What does mao mean. Features of the use of MAO inhibitors. MAO inhibitors

Monoamine oxidase inhibitors (MAOIs, MAOIs)- biologically active substances capable of inhibiting the enzyme monoamine oxidase contained in nerve endings, preventing the destruction of various monoamines (serotonin, norepinephrine, dopamine, phenylethylamine, tryptamines, octopamine) by this enzyme and thereby contributing to an increase in their concentration in the synaptic cleft.

Monoamine oxidase inhibitors include some antidepressants, as well as a number of natural substances.

IMAO classification

According to their pharmacological properties, monoamine oxidase inhibitors are divided into reversible and irreversible, selective and non-selective.

Selective MAOIs inhibit mainly one of the types of MAO, non-selective - both types (MAO-A and MAO-B).

Irreversible MAOIs interact with monoamine oxidase, forming chemical bonds with it. The enzyme is then unable to perform its functions and is metabolized, and instead the body synthesizes a new one, which usually takes about two weeks.

Reversible MAOIs bind to the active site of the enzyme and form a relatively stable complex with it. This complex gradually dissociates, releasing MAOI, which then enters the bloodstream and is excreted from the body, leaving the enzyme intact.

Non-selective irreversible MAOIs

Iproniazid
Nialamide
Isocarboxazid
Phenelzine
Tranylcypromine

Strictly speaking, it is not entirely correct to attribute tranylcypromine to this group, since it is a reversible inhibitor, however, it may take up to 30 days for the dissociation of its complex with the enzyme and its complete elimination from the body. In addition, it exhibits some selectivity towards MAO-A.

Currently, non-selective MAO inhibitors are rarely used. This is due to their high toxicity. Unlike most other non-selective MAOIs, iproniazid is not used at all, which is now universally discontinued due to high hepatotoxicity; in many countries, isocarboxazid has also been discontinued for the same reason.

Isoniazid, an anti-tuberculosis drug, historically the first MAOI, also has clinically significant activity: it was the euphoric effect of isoniazid observed in tuberculosis patients that led to the discovery of monoamine oxidase inhibitors. Due to its significant hepatotoxicity and potential to cause pyridoxine-deficient polyneuropathies, isoniazid has ceased to be used as an MAOI, except for its use off-label at high doses in combination with high doses of vitamin B6 in countries where other hydrazine MAOIs are not available.

Reversible selective MAO-A inhibitors

Moclobemide
Pirlindol (pyrazidol)
befol
Metralindol
Garmalin
Derivatives of beta-carbolines

Irreversible selective MAO-B inhibitors

Selegiline
Rasagiline
Pargylin

The division into MAOI-A and MAOI-B is partly conditional, since at high doses MAOI-Bs lose their selectivity and begin to block MAO-A as well, and MAOI-A at high doses (exceeding the maximum doses recommended in the instructions) also significantly block MAO-B . The division into irreversible and reversible MAOs is also somewhat arbitrary: only hydrazine derivatives - nialamide, phenelzine, isocarboxazid, iproniazid - are completely irreversible MAOIs. Tranylcypromine and selegiline are partly reversible: after stopping their intake, monoamine oxidase is restored not after 2 weeks, as after stopping the intake of hydrazine MAOIs, but after 5-7 days.

Selegiline and rasagiline are officially registered in Russia only for the treatment of Parkinson's disease. The antidepressant effect of selegiline in monotherapy is observed only at high doses, when it loses its selective effect. However, as potentiators, selegiline and rasagiline can be used in selective MAO-B dosages, in which they act as dopaminergic agents.

Tranylcypromine and selegiline are metabolized to amphetamine to a small extent in the body, which is partly due to their strong stimulant activity.

Therapeutic action

MAOIs, blocking the destruction of monoamines by monoamine oxidase, increase the content of one or more mediator monoamines (norepinephrine, serotonin, dopamine, phenylethylamine, etc.) in the synaptic cleft and enhance monoaminergic (monoamine-mediated) transmission of nerve impulses (neurotransmission). For this reason, for medical purposes, these substances are used mainly as antidepressants. MAOI-Bs are also used in the treatment of parkinsonism and narcolepsy.

Side effects

Non-selective inhibitors

The main undesirable effect is orthostatic hypotension, which is observed in almost all patients taking these drugs, while a hypertensive reaction as a result of the interaction of MAO inhibitors with products or drugs that can provoke a hypertensive crisis is rare.

Non-selective MAO inhibitors have a large number of side effects. These include dizziness, headache, urinary retention, constipation, fatigue, dry mouth, blurred vision, skin rashes, anorexia, paresthesia, swelling of the legs, convulsive epileptiform seizures, hepatitis. In addition, due to a pronounced psychostimulant effect, these drugs can cause euphoria, insomnia, tremors, hypomanic agitation; due to the accumulation of dopamine - delirium, hallucinations and other mental disorders. Perhaps the development of Korsakov's syndrome. The use of non-selective MAO inhibitors often leads to sexual side effects such as reduced libido, erectile dysfunction, delayed or absent orgasm, delayed or absent ejaculation.

Like other antidepressants, MAOIs can induce a manic episode in predisposed patients. MAOIs are more likely to cause manic episodes than some other antidepressants, and for this reason they are not the drugs of choice for the treatment of depressive episodes with a previous manic episode.

Iproniazid has a pronounced hepatotoxic effect, which predetermines its unsuitability for widespread use in psychiatry. Phenelzine is less liver toxic than iproniazid, but hypotension and sleep disturbances are common side effects, and isocarboxazid can be used in cases where patients respond well to phenelzine treatment but suffer from these side effects.

Tranylcypromine differs from other MAOIs in its combination of MAO inhibition and amphetamine-like stimulant action; this drug is partially metabolized to amphetamine. Some patients become dependent on the stimulant effect of tranylcypromine. Compared with phenelzine, it can more often provoke hypertensive crises, but less affects the liver. For these reasons, tranylcypromine should be administered with great caution.

Selective inhibitors

They are used more widely, as they give significantly fewer side effects. Possible side effects include mild dry mouth, urinary retention, tachycardia, dyspepsia; in rare cases, dizziness, headache, anxiety, restlessness, hand tremors are possible. Skin allergic reactions may also occur.

Interactions

The combination of monoamine oxidase inhibitors with substances that affect the metabolism of monoamines can lead to an unpredictable increase in their action and be life-threatening.

Foods incompatible with MAOIs

Significant danger in the use of MAOIs, especially non-selective irreversible MAOIs, represents the consumption of foods containing various monoamines and their metabolic precursors. First of all, it is tyramine and its metabolic precursor amino acid tyrosine, as well as tryptophan. Tyramine, like amphetamine psychostimulants, causes the release of catecholamines from nerve endings. Its joint intake with MAOIs is fraught with a hypertensive crisis (see tyramine syndrome).

Tryptophan is used by the body to produce serotonin, and eating foods high in tryptophan can lead to serotonin syndrome.

