Monoamine Oxidase Inhibitors (MAOIs)

Introduction

• MAOIs are a class of antidepressants.
• Known for having significant drug and food interactions.
• Use mnemonic "Maui" to remember MAOIs.

Common MAOIs

1. Isocarboxazid
   • Symbol: Ice cubes.
   • Mnemonic: "Ice cube oxazid."
2. Phenylzine
   • Symbol: Fennel.
   • Mnemonic: "Fennel for phenylzine."
3. Tranylcypromine
   • Symbol: Waitress in training.
   • Mnemonic: "Training for tranylcypromine."

Use of MAOIs

• Primarily used to treat depression.
• Not a first-line treatment due to side effects and interactions.

Side Effects and Risks

1. Hypertensive Crisis
   • Symbol: Inflating beach ball (increased pressure).
   • Condition triggered by high blood pressure (>180/120).
   • Symptoms: Headaches, neck stiffness.
   • Triggered by foods containing tyramine.
2. Serotonin Syndrome
   • Symbol: Happy face on take-out bag.
   • Due to an overload of serotonin.
   • Symptoms: Agitation, restlessness, tachycardia, hypertension, muscle rigidity.
   • Avoid taking MAOIs with other serotonin-altering drugs (SSRIs, TCAs).
   • Require a 2-week drug-free period between SSRIs/TCAs and MAOIs.

Dietary Considerations

• Avoid tyramine-rich foods:
  • Wine, aged cheeses, processed meats.
  • Also includes chocolate, yogurt, pickled or fermented foods.

Summary

• MAOIs include isocarboxazide, phenylzine, and tranylcypromine.
• Used for depression but not first-line due to interactions.
• Watch for hypertensive crisis and serotonin syndrome.
• Avoid tyramine and do not combine with other serotonin-altering medications within 14 days.