From the Guidelines
Monoamine oxidase (MAO) inhibitors, including phenelzine, isocarboxazid, moclobemide, isoniazid, and linezolid, are examples of medications that play a role in most cases of serotonin syndrome and should be avoided in combination with any other serotonergic drug. These medications work by blocking the monoamine oxidase enzyme, which breaks down neurotransmitters like serotonin, dopamine, and norepinephrine in the brain, thereby increasing their levels and improving mood. Some key points to consider when prescribing MAO inhibitors include:
- Strict dietary restrictions to avoid foods high in tyramine (aged cheeses, cured meats, fermented products) as these can cause dangerous hypertensive crises.
- Numerous drug interactions, particularly with other antidepressants, pain medications, and certain over-the-counter cold remedies.
- Potential side effects, such as dizziness, drowsiness, and malaise.
- The need for careful monitoring, especially in the first months of treatment and following dosage adjustments, due to the risk of serotonin syndrome and other adverse effects 1. It is essential to weigh the benefits and risks of MAO inhibitors and to consider alternative treatment options before prescribing these medications, as they are usually prescribed only after other antidepressants have failed. Key examples of MAO inhibitors include:
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Selegiline (Emsam, Eldepryl)
- Isocarboxazid (Marplan)
- Moclobemide
- Isoniazid
- Linezolid These medications should be used with caution and under close supervision due to their potential for serious side effects and interactions 1.
From the FDA Drug Label
A List of MAO Inhibitors by Generic Name Follows: pargyline hydrochloride, pargyline hydrochloride and methylclothiazide, furazolidone, isocarboxazid, procarbazine, tranylcypromine The following list includes some other MAO inhibitors, dibenzazepine-related entities, and tricyclic antidepressants. Generic Name Trademark (Manufacturer) Other MAO Inhibitors Furazolidone Furoxone (Roberts Laboratories) Pargyline HCL Eutonyl® (Abbott Laboratories) Pargyline HCL and methyclothiazide Eutron® (Abbott Laboratories) Phenelzine sulfate Nardil® (Parke-Davis) Procarbazine Matulane® (Roche Laboratories) Tranylcypromine sulfate Parnate® (SmithKline Beecham Pharmaceuticals)
- Examples of MAO inhibitors include:
- Pargyline hydrochloride
- Pargyline hydrochloride and methylclothiazide
- Furazolidone
- Isocarboxazid
- Procarbazine
- Tranylcypromine
- Phenelzine sulfate 2, 3 These are monoamine oxidase inhibitors used in the treatment of certain conditions, but their use is subject to various contraindications and warnings due to potential drug interactions and side effects.