Monoamine Oxidase Inhibitors (MAOIs)

Key Drug Names

• Isocarboxazide
  • Mnemonic: Ice cube = isocarboxazide
• Phenylzine
  • Mnemonic: Fennel = phenylzine
• Tranylcypromine
  • Mnemonic: Waitress in training = tranylcypromine

Usage

• MAOIs are antidepressants used to treat depression
• Not first-line treatment due to many side effects and interactions

Side Effects and Risks

• Hypertensive Crisis

  • Trigger: Foods containing tyramine (e.g., wine, aged cheese, processed meats)
  • Symptoms: Severe high blood pressure (higher than 180/120), headaches, neck stiffness
  • Risk of stroke

• Serotonin Syndrome

  • Mnemonic: Happy face on takeout bag = serotonin
  • Symptoms: Agitation, restlessness, tachycardia, hypertension, muscle rigidity
  • Avoid: MAOIs should not be combined with other serotonin-altering medications (e.g., SSRIs, TCAs)
  • Wait two weeks after stopping SSRIs or TCAs before starting MAOIs

Exam Tips

• MAOIs:
  • Isocarboxazide (Ice cube)
  • Phenylzine (Fennel)
  • Tranylcypromine (Waitress in training)
• Avoid foods with tyramine: wine, aged cheese, processed meats, chocolate, yogurt, pickled or fermented foods
• Monitor for hypertensive crisis symptoms
• Prevent serotonin syndrome by avoiding combination with SSRIs/TCAs and observing a 14-day washout period.