Foods to avoid:

All cheeses, except for fresh homemade cheese (cottage cheese), especially spicy and aged; milk, cream, sour cream, kefir
Ice cream with syrup
Red wine, beer containing yeast (unrefined), ale, liqueurs, whiskey
Smoked meats, salami, chicken and beef liver, chicken pate, meat broths, marinades, any stale meat products, fried poultry and fried game
Caviar, smoked fish, herring (dried or salted), dried fish, shrimp pate, marinated fish (fresh fish is relatively safe)
Yeast extracts and brewer's yeast (regular baker's yeast is safe)
Protein Supplements
Legumes (beans, lentils, beans, soy), soy juice
Sauerkraut
Overripe fruits, canned figs, bananas, avocados, raisins
Spices
All types of cookies

Products to be treated with caution:

White wine, port
Strong alcoholic drinks (danger of depression of the respiratory center)
Certain fruits such as figs, prunes, raspberries, pineapple, coconut
Dairy products (curdled milk, yogurt, etc.)
Chocolate
Soy sauce
Peanut
Caffeine, theobromine, theophylline (coffee, tea, mate, coca-cola)
Spinach

Irreversible, non-selective MAOIs require that these products and the drugs and narcotics mentioned below be avoided while taking them and for two weeks after the end of the use. In the case of reversible MAOIs, dietary restrictions are usually less severe and apply to the time that the substance remains in the body (no more than a day). The use of drugs and surfactants listed in the list together with reversible MAOIs should also be abstained until they are completely eliminated.

Interaction with drugs and drugs

To prevent tyramine syndrome and serotonin syndrome, the following agents should be avoided during MAOI therapy:

Psychostimulants of the amphetamine group and related to them - increasing the levels of catecholamines in the synaptic cleft (amphetamine, methamphetamine, sydnocarb, etc.)
Any empathogens (entactogens)
Cold remedies containing sympathomimetics (ephedrine, pseudoephedrine, phenylpropanolamine, phenylephrine, chlorpheniramine, oxymetazoline, etc.): coldrex, teraflu, rinza, etc., nasal sprays and drops (naphthyzine, etc.)
Means for weight loss
Oral hypoglycemic agents
Monoamine reuptake inhibitors:
- Cocaine
- Cyclic antidepressants, including clomipramine, imipramine
- Selective serotonin reuptake inhibitors (SSRIs), eg paroxetine, citalopram, fluoxetine
- Venlafaxine
- Trazodone, nefazodone
Herbal antidepressants containing St. John's wort
5-hydroxytryptophan, tryptophan
Lithium preparations
Dextromethorphan (DXM)
Metabolic precursors of monoamines: levodopa, methyldopa, 5-hydroxytryptophan
Antihypertensive drugs (guanethidine, reserpine, pargyline)
Adrenaline and local anesthetics containing epinephrine (lidocaine and novocaine are harmless)
Anti-asthma drugs
Diuretics
Beta blockers
Antihistamines
Barbiturates
Anticholinergic drugs
Narcotic analgesics.
Alcohol.

After discontinuation of fluoxetine before the appointment of an irreversible MAOI, it is necessary to maintain a gap of at least five weeks to prevent serotonin syndrome. In elderly patients, this interval should be at least eight weeks. After the withdrawal of short-acting SSRIs, there should be a break of at least two weeks before the appointment of MAOIs.

When transferring from irreversible MAOIs to SSRIs, a break of four weeks should be maintained; when transferring from moclobemide to SSRIs, 24 hours is sufficient.

The likelihood of developing serotonin syndrome in the interaction of SSRIs with selegiline or moclobemide is significantly lower compared to the risk of its occurrence when SSRIs are combined with non-selective irreversible MAOIs, but such an interaction is still possible. Serotonin syndrome was also noted in monotherapy with moclobemide.

Irreversible MAOIs should not be combined with antihypertensive drugs due to the risk of severe orthostatic hypotension, or the dose of the antihypertensive drug should be reduced.

MAOIs enhance the effects of alcohol, sedatives, anxiolytics, and painkillers, sometimes pushing these drugs beyond the safety limit.

MAOIs can complicate procedures involving anesthesia or analgesia, as they interact with narcotic substances, causing a syndrome manifested by agitation, fever, headaches, convulsions, and coma with the possibility of death. They can cause respiratory depression. Fatal outcomes have been reported with the use of meperidine. Patients who are to undergo surgery should reduce the dose of MAO inhibitors in advance in order to exclude unwanted reactions to medications.

Patients with diabetes who take insulin may experience a more dramatic drop in blood sugar levels. In this case, the dose of insulin can be reduced.

Application restrictions

The presence of irreversible MAOIs of a hypotensive effect and the ability to provoke orthostatic hypotension makes it difficult to use them in patients with initial hypotension and a tendency to fainting, in elderly patients with severe cerebral atherosclerosis, with severe arterial hypertension, when a sharp decrease in blood pressure is dangerous.

Precautionary measures

With a sudden change in body position, a feeling of instability may occur. This can be avoided by rising slowly from a horizontal position. If the tablets are taken with meals, this and other side effects are much less pronounced.

Care should be taken when servicing machinery and when operating a machine, since many patients in the initial period of treatment with MAOIs are prone to increased drowsiness.

Non-medical use

There are a number of reports of abuse of MAO inhibitors. The mechanism of abuse may be due to the similarity of the chemical structure of MAOIs to that of amphetamine; however, the mechanism of action of MAOIs and amphetamines differ significantly. MAOI abusers may be particularly prone to developing hypertensive crises because they use high doses of MAOIs and/or may not be aware of the recommended diet.

Interactions with phenethylamine and tryptamine psychedelics

Most tryptamines are good substrates for MAO-A. DMT and 5-MeO-DMT, when taken orally, are metabolized by it already in the gastrointestinal tract and liver, without having time to get into the blood, so they are inactive when taken orally. 4-hydroxy-DMT (psilocin) is less susceptible to degradation by MAO, since its hydroxyl group in the 4-position makes it difficult for it to bind to the active site of the enzyme, as a result of which it is orally active. Alkyl substituents on the amino group, which are bulkier than methyl (ethyl, propyl, cyclopropyl, isopropyl, allyl, etc.), also make it difficult for tryptamines with such substituents to be metabolized by MAO, so all such tryptamines are active when taken orally. Alpha-methyl in tryptamine molecules like AMT and 5-MeO-AMT significantly impedes their metabolism by MAO and turns them de facto from substrates into weak inhibitors of this enzyme.

Inhibition of peripheral MAO-A in the gastrointestinal tract and liver by strong MAOIs makes tryptamines such as DMT and 5-MeO-DMT orally active as well as enhancing and prolonging the action of other tryptamines such as psilocin and DET. On the other hand, long-term use of MAOIs as antidepressants significantly weakens the effects of psychedelics. This is apparently due to changes in the monoaminergic systems of the brain caused by increased levels of monoamines. The nature of this phenomenon is currently unclear and is not explained by a simple desensitization of the serotonin receptors with which psychedelics interact.

Thus, the use of MAOIs with tryptamines or immediately before the use of tryptamines prolongs and in some cases enhances the effect of the latter, and in addition, makes it possible to use oral tryptamines such as DMT. This is the basis of the principle of action of ayahuasca and similar mixtures, including the so-called pharmacoasca, in which pure DMT is used instead of plant components, and traditional Banisteriopsis Caapi, and Peganum Harmala seeds, or their extracts, or even moclobemide (Aurorix). However, taking an irreversible MAOI a few days before taking a psychedelic will weaken its effect. The same will happen with long-term use of both irreversible and reversible MAOIs before a psychedelic is taken.

It is not safe to use 5-MeO-DMT with MAOIs. Many note the strong and unpleasant side effects of this combination, up to serotonin syndrome. In addition, this experience is psychologically extremely difficult for many people and can be associated with serious mental health risks.

Tryptamines, which significantly increase levels of monoamines in the synaptic cleft (AMT, 5-MeO-AMT, AET, etc.), can be deadly when combined with MAOIs. There is some concern about the safety of using MAOIs with tryptamines such as DPT.

The metabolism of LSD is currently not well understood, but MAO does not seem to play any role in it. However, according to some authors, when used in conjunction with harmala, its effects are enhanced and prolonged. The same applies to other ergolines.

