Overview
This lecture covers monoamine oxidase inhibitors (MAOIs), their key drug names, uses, dangerous interactions, and main side effects relevant for exams.
MAOI Drug Names
- The main MAOIs are isocarboxazid, phenelzine, and tranylcypromine.
- Mnemonics: "Ice cube" for isocarboxazid, "fennel" for phenelzine, and "training" for tranylcypromine.
Clinical Use
- MAOIs are antidepressants used to treat depression.
- They are not first-line treatments due to significant side effects and interactions.
Adverse Effects & Safety Concerns
- MAOIs can cause hypertensive crisis (dangerously high blood pressure), especially if combined with certain foods.
- Symptoms of hypertensive crisis include severe headache and neck stiffness; immediate blood pressure check is needed.
Food & Drug Interactions
- Eating foods high in tyramine (e.g., wine, aged cheese, processed meats) while on MAOIs can trigger hypertensive crisis.
- Other tyramine-rich foods include chocolate, yogurt, and fermented products.
- MAOIs should not be taken with serotonin-altering drugs like SSRIs or TCAs due to risk of serotonin syndrome.
Serotonin Syndrome
- MAOIs increase serotonin, which can cause serotonin syndrome if combined with other serotonergic drugs.
- Serotonin syndrome symptoms: agitation, restlessness, tachycardia, hypertension, and muscle rigidity.
- There must be a 2-week (14-day) gap between stopping an SSRI/TCA and starting an MAOI (or vice versa).
Key Terms & Definitions
- MAOI (Monoamine oxidase inhibitor) — a class of antidepressants that block the enzyme monoamine oxidase.
- Hypertensive crisis — sudden, severe increase in blood pressure that can lead to stroke.
- Tyramine — amino acid in certain foods that can raise blood pressure when combined with MAOIs.
- Serotonin syndrome — potentially fatal condition from excess serotonin, causing unstable vitals and neuromuscular symptoms.
Action Items / Next Steps
- Memorize MAOI drug names and core adverse effects.
- Learn dietary restrictions for patients on MAOIs.
- Remember the 14-day washout period with other serotonergic meds.