Monoamine Oxidase Inhibitors (MAOIs)

Psychiatric

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Examples

phenelzinetranylcypromineselegilineisocarboxazid

Prefix / Suffix: No consistent suffix

Physiology

Monoamine oxidase breaks down serotonin, norepinephrine, and dopamine. Inhibiting it increases their levels.

Mechanism of Action

Inhibit monoamine oxidase enzymes, preventing breakdown of monoamine neurotransmitters.

Indications

Treatment-resistant depression
Atypical depression
Parkinson's disease (selegiline)

Side Effects / Adverse Effects

Hypertensive crisis with tyramine-containing foods
Orthostatic hypotension
Insomnia
Weight gain
Serotonin syndrome with serotonergic drugs

Contraindications

Concurrent SSRIs, SNRIs, TCAs (wait 2 weeks; 5 weeks for fluoxetine)
Pheochromocytoma
Severe cardiovascular disease
Foods high in tyramine

Nursing Considerations

Strict tyramine-free diet — avoid aged cheeses, cured meats, fermented foods, soy sauce, tap beer, red wine (hypertensive crisis)
Teach signs of hypertensive crisis: severe headache, neck stiffness, chest pain, palpitations
Avoid OTC cold medicines, decongestants (sympathomimetics)
Wait 2 weeks before/after switching antidepressants (5 weeks for fluoxetine)
Monitor BP regularly
Used as last-line due to dietary restrictions and interactions

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