MAO plays a minor role or even practically does not participate in the metabolism of phenylethylamine psychedelics. Therefore, taking MAOIs together with them is devoid of practical meaning. Although, according to some users, both harmala and moclobemide increase the effect of some PEAs, such as 2C-B.

In most cases, the use of MAOIs with phenylethylamine psychedelics does not pose a serious health hazard. However, the use of MAOIs with sulfur-containing phenethylamines such as 2C-T-7 and Aleph-7 should be avoided due to their controversial and little-studied effects on brain monoamine levels and high toxicity. Combinations of MAOIs with TMA-6 and TMA-2 may also be unsafe.

Overdose

MAOI antidepressants are extremely toxic in overdose, and the symptoms of intoxication do not necessarily appear immediately. In acute poisoning with large doses of MAOIs, general weakness, dizziness, ataxia, blurred speech, clonic muscle twitching are observed; this is followed by coma or convulsive seizures (such as generalized epileptiform seizures) followed by coma. After coming out of a coma, the state of stun may persist for some time. In some cases, coma does not occur, while the initial symptoms of an overdose are replaced by a delirious syndrome. Impaired consciousness with an overdose of MAOIs is not always noted; in those cases when they are absent, the depression that caused the appointment of MAOIs is very quickly, paroxysmal, replaced by euphoria.

Overdose manifestations can also be anxiety, confusion, hypertensive crisis, cardiac arrhythmias, rhabdomyolysis, coagulopathy.

Due to the high toxicity of MAOIs in patients with suicidal tendencies, they should be prescribed in quantities sufficient for only a few days of admission.

The latter have antidepressant and psycho-energizing properties. They serve to suppress the deamination of serotonin and norepinephrine.

List of drugs

Indications for use

Contraindications

Hypersensitivity to the drug;
Acute inflammatory diseases of the liver or kidneys have been identified.

Side effects

MAO inhibitors: pharmacological properties and trade names

Monoamine oxidase inhibitors (MAOIs) are biological substances that, by reducing the rate of chemical reactions of the monoamine oxidase enzyme, prevent the destruction of various monoamines (this group includes serotonin, norepinephrine, dopamine, phenylethylamine, tryptamine and octamine). This enhances the concentration of the active element between two neurons or between a neuron and an effector molecule (a particle that binds to proteins to increase biological activity).

For medical purposes, MAOIs are used as antidepressants and sometimes to treat Parkinson's disease and narcolepsy attacks, a pathological condition of the nervous system that causes drowsiness and a sudden "attack" of sleep.

According to their pharmacological properties, MAOIs are divided into:

non-selective irreversible;
reversible selective;
irreversible selective.

So, let's take a brief look at each group and learn about the active ingredients, properties and trade names.

MAO inhibitors - drugs, list, intake

MAO is classified according to pharmacological properties into non-selective irreversible, reversible selective and irreversible selective.

Phenelzine;
Iproniazid;
Isocarboxazid;
Nialamide;
Tranylcypromine.

Metralindol;
Pirlindol;
Befol;
Moclobemide;
Derivatives of beta-carbolines.

Contraindications

hypersensitivity;

hypersensitivity;
liver failure;

Taking other antidepressants;
hypersensitivity;
Essential tremor;
Chorea of Huntington.

irreversible selective MAO inhibitors are prescribed for:

progressive dementia;
tardive dyskinesia;
severe psychosis;
severe angina;
Angle-closure glaucoma;
large-scale tremor;
tachycardia;
Pheochromocytoma;
Diffuse toxic goiter.

Side effects

Anxiety;
dry mouth;
Headache;
Insomnia.

Dyspepsia;
Decreased blood pressure;
Anxiety;
insomnia;
Headache;
dry mouth;
Constipation.

MAO inhibitors

Instructions for use:

MAO inhibitors are antidepressants used in the treatment of parkinsonism and narcolepsy.

Pharmacological action of MAO inhibitors

MAO inhibitors are classified according to their pharmacological properties into non-selective irreversible, reversible selective and irreversible selective.

Non-selective irreversible MAO inhibitors are similar in chemical structure to iproniazids, improve the general condition of patients with depression and reduce angina attacks.

Reversible selective MAO inhibitors have antidepressant and psychoenergizing effects, actively suppress the deamination of serotonin and norepinephrine.

Irreversible selective MAO inhibitors have an antiparkinsonian effect, are involved in the metabolism of dopamine and catecholamines.

List of MAO inhibitor drugs

The list of non-selective irreversible MAO inhibitors includes:

Selegiline is an irreversible selective MAO inhibitor.

The list of reversible selective MAO inhibitors includes:

Indications for the use of MAO inhibitors

Non-selective irreversible MAO inhibitors are prescribed in the treatment of chronic alcoholism and depression (neurotic, involutional and cyclothymic), reversible selective - in depression of various origins, depressive syndrome, melancholic syndrome and astheno-dynamic disorders, and irreversible selective - in the treatment of Parkinson's disease.

Contraindications

The intake of reversible selective MAO inhibitors is contraindicated in:

hypersensitivity;
Acute inflammatory diseases of the kidneys and liver;
Withdrawal alcohol syndrome;
Pregnancy and lactation.

Also, reversible selective MAO inhibitors are not prescribed in infancy.

Reception of non-selective irreversible MAO inhibitors is not prescribed for:

hypersensitivity;
liver failure;
Violation of cerebral circulation;
Chronic renal failure;
Chronic heart failure.

Reception of irreversible selective MAO inhibitors is contraindicated in:

Pregnancy and lactation;
Taking other antidepressants;
hypersensitivity;
Essential tremor;
Chorea of Huntington.

With caution, irreversible selective MAO inhibitors are prescribed for:

progressive dementia;
tardive dyskinesia;
severe psychosis;
Peptic ulcer of the gastrointestinal tract;
Hyperplasia of the prostate;
severe angina;
Angle-closure glaucoma;
large-scale tremor;
tachycardia;
Pheochromocytoma;
Diffuse toxic goiter.

Side effects

The use of reversible selective MAO inhibitors can cause:

The use of non-selective irreversible MAO inhibitors can cause:

The use of irreversible selective MAO inhibitors can cause complications from various body systems, namely:

Decreased appetite, dryness of the oral mucosa, increased activity of transaminases, nausea, diarrhea, constipation and dysphagia (digestive system);
Increased fatigue, insomnia, dizziness, hallucinations, headache, anxiety, dyskinesia, motor and mental agitation, confusion and psychosis (nervous system);
Increased blood pressure, orthostatic hypotension and arrhythmia (cardiovascular system);
Diplopia and impaired visual acuity (sense organs);
Nocturia, urinary retention and painful urge to urinate (urinary system);
Shortness of breath, photosensitivity, skin rash and bronchospasm (allergic reactions).

Also, taking irreversible selective MAO inhibitors can cause perspiration, hypoglycemia, and hair loss.

Information about the drug is generalized, provided for informational purposes and does not replace the official instructions. Self-medication is dangerous to health!

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MAO inhibitors

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MAO inhibitors are antidepressants that are prescribed for the treatment of parkinsonism, as well as epilepsy.

pharmachologic effect

Preparations of MAO inhibitors are divided into the following groups: non-selective reversible, selective irreversible and reversible selective. The latter have antidepressant and psycho-energizing properties. They serve to suppress the deamination of serotonin and norepinephrine.

Non-selective irreversible drugs are designed to reduce angina attacks, as well as improve the condition of patients who are in deep depression. These drugs are similar in structure to iproniazids.

Irreversible selective MAO inhibitors have antiparkinsonian properties and are involved in the metabolism of dopamine and catecholamines.

Video: Brain Biochemistry

List of drugs

Non-selective irreversible drugs include: Nialamide, Iproniazid, Phenelzine, Isocarboxazid, Tranylcypromine.

