Tuesday, February 7, 2023
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The monoamine oxidase inhibitor (MAOI) agents currently available in the United States include phenelzine sulfate (Nardil), tranylcypromine sulfate (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl [specific for the MAO-B enzyme]), all of which irreversibly bind to MAO. Reversible inhibitors of MAO are available in Europe (eg, brofaromine, cimoxatone, clorgyline, lazabemide, moclobemide). Substances, such as St. John's wort, that may have MAOI-like activity are frequently used for self-treatment of depression. Methylene blue has also been reported to cause serotonin toxicity because of its possible MAO-A inhibitor activity.[14,15,16,17]
According to recent reviews of the experience with one of the newer selective MAOIs, moclobemide (Aurorix, Manerix), little is expected in the way of symptoms and signs from a simple overdose, except in the circumstance of the co-ingestion of another serotonin-active substance.
For food and drug interactions, the history must include a careful search for potential offending agents, including over-the-counter preparations.
Often, a significant lag or so-called latent period occurs between exposure and manifestation of clinical effects. Often, the initial effects are that of progressively severe catecholamine excess, hyperthermia, tachycardia, sweating, hypertension, and agitation followed after a lag of many hours with hypotension, seizures, and coma.
Monoamine oxidase inhibitor (MAOI) overdoses or interactions present with excessive catecholamine stimulation toxidromes. Late in the course, the patient may become hypotensive and comatose. Symptoms can be classified into mild, moderate, and severe.
A peculiar nystagmus has been reported in cases of overdose. Rapid jerking movement of the eyes as if watching a tennis or ping pong match termed "ping pong gaze"[18] or opsoclonus has been reported in severe MAOI intoxication.
Monoamine oxidase inhibitors (MAOIs) may have drug interactions with serotonin reuptake inhibitors, several analgesics (particularly meperidine [Demerol]), and tyramine-containing foods. Any drug that releases catecholamines may precipitate life-threatening events in individuals also using MAOIs.
