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.
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
| Drug name | Learn more | See SingleCare price |
|---|---|---|
| Azilect | Azilect details | Azilect price |
| Rasagiline Mesylate | Rasagiline-Mesylate details | Rasagiline-Mesylate price |
| Emsam | Emsam details | Emsam price |
| Marplan | Marplan details | Marplan price |
| Nardil | Nardil details | Nardil price |
| Phenelzine Sulfate | Phenelzine-Sulfate details | Phenelzine-Sulfate price |
| Parnate | Parnate details | Parnate price |
| Cyclobenzaprine Hcl | Cyclobenzaprine-Hcl details | Cyclobenzaprine-Hcl price |
| Xadago | Xadago details | Xadago price |
Who can take MAOIs?
Although MAOIs carry the potential for serious side effects, they have been established as effective treatments for depression in adults. Their utilization is less common compared to other antidepressants due to dietary restrictions and the risks of adverse reactions when combined with specific medications.
Use caution when prescribing MAOIs to seniors
Elderly individuals may face an elevated risk of adverse reactions when using MAOIs. Typically, dosage selection for older patients should commence at the lower end of the dosing spectrum, especially if they exhibit reduced liver, kidney, or cardiac function. Seniors are also more prone to secondary diseases or undergoing drug therapy that could affect the effectiveness or safety of an MAOI.
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
Serotonin syndrome is a severe and potentially life-threatening condition characterized by an excess of serotonin in the body. Symptoms may include high fever, seizures, irregular heartbeat, or loss of consciousness. If any of these symptoms occur, urgent medical attention may be necessary. MAOIs should not be combined with other medications that can elevate serotonin levels. Below is a list of drug classes and medications that should not be used with MAOIs due to concerns about serotonin syndrome:
- Selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), Zoloft (sertraline), or Paxil (paroxetine)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor (venlafaxine) or Cymbalta (duloxetine)
- Tricyclic antidepressants (TCAs) like Elavil (amitriptyline), Pamelor (nortriptyline), or Tofranil (imipramine)
- Atypical antidepressants like Wellbutrin (bupropion), Ludiomil (maprotiline), Serzone (nefazodone), or Desyrel (trazodone)
- Opioids and other pain medications such as MS Contin (morphine sulfate), OxyContin (oxycodone), Demerol (meperidine), Duragesic (fentanyl), Dilaudid (hydromorphone), Dolophine (methadone), or Ultram (tramadol)
- Sympathomimetic drugs like amphetamines, as well as certain cold, hay fever, or weight-reducing products containing dextromethorphan, pseudoephedrine, phenylephrine, or ephedrine
- Triptans such as Imitrex (sumatriptan), Maxalt (rizatriptan), or Zomig (zolmitriptan)
- Miscellaneous drugs like Flexeril (cyclobenzaprine), Tegretol (carbamazepine), Buspar (buspirone), lithium, dopamine, reserpine, or St. John’s wort.
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.