Selective irreversible drugs include the drug Selegiline.

The list of MAO inhibitors (reversible selective) includes the following drugs: Befol, Metralindol, Moclobemide, Pirlindol, beta-carboline derivatives.

Indications for use

Preparations of MAO inhibitors (reversible selective) should be taken for depression of a different nature, with melancholic syndrome, depressive syndrome, astheno-dynamic disorders. Non-selective irreversible drugs should be prescribed to patients with neurotic, cyclothymic, involutional depressions. Taking pharmaceuticals is also indicated in the treatment of chronic alcoholism.

Irreversible selective drugs should be prescribed in the treatment of Parkinson's disease.

Contraindications

Reception of MAO inhibitors (reversible selective) is contraindicated in patients who have:

Drugs are not prescribed for alcohol withdrawal syndrome. It is strictly forbidden to take medicines during pregnancy and lactation.

You should not take drugs (non-selective irreversible) in the following cases:

If the patient has hypersensitivity;
Revealed liver failure;
There is a violation of cerebral circulation;
A diagnosis of chronic heart failure was made.

The intake of MAO inhibitors (irreversible selective) is strictly contraindicated in patients who are taking other antidepressants. Also, drugs in this category are not prescribed during pregnancy and during lactation, with Huntington's Chorea, essential tremor.

With caution, drugs (irreversible selective) should be taken by patients who have: severe angina pectoris, progressive dementia, severe psychosis, prostatic hyperplasia, angle-closure glaucoma, large-scale tremor, peptic ulcer of the gastrointestinal tract, tardive dyskinesia, tachycardia, diffuse toxic goiter, as well as pheochromocytoma.

Side effects

When using reversible selective drugs, the patient may experience the following body reactions: insomnia, headache (of a periodic nature), dry mouth, anxiety.

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When using non-selective irreversible drugs, a person may experience: dyspepsia, lower blood pressure, anxiety, insomnia, headache, constipation.

When using irreversible selective MAO inhibitors, the following body reactions may occur:

Increased blood pressure, arrhythmia, hypotension;
In some cases, the patient's appetite decreases, the mucous membrane of the eye becomes dry, and transaminase activity increases;
In addition, diarrhea, constipation, dysphagia, nausea may occur;
A small percentage of people experience urinary retention, painful urge to urinate;
When taking drugs, shortness of breath, skin rash, bronchospasm may appear.

When taking drugs (irreversible selective), a person may begin the process of hair loss, hypoglycemia may form.

MAO inhibitors - what is it and a list of drugs. Mechanism of action and use of monoamine oxidase inhibitors

MAO inhibitors - that only people who are interested in medical news know this. The decoding is simple - this is a group of medicines that belongs to antidepressants that block the breakdown of MonoAmin Oxidase. They are used as medicines for depression, to restore normal emotional background and mental health.

What are MAO Inhibitors

To understand which drugs are MAO inhibitors, you need to know their pharmacological action. These medicines have the ability to improve the quality of life and fight anxiety. Another name for them is monoamine oxidase inhibitors (MAOIs). These are substances of plant and chemical origin, widely used in psychiatry.

The impact on the body is based on blocking the enzyme monoamine oxidase. As a result, the breakdown of various substances and neurotransmitters is disrupted in the stomach. The symptoms of depressive and mental disorders are alleviated. It is possible to classify the entire list of drugs according to their pharmacological action.

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irreversible MAO inhibitors

Irreversible MAOIs include drugs whose principle of action is based on the formation of chemical bonds with monoamine oxidase. As a result, the enzyme functionality is suppressed. These are first generation drugs with a lot of side effects. They have poor compatibility with other pharmacological agents. The patient during treatment must adhere to a diet. They can also be divided into hydrazine (Nialamide, Iproniazid) and non-hydrazine (Tranylcypromine, Isocarboxazid).

Reversible MAO inhibitors

Reversible MAOIs are prescribed for many diseases. They are representatives of the second generation. They do not have serious negative effects, a diet is not required when taking them. The principle of functioning of this group of medicines is based on the capture of the enzyme and the creation of a stable complex with it. They are divided into: selective (Moclobemide, Tetrindol) and non-selective (Caroxazon, Inkazan).

Selective MAO inhibitors

Selective MAOIs are able to inactivate only one type of monoamine oxidase. As a result, the breakdown of serotonin, norepinephrine and dopamine decreases. Simultaneous use with drugs that increase the level of serotonin leads to the appearance of serotonin syndrome. This dangerous disease is a sign of intoxication of the body. For its treatment it is necessary to cancel all antidepressants.

Non-selective MAO inhibitors

Non-selective MAOIs block the enzyme monoamine oxidase in A and B varieties. They are rarely prescribed because they have a pronounced toxic effect on the liver. The effect of the use of these drugs persists for a long time (up to 20 days) after the end of therapy. They tend to reduce the frequency of attacks in angina pectoris, which allows them to be prescribed to patients with cardiovascular diseases.

MAO inhibitors - list of drugs

What drugs belong to MAOI, and what can help in a particular case, you can find out in a medical institution. The use of antidepressants must be agreed with the attending physician. The doctor selects drugs individually, based on the symptoms of the disease. The entire list of drugs is divided according to the pharmacological classification. List of MAO inhibitors:

Irreversible non-selective are: Phenelzine, Tranylcypromine, Isocarboxazid, Nialamide.
The smallest is the list of irreversible selective representatives: Selegilin, Razagilin, Pargilin.
Reversible selective drugs are the largest group, they include such drugs: Pirlindol (pyrazidol), Metralindol, Moclobemide, Befol, Tryptamine, beta-carboline derivatives (trade name Garmalin).

MAO inhibitors - instructions for use

The use of MAO inhibitors:

Irreversible non-selective are used to treat:

involutional depressions;
neurotic depressions;
cyclothymic depressions;
in the treatment of chronic alcoholism.

Irreversible selective drugs are used only in the treatment of Parkinson's disease.

Reversible selective use:

with melancholic syndrome;
with asthenodynamic disorders;
with depressive syndrome.

Contraindications depend on the type of medication. Irreversible non-selective should not be used in the presence of cardiac, renal, hepatic insufficiency, coronary circulation disorders. Irreversible selective drugs are prohibited during pregnancy and breastfeeding and Huntington's chorea. Do not prescribe them in combination with antipsychotic drugs. Contraindications to taking reversible selective drugs will be: infancy, acute liver failure.

Side effects when using a drug that has a reversible selective effect will be expressed by the following symptoms: insomnia, recurrent headache, constipation, dry mouth, increased anxiety. With an increase in the recommended dosage or non-compliance with the treatment regimen in patients, this drug increases the manifestation of side effects.

When taking non-selective irreversible MAOIs, the following side effects are possible: dyspepsia, disruption of the gastrointestinal tract. Often there is the appearance of hypotension (lowering blood pressure), headaches in the frontal part of the head. When taking reversible MAOIs, the list of negative effects is replenished: hypertension, decreased appetite, urinary retention, rash, shortness of breath.

MOA inhibitors: what is it, a list of drugs and their trade names

Depression is not just "I'm in a bad mood today." This is a dangerous and serious condition that is associated with an imbalance of certain chemical compounds in the brain. To normalize this imbalance, as well as to treat Parkinson's disease, MAO inhibitors are used. We offer a list of such drugs and their brief characteristics.

These drugs are intended for the treatment of severe depression, in which other drugs do not work properly. They provide a long-term pharmacological effect, which lasts from 1 to 2 weeks after the end of therapy, but they have many contraindications and can provoke quite serious adverse reactions. Therefore, their reception can be considered a last resort. Such medications are prescribed by a psychiatrist or neurologist.

