deactivating, specific neurotransmitters collectively referred to as monoamines, which include serotonin, dopamine, epinephrine, and norepinephrine. It is hypothesized that individuals with depression exhibit reduced levels of these neurotransmitters in the brain. MAOIs function by blocking the activity of monoamine oxidase, thereby impeding the breakdown of monoamines and leading to elevated levels of these neurotransmitters in the brain.

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What are MAOIs used for?

MAOIs are primarily prescribed to address depression; however, they may also be employed in treating the following conditions:

• Parkinson’s disease
• Alzheimer’s disease
• Panic disorder
• Social anxiety disorder
• Bulimia

List of MAOIs

Who can take MAOIs?

Warnings for MOAIs in children and adolescents

Antidepressants, including MAOIs, are subject to a mandated “boxed warning,” also known as a black box warning, by the U.S. Food and Drug Administration (FDA) due to an elevated risk of suicidality in individuals under 24 years of age. Safety and effectiveness for pediatric use have not been established for most MAOIs. When contemplating the use of an MAOI in a child or adolescent, the prescriber must carefully weigh the potential risks against the clinical benefits.

Pros and Cons of mao

Pros:

• Effectiveness
• Unique Mechanism
• Treatment for Atypical Depression
• Use in Other Conditions

Cons:

• Side Effects
• Dietary Restrictions
• Drug Interactions

Differences Between mao and sulindac

MAO (Monoamine Oxidase):

MAO is an enzyme found in the body that helps break down neurotransmitters such as serotonin, dopamine, and norepinephrine.

Sulindac:

Sulindac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, inflammation, and swelling caused by various conditions such as arthritis and gout.

Alternative to mao

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

• SNRIs are another class of antidepressants that increase levels of serotonin and norepinephrine in the brain.
• Examples include venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).

Are MAOIs safe?

MAOIs come with a boxed warning concerning the heightened risk of suicidal ideation and behavior in some younger patients. All patients, regardless of age, who commence antidepressant therapy should undergo monitoring for indications of suicidal thoughts and behaviors. Additionally, MAOIs feature a second boxed warning regarding a sudden and severe rise in blood pressure that may result from consuming specific foods or beverages during treatment.

Prior to initiating an MAOI regimen, patients should be informed about the significant drug-food and drug-drug interactions that could lead to serotonin syndrome or hypertensive crisis.

Serotonin syndrome

Hypertensive crisis

An elevation in blood pressure may occur significantly when there are excessive levels of tyramine in the body. Tyramine, a naturally occurring amino acid aiding blood pressure regulation, is commonly found in certain foods. The enzyme monoamine oxidase facilitates the breakdown of surplus tyramine. However, since MAOIs inhibit monoamine oxidase, tyramine levels can accumulate to hazardous levels. This elevation in tyramine can trigger a severe surge in blood pressure necessitating immediate medical attention. Patients should be cautioned to avoid the following foods and beverages while taking MAOIs and for two weeks after discontinuation:

Meat and fish

Pickled herring

Liver

Dry sausage varieties (including Genoa salami, hard salami, pepperoni, and Lebanon bologna)

Spoiled or improperly stored meat, poultry, and fish

Vegetables

Broad bean pods (fava bean pods)

Sauerkraut

Fruits

Overripe avocados, bananas, raisins, or figs

Dairy products

Aged cheeses

Yogurt

Beverages

Beer and wine

Alcohol-free and reduced-alcohol beer and wine products

Miscellaneous

Yeast extract (including brewer’s yeast in large quantities)

Meat extract

Most soybean products (including soy sauce and tofu)

Excessive quantities of chocolate and caffeine

Over-the-counter supplements containing tyramine

Common MAOI side effects

The following are potential common side effects associated with MAOIs. This list is not exhaustive, and it is essential to seek professional medical advice from a healthcare provider before initiating MAOI therapy:

• Orthostatic hypotension (temporary drop in blood pressure, often upon standing suddenly)
• Dizziness
• Headache
• Insomnia
• Restlessness
• Central nervous system (CNS) stimulation
• Muscle spasms
• Tremor
• Myoclonic jerks (abrupt muscle contractions)
• Anxiety
• Agitation
• Weakness
• Blurred vision
• Nausea
• Vomiting
• Drowsiness
• Loss of appetite
• Palpitations
• Tachycardia (rapid heart rate)
• Ejaculatory dysfunction
• Impotence
• Dry mouth
• Swelling of lower legs or hands
• Diarrhea
• Constipation
• Paresthesia (tingling or prickly sensation in hands or feet)
• Tinnitus (ringing or buzzing in the ears)
• Urinary retention
• Rash

Conclusion

MAOIs offer effective treatment options for depression in adults, albeit with the potential for significant side effects and interactions. Caution is warranted, especially when considering their use in elderly patients and younger individuals. The risk of serotonin syndrome and hypertensive crisis underscores the importance of careful medication management and adherence to dietary restrictions. Patients should be vigilant about potential adverse effects and promptly report any concerning symptoms to their healthcare providers. Ultimately, collaboration between patients and healthcare professionals is paramount to ensure safe and effective treatment with MAOIs.

Authoritative References:

1. National Institutes of Health (NIH) – MedlinePlus. Monoamine Oxidase Inhibitors (MAOIs).
https://medlineplus.gov/ency/article/007434.htm

2. American Psychiatric Association. (2023). Practice Guidelines for the Use of Antidepressants.
https://www.psychiatry.org

3. Mayo Clinic. (2024). Depression (major depressive disorder) – MAOIs.
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273