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Toxicity, Monoamine Oxidase Inhibitor

  • Authors: Steven Marcus, MD
  • CME/CE Released: 1/4/2011
  • Valid for credit through: 1/4/2013
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  • Laurie E. Scudder, DNP, NP

    Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC


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Toxicity, Monoamine Oxidase Inhibitor: Treatment



Prehospital Care

Prehospital care for MAOI toxicity may include the following:

  • Stabilization of vital signs - IV fluids
  • Treatment of seizure activity - Benzodiazepines
  • Attention to airway maintenance
  • Attention to temperature control

Emergency Department Care

  • Decontamination
    • Because of the potential for severe toxicity and lack of antidotes, an aggressive decontamination is very important.
    • Consider gastric lavage, particularly in patients with recent ingestion (within an hour).
    • Administer charcoal: Secure unprotected airway prior to lavage and charcoal administration if needed.
    • Because of its pharmacokinetics, extracorporeal removal, such as hemodialysis or repeat dosed of activated charcoal, is likely less effective to reduce its level.
  • If the patient is hyperthermic, rapidly (within 20-30 min) decreasing the temperature is imperative.
    • Antipyretics and use of a cooling blanket are generally inadequate.
    • The best methods for cooling patients include increasing evaporative losses by wetting their skin with warm water and maintaining airflow over them with fans.
    • Removing the patient's clothing and exposing the patient to room air may help. In extreme cases, packing the individual in ice or in a bath of ice water may prove life saving.
  • Fluid therapy is of paramount importance. Patients may be significantly dehydrated from hyperthermia.
  • Treating the associated hypertension is usually not necessary.
    • It may actually be dangerous because of the eventual hypotensive phase (avoid beta-blockers because they leave unopposed alpha-stimulation), which may exacerbate the clinical picture.
    • If antihypertensive therapy is deemed necessary, use of a short-acting antihypertensive agent, such as nitroprusside, nitroglycerine or phentolamine, is advisable.
  • Intravenous benzodiazepines are useful for agitation and seizure control; they also may help control the hypertension.
  • Hospital admission is recommended in a patient with a tyramine reaction if symptoms do not resolve within 6 hours of onset and if it was an intentional MAOI overdose.


  • Consult the regional poison control center or a local medical toxicologist (certified through the American Board of Medical Toxicology and/or the American Board of Emergency Medicine) to obtain additional information and patient care recommendations.
  • Critical care management may be required for cardiovascular complications.
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