The first generation of MAO inhibitors: dangerous irreversible non-selective

Such drugs are rarely used today, as they do not combine well with other drugs, are toxic (very harmful to the liver), and have a wide variety of side effects. In addition, their intake requires the patient to follow a certain diet: you have to exclude cheese, coffee, wine, beer, cream, smoked meats from the diet. They are prescribed for the elimination of neurotic, involutional, cyclomatic depression and the treatment of chronic alcohol dependence.

The list of irreversible MAO inhibitors with non-selective action is quite wide. Here is what applies to them:

Nardil (Belgium). A drug based on phenelzine, a powerful MAO inhibitor. Eliminates the feeling of anxiety, fear, sadness, restores peace of mind. Not the most modern antidepressant, however, it is often used to treat social phobias. The effect is found after a 2-week intake;
Marplan. The active substance is isocarboxazid. Relieves some symptoms of depression: longing, feeling of worthlessness, low self-esteem, chronic sadness, phobias. In many countries, it has ceased to be produced, as it leads to the destruction of the liver and provokes serious side effects;
Parnat (Japan). Its action is due to the presence of the active component of tranylcypromine. It has a positive effect on the emotional and mental background in a depressed state, lethargy, lethargy, obsessive disorders. It shows relatively little side activity, but produces a very short effect on MAO - about 12 hours;
Iprazid (Russia). The active substance is iproniazid. It was used in psychiatry and in cardiology (in the treatment of angina pectoris to reduce pain and improve the ECG). Causes persistent inhibition of MAO. It is now universally discontinued due to high hepatotoxicity. It is forbidden to drink it for more than 2 weeks;
Nialamide. A psychostimulant with the same active ingredient, produced in Russia. It has a more gentle effect, improves the general condition of people suffering from depression. It is indicated for asthenia, oligophrenia, trigeminal neuralgia, angina pectoris. The result of therapy is noticeable after 1-2 weeks of admission. The course is from 1 to 6 months.

Important! Although these drugs are sold without a prescription, they are not the first choice in the treatment of depression. Such drugs can cause clinical deterioration, fatal side effects, and increase the risk of suicide. Thus, they should only be taken with the permission of a doctor.

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Irreversible selective: narrow spectrum agents

With the help of drugs included in this group, only one pathology is treated - Parkinson's disease. Since they are highly specialized, the list of these MAO inhibitors is not too long. Here are the trade names of such drugs, under which they are sold in the pharmacy chain:

Yumeks (Hungary), Stillin (Israel). The registration period of the second drug has expired, so it is not sold in pharmacies in our country. The active active ingredient of drugs is selegin. It inhibits the metabolism of dopamine, thereby increasing its concentration in the nuclei of cells of certain parts of the brain. The main purpose of these drugs is the treatment of Parkinson's disease and the symptoms of parkinsonism (as monotherapy or together with Levodopa), but there are attempts to use them as antidepressants and anti-smoking agents. Some experts are of the opinion that Yumex is a drug for prolonging life, as it has neuroprotective properties;
Pargylin (India). It is an antidepressant, recommended for neuropsychiatric disorders. The active substance is parligin. It is considered a fairly safe drug, is actively used in psychiatry;
Azilect. Produced in Israel, contains rasagiline. Fairly new inhibitor. Recommended for the treatment of true Parkinson's disease and essential tremor. Restores motor activity, coordination, gait in such patients. Additionally, it stops age-related memory decline, improves mood and learning outcomes. The produced effect is associated with the accumulation of special natural compounds in the brain.

Important! All of these drugs should not be combined with serotonin drugs, including fluoxetine.

Reversible selective: gentle but effective

Such drugs belong to the second generation of MAO inhibitors. They help to alleviate the condition of those who suffer from asthenic, melancholic syndrome and asthenodynamic disorders. They revealed several advantages over their predecessors at once: their intake is not accompanied by dangerous side effects, the patient does not have to adhere to dietary restrictions.

This group of MAO inhibitors is the most extensive. The list of medicines includes, in particular:

Tetrindol (Russia). Fast-acting remedy: the result of its administration is manifested in just 2-3 days from the start of treatment. It is indicated for depression of various origins (including in the case of organic brain damage), as well as for chronic alcoholism;
Aurorix (Switzerland). Contains moclobemide. Psychoanaleptic. Relieves symptoms of depression - nervous exhaustion, low concentration of attention, dysphoria, helps to eliminate social phobia, increases psychomotor activity. Not prescribed for agitation;
Metralindol (Russia). The active element is inkazan. It is often prescribed for manic-depressive syndrome, schizophrenia, unmotivated mood swings, and also to activate blood circulation in the brain;
Caroxazon. Refers to the "small" antidepressants. Produces a moderate stimulating effect. Out of production;
Befol (Russia). It is prescribed for delusional disorders, hallucinations, dependence on alcohol;
Pirlindol (created on the basis of pyrazidol). It is indicated for attacks of apathy, depressive disorders, emotional overexcitation, accompanied by fear and anxiety.

Important! All MAO inhibitors are prohibited for pregnant and lactating women.

Depression is a condition that many describe as "I don't want to live." Even specialists cannot always help in such a situation, so it is impossible to cure this disorder on your own. Even knowing what MAO inhibitors are and what names are included in the list of these drugs, you should not buy them at a pharmacy and start taking them: they are far from safe! And even more so, you should not try to select drugs for the treatment of Parkinson's disease without doctors. So you will not help, but only harm a loved one.

MAO inhibitors

Instructions for use:

MAO (monoamine oxidase) inhibitors are a group of drugs used in psychiatric practice for the treatment of depressive conditions of various origins. As a rule, MAO inhibitor drugs are used in cases of advanced depression, in which any other treatment methods are ineffective.

Pharmacological effect and classification of drugs-MAO inhibitors

MAO inhibitors are biologically active substances capable of inhibiting the enzyme monoamine oxidase. These drugs block the process of destruction of mediator monoamines (serotonin, norepinephrine, dopamine, phenylethylamine and others) and increase their concentration, thereby enhancing the transmission of nerve impulses.

A distinctive feature of this group of antidepressants is a long pharmacological effect: the therapeutic effect of MAO inhibitors continues for one to two weeks after the end of the course of treatment.

Depending on their pharmacological properties, MAO inhibitors are divided into selective and non-selective, as well as reversible and irreversible.

The action of selective monoamine oxidase inhibitors is directed mainly to the inhibition of one of the types of monoamine oxidase. Non-selective drugs inhibit both types of the enzyme.

Reversible MAO inhibitors bind to the enzyme and form a stable complex with it, which gradually releases the active components of the drug. They enter the bloodstream and then are excreted from the body naturally. Thus, the enzyme monoamine oxidase remains intact.

Irreversible MAO inhibitors form chemical bonds with monoamine oxidase, causing the enzyme to become non-functional and metabolized. Instead, the body synthesizes a new monoamine oxidase. On average, the enzyme production process takes about two weeks.

Non-selective irreversible MAO inhibitors include drugs such as Isocarboxazid, Iproniazid, Tranylcypromine, Nialamide, Phenelzine. The list of reversible MAO inhibitors includes Befol, Moclobemide, Metralindol, Pyrazidol and beta-carboline derivatives. Selegiline is an irreversible selective MAO inhibitor.

Indications for use

Irreversible MAO inhibitors are used in the treatment of depressive conditions accompanied by lethargy and lethargy. Reversible drugs are prescribed in the treatment of shallow depressions with not pronounced hypochondriacal and neurosis-like symptoms, as well as atypical depressive conditions. Selective MAO inhibitors of irreversible action are used in the treatment of narcolepsy and parkinsonism.

