What Are the Different Types of MAOI Drugs?

Monoamine Oxidase Inhibitor (MAOI) is the earliest antidepressant discovered. Once widely used in psychiatry. It was later discovered that the combination of MAOI with multiple drugs is potentially dangerous. Such as narcotic analgesics, sympathomimetics, antihypertensive drugs and so on. Even patients receiving MAOI cannot eat certain foods.

Monoamine oxidase inhibitor

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Monoamine Oxidase Inhibitor (MAOI) is the earliest antidepressant discovered. Once widely used in psychiatry. It was later discovered that the combination of MAOI with multiple drugs is potentially dangerous. Such as narcotic analgesics, sympathomimetics, antihypertensive drugs and so on. Even patients receiving MAOI cannot eat certain foods.

Drug Name

Monoamine oxidase inhibitor

Foreign name

Monoamine Oxidase Inhibitor

Whether prescription drugs

prescription

Main indications

Depression

Although MAOI has gradually been replaced by tricyclic antidepressants, MAOI has a better effect on patients with severe horror and anxiety symptoms and on patients who are not effective with tricyclic antidepressants. MAOI is also used in the treatment of Parkinson's syndrome, especially for patients who have developed tolerance after long-term use of levodopa, adjuvant MAOI can improve the efficacy. Some MAOIs have antihypertensive effects, and internal medicine is used to treat moderate and severe hypertension. Patients receiving MAOI may be complicated by surgical conditions, and surgery and anesthesia will inevitably be needed.

Although there are not many varieties of monoamine oxidase inhibitor (MAOI) drugs, some varieties are widely used in clinical applications. This class of drugs in combination with many drugs can cause serious toxic side effects, such as: dizziness, insomnia, myasthenia, blurred vision, hyperreflexia, dyspnea, and changes in blood. The most serious toxic reaction is liver necrosis, which is now more likely to cause this toxicity, which is 20% to 50% of cases fatal. Although other MAOIs are less toxic than isoniazid, It should still be absolutely prohibited in those who have had jaundice or liver dysfunction. In addition to the above-mentioned side effects, there have been repeated reports abroad that taking MAOI can cause severe hypertension crisis and even death due to intracranial hemorrhage. It deserves high vigilance.

1MAOI drug varieties

Antibacterials: isoniazid, furazolidone, ketoconazole, griseofulvin; antihypertensive drugs: Youjiangning;
Antidepressants: phenelzine, bromfaroxamine, toloxadone, isoxazine (boring cola), phencycline, moclobemide, selegiline;
Drugs for treating Parkinson's disease: levodopa;
Anticancer drugs: methylbenzide and so on.

2 interactions

2.1 Nootropic drugs: Duxil (both welcome) is forbidden to be used in combination with MAOI, because of increased toxicity, tachycardia, hypotension and shortness of breath are prone to appear.

2.2 Antiarrhythmic drugs: Morrezine, Amiodarone, MAOI can block its metabolic inactivation, increase the effect and cause bradycardia and conduction disorders.

2.3 Analgesics: fentanyl, morphine, dulentin, MAOI can inhibit the liver drug enzyme system, block its metabolic inactivation, cause severe hypotension, respiratory arrest and shock.

2.4 Antiepileptic drugs: Combining carbamazepine with MAOI can easily cause hypotension.

2.5 Anxiolytics: Diazepam, sulbutamine, nitroazepam, etc. in combination with MAOI can cause extreme sedation and convulsions.

2.6 Antihypertensive drugs: guanethidine, guanidine, clonidine, uronidine, depressor, reserpine, MAOI can antagonize its antihypertensive effect, the principle is to inhibit the release of norepinephrine (NA) transmitters And deplete its storage. MAOI attenuates the metabolic inactivation of NA. For example, combined use of MAOI can reduce inactivation and antagonize its hypotensive effect. Butofilolo, Budralazine: Combined with MAOI, the latter can slow down the metabolism of the second drug and increase the antihypertensive effect.

2.7 Weight-loss medicines: fenfluramine and sibutramine, do not take fenfluramine at the same time or within 14 days after taking MAOI, otherwise it can cause hypertension crisis; sibutramine is an oral central-acting weight-loss medicine The mechanism of action is to inhibit the reuptake of serotonin (5-HT) and NA by the central nervous cells, reduce appetite, and cannot be combined with MAOI drugs.

2.8 Hypoglycemic drugs: Insulin, D860, chlorosulfuramide, MAOI can prevent the former's metabolism and enhance the hypoglycemic effect.

2.9 Local anesthetic: Cocaine, can make the NA released from the sympathetic nerve endings can not be retaken, but accumulated outside the cell. Concomitant use of MAOI can block the inactivation of NA, increase the NA with physiological activity, and constrict blood vessels and increase blood pressure.

2.10 Thiazine diuretics: MAOI can enhance the antihypertensive effect of the former and easily cause orthostatic hypotension.

2.11 Antiasthmatic drugs: Ephedrine, combined with MAOI can inhibit the former's metabolic inactivation, leading to a fatal hypertension crisis.

2.12 Antiparkinsonian drugs: Levodopa, combined with MAOI, can inhibit the former's metabolic inactivation, leading to a fatal hypertension crisis.

2.13 Antidepressants: SSRI drugs (selective 5-HT reuptake inhibitors): paroxetine, fluoxetine, sertraline, etc., combined with MAOI often cause 5-HT syndrome. At present, a large number of SSRI and Reports of lethal 5-HT syndrome caused by combined use of MAOI often occur when SSRI is discontinued and when MAOI is started. In contrast, SSRI has fewer drug interactions when used in combination with reversible and selective MAOI (such as morphobexamide). Regarding the time of withdrawal, it has been reported that when patients with fluoxetine treatment fail to switch to MAOI drugs, fluoxetine should be stopped for at least 5 weeks to ensure the complete discharge of the drug and its metabolites.

Tricyclic antidepressants (TCA), such as imipramine, normipramine, and amitriptyline, together with maprotiline, mirtazapine antidepressants, and amphetamine, can be combined with MAOI to inhibit the former. Metabolic inactivation, leading to a fatal hypertension crisis. However, when refractory depression is ineffective with amitriptyline, MAOI can be added. When the first use of MAOI is not effective and it is necessary to switch to amitriptyline, MAOI should be discontinued two weeks later.

2.14 Chinese medicine: Chinese medicine or proprietary Chinese medicines containing belladonna alkaloids (belladonna, Weitongsan, Tongqiaosan, etc.), ephedra and its preparations (Xiaoqinglong Mixture, Tongxuanlifei pills, Dingchuan pills, etc.), and MAOI use. In addition, patients receiving MAOI should be restricted or prohibited from eating foods rich in tyramine (cheese, yogurt, meat, etc.).

2.15 Interaction between MAOI: MAOI cannot be used together. Selective MAOI selegiline mainly inhibits monoamine oxidase B, so it is considered to be unlikely to cause high blood pressure risk in people who eat amine-rich foods or take catecholamine-enhanced prescriptions; reversible selective MAOI moclobemide inhibits monoamine oxidase A, so there are fewer side effects. But selective MAOI interactions can also cause CNS (antipsychotic malignant syndrome).