A Clinician's Guide to Monoamine Oxidase Inhibitors

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:Objective:This article provides an up-to-date review of major drug interactions and an overview of food interactions with monoamine oxidase inhibitors (MAOI) including both antidepressants and other drugs used in general medicine.Data Sources:English language literature identified by PubMed search of terms including monoamine oxidase, phenelzine, tranylcypromine, isocarboxazide, selegiline, rasagiline, linezolid, methylene blue, serotonin syndrome, hypertensive crisis. Articles were selected primarily from the last 10 years of published journals with a selection of classical older articles. Exclusion criteria were not applied because of the interest in including case reports of drug interactions.Data Extraction:type, frequency, and severity of drug interactions.Results:Classical irreversible non-selective monoamine oxidase inhibitors (MAOI) (phenelzine, tranylcypromine, and isocarboxazid) have been minimally utilized due to fear of dietary and drug interactions. Moclobemide and transdermal selegiline offer greatly improved safety and comparable psychiatric efficacy, while non-psychiatric MAOIs such as linezolid, methylene blue, oral selegiline and rasagiline have similar potential drug interactions. The most hazardous MAOI drug interactions involve SSRI and SNRI antidepressants, meperidine, tramadol, dextromethorphan and sympathomimetics while the food interactions involve high tyramine aged fermented foods.Conclusions:Awareness of hazardous MAOI drug interactions is essential both in using these drugs for treatment of depression and in general medical consultation.

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