Reception features

The scheme of therapy and the dosage of drugs are determined strictly individually and depend on the indications, as well as the nature of the course of the disease.

Patients who are prescribed MAO inhibitors, in some cases, should follow a special diet. For the duration of treatment and for at least two weeks after its completion, the following foods and drinks should be excluded from the diet:

meat, chicken and beef liver;
smoked and pickled fish;
dry sausages;
chocolate and caffeine;
dairy products (only cream cheeses and pressed cottage cheese are allowed);
soy sauce;
canned dates;
bean pods;
bananas, avocados;
yeast extract, including brewer's yeast;
any alcoholic drinks;
stale recycled meat, fish and dairy products.

In addition, during the period of taking MAO inhibitors, patients should not use the following drugs:

cold remedies;
drugs for colds (tablets, medicines);
stimulants;
inhalants and asthma medications;
drugs for weight loss and appetite suppression;
any drugs with a narcotic effect, including those containing caffeine.

When using reversible MAO inhibitors, dietary nutrition is not necessary.

Contraindications and side effects

The use of MAO inhibitors from the list of reversible selective drugs is contraindicated in case of hypersensitivity, alcohol withdrawal syndrome, acute inflammatory diseases of the liver and kidneys, as well as during pregnancy and breastfeeding.

MAO inhibitors of irreversible non-selective action are not prescribed for hypersensitivity, chronic renal or heart failure, liver failure and cerebrovascular accidents.

Irreversible selective MAO inhibitors are contraindicated in case of hypersensitivity, during pregnancy and breastfeeding, as well as in Huntington's chorea and essential tremor. In addition, MAO inhibitors from the list of drugs of irreversible selective action are not prescribed in combination with other antidepressants.

Side effects caused by reversible selective MAO inhibitors are most often manifested as insomnia, anxiety, headache and dry mouth. When taking MAO inhibitors of irreversible non-selective action, the same side effects may occur. In addition, drugs in this group can cause dyspepsia, constipation and lowering blood pressure.

Irreversible selective monoamine oxidase inhibitors have the following side effects:

dizziness, headache, insomnia, anxiety, fatigue, dyskinesia, increased mental and motor excitability, psychosis, confusion;
nausea, loss of appetite, dry mouth, constipation, diarrhea;
arrhythmia, orthostatic hypotension, increased blood pressure;
visual impairment, diplopia;
violations of the functions of the urinary system (urinary retention, nocturia);

It is also necessary to know that the use of MAO inhibitors in combination with alcohol can provoke a hypertensive crisis and an increased effect on the central nervous system.

The description posted on this page is a simplified version of the official version of the annotation for the drug. The information is provided for informational purposes only and is not a guide for self-treatment. Before using the drug, you should consult with a specialist and read the instructions approved by the manufacturer.

Pharmacological group - Antidepressants

Subgroup drugs are excluded. Turn on

Description

Drugs that specifically treat depression appeared in the late 1950s. In 1957, iproniazid was discovered, which became the ancestor of the group of antidepressants - MAO inhibitors, and imipramine, on the basis of which tricyclic antidepressants were obtained.

According to modern concepts, in depressive states, a decrease in serotonergic and noradrenergic synaptic transmission is observed. Therefore, the accumulation of serotonin and norepinephrine in the brain caused by them is considered an important link in the mechanism of action of antidepressants. MAO inhibitors block monoamine oxidase, an enzyme that causes oxidative deamination and inactivation of monoamines. Currently, two forms of MAO are known - type A and type B, which differ in the substrates exposed to them. Type A MAO causes mainly the deamination of norepinephrine, adrenaline, dopamine, serotonin, tyramine, and type B MAO causes the deamination of phenylethylamine and some other amines. Allocate inhibition competitive and non-competitive, reversible and irreversible. Substrate specificity can be observed: a predominant effect on the deamination of various monoamines. All this significantly affects the pharmacological and therapeutic properties of various MAO inhibitors. Thus, iproniazid, nialamide, phenelzine, tranylcypromine irreversibly block MAO type A, and pirlindol, tetrindole, metralindol, eprobemide, moclobemide, etc. have a selective and reversible effect on it.

Tricyclic antidepressants are named because of their characteristic tricyclic structure. The mechanism of their action is associated with inhibition of the reuptake of neurotransmitter monoamines by presynaptic nerve endings, resulting in the accumulation of mediators in the synaptic cleft and activation of synaptic transmission. Tricyclic antidepressants, as a rule, simultaneously reduce the capture of various neurotransmitter amines (norepinephrine, serotonin, dopamine). Recently, antidepressants have been created that block predominantly (selectively) the reuptake of serotonin (fluoxetine, sertraline, paroxetine, citalopram, escitalopram, etc.).

There are also so-called "atypical" antidepressants, which differ from the "typical" ones both in structure and in the mechanism of action. Preparations of a bi- and four-cyclic structure appeared, in which no pronounced effect was found either on the capture of neurotransmitters or on the activity of MAO (mianserin, etc.).

A common property of all antidepressants is their thymoleptic effect, i.e., a positive effect on the affective sphere of the patient, accompanied by an improvement in mood and general mental state. Different antidepressants differ, however, in the amount of pharmacological properties. So, in imipramine and some other antidepressants, the thymoleptic effect is combined with a stimulating one, while in amitriptyline, pipofezin, fluacizine, clomipramine, trimipramine, doxepin, a sedative component is more pronounced. In maprotiline, the antidepressant effect is combined with anxiolytic and sedative. MAO inhibitors (nialamide, eprobemide) have stimulating properties. Pirlindol, removing the symptoms of depression, exhibits nootropic activity, improves "cognitive" ("cognitive") functions of the central nervous system.

Antidepressants have found application not only in psychiatric practice, but also for the treatment of a number of neurovegetative and somatic diseases, in chronic pain syndromes, etc.

The therapeutic effect of antidepressants, both oral and parenteral, develops gradually and usually manifests itself after 3-10 days or more after the start of treatment. This is explained by the fact that the development of the antidepressant effect is associated both with the accumulation of neurotransmitters in the region of nerve endings, and with slowly appearing adaptive changes in the circulation of neurotransmitters and in the sensitivity of brain receptors to them.

How antidepressants can help us: MAO inhibitors

Medical educational program

Anyone who monitors their health, is interested in medical news, is well aware of such an expression as MAO inhibitors. What it is, not everyone can explain. And meanwhile, everything is not so difficult. This is what psychotropic drugs are called. In other words, antidepressants. These remedies are able to eliminate negative emotions, feelings of longing or hopelessness. Particularly valuable is the fact that some representatives of the antidepressant group can cause not only a psychostimulant, but also a sedative (calming) effect. This distinguishes them from stimulants. Therefore, MAO inhibitors are often used in psychiatry.

What is an MAO inhibitor?

Let's figure out what this phrase means, let's define the words that make it up. An inhibitor is a substance that slows down or prevents the course of any chemical reaction. MAO (full name - monoamine oxidase) is an enzyme produced by the gastrointestinal tract. It helps to break down literally all the substances that enter the human body with food. Thus, MAO inhibitors are biologically active substances that block the enzyme monoamine oxidase. Once in the body, they inhibit the reactions associated with the decomposition of certain substances. For example, serotonin (the so-called joy hormone), melatonin, dopamine. This alleviates the symptoms of depression.

Herbal MAO inhibitors

I must say that this group includes not only medications, but also some plants. For example, Indian tribes used the vine Banisteriopsis caapi as an MAO inhibitor. In modern medicine, Siberian rue seeds are used. It contains harmine and harmaline. When taken in large quantities, these alkaloids can cause vomiting, nausea, hallucinations, and convulsions.

Classification of MAO inhibitors by pharmacological properties

All existing inhibitors are divided into 3 categories.

Non-selective irreversible inhibitors. Their distinctive feature can be called the fact that they not only fight depression, but are also able to reduce angina attacks. These include "Nialamid", "Fenelzin" and other drugs.
Selective reversible inhibitors. They have a psycho-energizing effect. Excellent antidepressants, as they increase serotonin and norepinephrine. For example, "Befol" or "Pirlindol".
Selective irreversible inhibitors. Indispensable in the treatment of Parkinson's disease. A typical representative of this group is Selegiline.

Application in medicine

To date, MAO inhibitors are prescribed quite rarely. This is due to the large number of side effects they can cause. Their use is justified only in cases where other, more gentle means have been tried. Most often, synthetic inhibitors are used for treatment. This is due to the fact that they have a longer duration of action compared to herbal counterparts. So, for example, the same harmaline can act within 1-3 days after ingestion, while the effect of a synthetic inhibitor can last up to two weeks.

Contraindications

These psychotropic drugs should be taken with extreme caution, as they have many contraindications:

Non-selective irreversible inhibitors are not prescribed for heart or kidney failure, as well as in cases where the patient has a cerebrovascular accident.
Selective reversibles are contraindicated in acute inflammatory diseases, during pregnancy or lactation, in infancy, and in alcohol withdrawal.
Selective irreversible MAO inhibitors should never be combined with other antidepressants. In addition, they are not used for tremor and Huntington's chorea (a disease characterized by mental and movement disorders). It is necessary to prescribe them with caution in psychosis, angina pectoris, tachycardia.

Precautionary measures

Taking inhibitors is associated with many side effects, so you must follow all the necessary rules for taking. Be sure to inform your doctor about your chronic diseases, pregnancy or intention to become pregnant, allergies to any drugs. It is better to consult a doctor if you are going to take other medicines. And, of course, you must strictly follow the diet.

Features of nutrition while taking MAO inhibitors

Taking inhibitors can be extremely hazardous to your health if you eat certain foods. This is due to this: blocking the MAO enzyme contributes to the accumulation of such an amino acid as tyramine. In the normal state, its level is successfully regulated by the body itself. But by taking MAO inhibitors, you increase this substance in the blood. Therefore, it is necessary to exclude from the diet all foods containing tyramine. These include:

Mature cheeses. For example, cheddar cheese contains 40 mg of tyramine per 30 g piece. Most likely, such a high content of this amino acid is due to fermentation processes. There is little tyramine in cottage cheese and processed cheeses, they can be eaten without harm to health.
Alcohol. In ale, chianti, live beer - 11 mg of this substance per 100 g of product. Therefore, they cannot be used. Red wine and bottled beer are allowed, but the measure must be observed.
Processed meat and fish products. It is forbidden to use smoked meats, dry sausages, pickled fish. The content of tyramine in them can reach up to 86 mg per serving. Such a high rate is due to aging and the presence of preservatives.
Seasonings. It is very difficult to single out one thing here, since tyramine is often found in mixed products. For example, Asian cuisine cannot be imagined without soy sauce. And it contains a huge amount of dangerous amino acids. Therefore, it is better to give preference to simple-to-cook dishes.

Prohibited drugs

As already mentioned, it is necessary to carefully combine inhibitors with other medications and always inform the attending physician. In no case should inhibitors be used with drugs such as:

Remedies for colds or sinusitis.
Inhalers for asthma.
Drugs that are used to reduce appetite or weight loss.
Stimulants.

Side effects

In many patients, taking inhibitors does not cause side effects. However, failure to follow the recommendations of a doctor can lead to sad consequences:

The use of non-selective irreversible inhibitors can cause headache, constipation, dry mouth, and low blood pressure.
Selective reversible inhibitors have side effects such as: insomnia, anxiety, headache.
Selective irreversible inhibitors can cause impaired visual acuity, arrhythmia and urinary retention, dizziness and hallucinations.

I would like to say one more thing: taking inhibitors should not be abandoned in the middle of a course of treatment. Often, these funds do not work immediately. In some cases, the effect appears only 4 weeks after taking the medication. But your patience will be rewarded with improved well-being. And that means you have conquered the disease.

What is an MAO inhibitor?

Herbal MAO inhibitors

Classification of MAO inhibitors by pharmacological properties

All existing inhibitors are divided into 3 categories.

Non-selective irreversible inhibitors. Their distinctive feature can be called the fact that they not only fight depression, but are also able to reduce angina attacks. These include "Nialamid", "Fenelzin" and other drugs.
Selective reversible inhibitors. They have a psycho-energizing effect. Excellent antidepressants, as they increase serotonin and norepinephrine. For example, "Befol" or "Pirlindol".
Selective irreversible inhibitors. Indispensable in the treatment of Parkinson's disease. A typical representative of this group is Selegiline.

Application in medicine

So, for example, the same harmaline can act within 1-3 days after ingestion, while the effect of a synthetic inhibitor can last up to two weeks.

Contraindications

These psychotropic drugs should be taken with extreme caution, as they have many contraindications:

Non-selective irreversible inhibitors are not prescribed for heart or kidney failure, as well as in cases where the patient has a cerebrovascular accident.
Selective reversibles are contraindicated in acute inflammatory diseases, during pregnancy or lactation, in infancy, and in alcohol withdrawal.
Selective irreversible MAO inhibitors should never be combined with other antidepressants. In addition, they are not used for tremor and Huntington's chorea (a disease characterized by mental and movement disorders). It is necessary to prescribe them with caution in psychosis, angina pectoris, tachycardia.

Precautionary measures

Features of nutrition while taking MAO inhibitors

Mature cheeses. For example, cheddar cheese contains 40 mg of tyramine per 30 g piece. Most likely, such a high content of this amino acid is due to fermentation processes. There is little tyramine in cottage cheese and processed cheeses, they can be eaten without harm to health.
Alcohol. In ale, chianti, live beer - 11 mg of this substance per 100 g of product. Therefore, they cannot be used. Red wine and bottled beer are allowed, but the measure must be observed.
Processed meat and fish products. It is forbidden to use smoked meats, dry sausages, pickled fish. The content of tyramine in them can reach up to 86 mg per serving. Such a high rate is due to aging and the presence of preservatives.
Seasonings. It is very difficult to single out one thing here, since tyramine is often found in mixed products. For example, Asian cuisine cannot be imagined without soy sauce. And it contains a huge amount of dangerous amino acids. Therefore, it is better to give preference to simple-to-cook dishes.

Prohibited drugs

As already mentioned, it is necessary to carefully combine inhibitors with other medications and always inform the attending physician. In no case should inhibitors be used with drugs such as:

Remedies for colds or sinusitis.
Inhalers for asthma.
Drugs that are used to reduce appetite or weight loss.
Stimulants.

Side effects

In many patients, taking inhibitors does not cause side effects. However, failure to follow the recommendations of a doctor can lead to sad consequences:

MAO inhibitors - antidepressants used in the treatment of parkinsonism and narcolepsy.

Pharmacological action of MAO inhibitors

Inhibitors
MAO is classified according to pharmacological properties into non-selective irreversible, reversible selective and irreversible selective.

Non-selective irreversible MAO inhibitors are similar in chemical structure to iproniazids, improve the general condition of patients with depression and reduce angina attacks.

Reversible selective MAO inhibitors have antidepressant and psychoenergizing effects, actively suppress the deamination of serotonin and norepinephrine.

Irreversible selective MAO inhibitors have an antiparkinsonian effect, are involved in the metabolism of dopamine and catecholamines.

List of MAO inhibitor drugs

The list of non-selective irreversible MAO inhibitors includes:

Phenelzine;
Iproniazid;
Isocarboxazid;
Nialamide;
Tranylcypromine.

Selegiline is an irreversible selective MAO inhibitor.

The list of reversible selective MAO inhibitors includes:

Metralindol;
Pirlindol;
Befol;
Moclobemide;
Derivatives of beta-carbolines.

Indications for the use of MAO inhibitors

Contraindications

The intake of reversible selective MAO inhibitors is contraindicated in:

hypersensitivity;
Acute inflammatory diseases of the kidneys and liver;
Withdrawal alcohol syndrome;
Pregnancy and lactation.

Also, reversible selective MAO inhibitors are not prescribed in infancy.

Reception of non-selective irreversible MAO inhibitors is not prescribed for:

hypersensitivity;
liver failure;
Violation of cerebral circulation;
Chronic renal failure;
Chronic heart failure.

Reception of irreversible selective MAO inhibitors is contraindicated in:

Pregnancy and lactation;
Taking other antidepressants;
hypersensitivity;
Essential tremor;
Chorea of Huntington.

Carefully
irreversible selective MAO inhibitors are prescribed for:

progressive dementia;
tardive dyskinesia;
severe psychosis;
Peptic ulcer of the gastrointestinal tract;
Hyperplasia of the prostate;
severe angina;
Angle-closure glaucoma;
large-scale tremor;
tachycardia;
Pheochromocytoma;
Diffuse toxic goiter.

Side effects

The use of reversible selective MAO inhibitors can cause:

Anxiety;
dry mouth;
Headache;
Insomnia.

The use of non-selective irreversible MAO inhibitors can cause:

Dyspepsia;
Decreased blood pressure;
Anxiety;
insomnia;
Headache;
dry mouth;
Constipation.

The use of irreversible selective MAO inhibitors can cause complications from various body systems, namely:

Decreased appetite, dryness of the oral mucosa, increased activity of transaminases, nausea, diarrhea, constipation and dysphagia (digestive system);
Increased fatigue, insomnia, dizziness, hallucinations, headache, anxiety, dyskinesia, motor and mental agitation, confusion and psychosis (nervous system);
Increased blood pressure, orthostatic hypotension and arrhythmia (cardiovascular system);
Diplopia and impaired visual acuity (sense organs);
Nocturia, urinary retention and painful urge to urinate (urinary system);
Shortness of breath, photosensitivity, skin rash and bronchospasm (allergic reactions).

Also, taking irreversible selective MAO inhibitors can cause perspiration., hypoglycemia and hair loss.

Sincerely,

Article structure:

Scientists are sure that the nature of a person is largely determined by a substance such as monoamine oxidase. Learn how MAO inhibitors work and what they are for.

Today's article is devoted to a very interesting topic. Agree that not every person knows what MAO inhibitors are. Soon you will know this, and you will decide whether to use these drugs in real life.

Inhibitor: what is it?

To regulate biological processes, two directions are used - activation and inhibition. It should be noted that "pure" inhibitors or activators do not occur in nature. In any case, when using these drugs, you can gain significant benefits in one area, but lose in another.

To illustrate all of the above, let's recall the sensations that arise when, say, dopamine and serotonin are activated and GABA is simultaneously inhibited - a feeling of pleasure and happiness with a decrease in judgment.

Summing up these arguments, we have to state that we suppress the activity of one substance and at the same time increase the activity of the second. Inhibitors are called drugs, the action of which is directed precisely at the suppression and destruction.

MAO: what is it?

First, we should understand or recall the basic provisions of the synaptic transmission of neurotransmitters in the body. One neuron synthesizes a neurotransmitter that penetrates the synaptic cleft and is absorbed by another neuron. At the moment when the mediators are outside the neurons, the body can remove the excess substance to maintain balance. For these purposes, a special enzyme is used - monoamine oxidase.

Despite the rather complicated name, everything is quite simple and you only need to break one word into three parts:

Mono is one.
Amine is an amine group.
Oxidase is a redox process.

As a result, it turns out that MAO is the substance that is able to oxidize (destroy) monoamines, which in turn are neurotransmitters.

There are two types of MAO, which should be discussed in a little more detail.

MAO-A

This substance is able to destroy serotonin, dopamine and norepinephrine while they are in the synaptic cleft. After that, the excess returns to the first neuron and accumulates for the next "shot" of the neurotransmitter. Just imagine a glass of water overflowing and running down the sides of the container. However, in the body, excess water (our neurotransmitters) is not poured out, but returned back.

MAO-B

This enzyme is found in mitochondria and is designed to destroy less significant neurotransmitters. What you probably don't know is that more than a hundred neurotransmitters have been discovered by scientists so far.

Thus, MAO inhibition is a process of suppression of the monoamine destroyer. Remembering the school mathematics course, we get from minus to minus plus.

MAO inhibitors are powerful drugs that have the ability to completely change our behavior. It is quite obvious that the stronger the drug you use, the more significant the changes will be.

If you drink a cup of tea on the course of an MAO inhibitor, then a situation may arise that the result obtained from drinking this harmless drink will surpass the effects of psychostimulant narcotic substances. The MAO inhibitors produced today are distinguished by the strength of their effect on the body, and under certain conditions, even a lethal outcome is possible.

Scientists classify these drugs into three groups:

selective- are able to act on a certain type of MAO and thus a specific substance cannot be destroyed in the body.
irreversible- are able to almost completely destroy all reserves of monoamine oxidase, the restoration of which will take about 14 days.
reversible- designed to inhibit MAO for a certain time period.

You have probably heard about irreversible non-selective MAO inhibitors, which, however, are practically not used today. In terms of the use of these drugs, most antidepressants belong to the class of reversible selective inhibitors. They increase for some time the concentration of serotonin with dopamine in the synaptic cleft. Irreversible inhibitors are used in the treatment of serious conditions such as Parkinson's disease.

Interesting facts

If you enter the name of these drugs into the search engine, you will see an impressive list. However, many of them are very strong inhibitors and it is better to consider rhodiola rosea, nutmeg, green tea, yohimbine and a few others for home use.

Scientists have discovered a static pattern between monoamine oxidase activity and crime. This allows us to talk about a genetic predisposition to breaking the law. One of the special cases of this dependence is Brunner's syndrome.

For the first time, this syndrome began to be discussed in the nineties of the last century. Scientists have found that in one American family, all men had a certain MAO mutation. As a result, their body synthesized large amounts of serotonin, dopamine and norepinephrine.

Simply put, this indicates a partial suppression of enzyme activity throughout life. The intellectual abilities of these people were below average, and they often showed aggression and were very impulsive.

It has also been found that a child with an inactive monoamine oxidase exhibits a higher propensity for antisocial behavior in adulthood. It is with this fact that the assumption is connected that the genetic mutation of MAO is characteristic of people with low intelligence and prone to committing crimes.

The depressive state is also directly related to monoamine oxidase, more precisely, to the high activity of the enzyme. People taking antidepressants should also pay special attention to their diet. If an ordinary person needs to consume fish, milk and meat, then on a course of antidepressants, these products can cause side effects.

The thing is that they contain a large amount of amines, from which the body synthesizes neurotransmitters. For example, fish is an excellent source of tryptophan, which is essential for the production of serotonin. Since this mediator is not destroyed due to the work of antidepressants, the person will begin to experience dizziness, nausea, etc. will appear.

Also in conclusion, we note that MAO inhibitors cannot affect the concentration of acetylcholine, since this neurotransmitter is destroyed under the influence of a special enzyme - acetylcholine transferase.