Monoamine Oxidase Inhibitors (MAOIs) Attorneys


Monoamine oxidase inhibitors (MAOIs) are powerful antidepressants used in treating depression, agoraphobia, social anxiety, panic disorder and borderline personality disorder. Because of their potentially serious, and even lethal side effects, however, they are usually, but not always, prescribed only after other antidepressant drugs, such as serotonin reuptake inhibitors (SSRIs) and tricyclics, have been tried unsuccessfully.

MAOIs can be particularly effective in treating atypical depression (characterized by increased appetite, an increased need for sleep, and an increased severity of depressive symptoms towards the end of the day.), and some MAOIs are also used to treat Parkinson's disease, migraine prophylaxis, and to help quit smoking.

MAOIs include:

  • Isocarboxazid (Marplan)
  • Moclobemide (Aurorix, Manerix, Moclodura)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate, Jatrosom)
  • Selegiline (Selegiline, Eldepryl, Emsam)
  • Rasagiline (Azilect)
  • Iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida)
  • Iproclozide
  • Nialamide
  • Toloxatone
  • Linezolid (Zyvox, Zyvoxid)
  • Harmine
  • Dienolide kavapyrone desmethoxyyangonin (MAOI-B)
  • Dextroamphetamine
  • Safinamide
  • Geiparvarin

When taken orally, MAOIs slow down the metabolic breakdown of dietary amines, which are contained in foods such as ripened cheese, chocolate, certain wines, fish, yeast, and certain meats. Consumption of enough amounts of certain foods while taking MAOIs can lead to hypertensive crisis (sharp increase in blood pressure), hyperserotonemia (elevated serotonin levels), intracerebral hemorrhage (bleeding in the brain), or death. If left untreated, hypertensive crisis can lead to stroke or cardiac arrhythmia (irregular heartbeat).

There is also a high risk of developing the potentially fatal medical condition known as serotonin syndrome when combining non-selective MAOIs with drugs such as SSRIs, ecstasy (MDMA), or other phenylethylamines. Combining MAOIs with certain opioids such as meperidine can also lead to serotonin syndrome, and combining them with tricyclics and other antidepressants can also lead to hypertensive crisis.

Even when taking dietary precautions and avoiding dangerous drug interactions, taking excessive amounts of MAOIs is much more dangerous than doing so with other antidepressants. It is also dangerous to suddenly discontinue taking MAOIs. And even when properly tapering off of them, the same dietary restrictions as when beginning MAOI therapy should be followed at least two weeks after discontinuing usage.

Symptoms of MAOI overdose include:

  • severe anxiety
  • confusion, seizures
  • severe drowsiness
  • dizziness
  • cold, clammy skin
  • rapid, irregular pulse
  • fever
  • convulsions
  • hallucinations
  • severe headache
  • coma
  • tremors
  • spasms
  • excessively low or high blood pressure
  • muscle stiffness
  • difficulty breathing
  • extreme sleep difficulties
  • irritability

There are also some indications that children under the age of 16 may have their growth stunted or may be exposed to an increased risk of adverse reactions when taking MAOIs. And because of the risks for developing hypertensive crisis, individuals over the age of 60 and persons with heart or blood vessel diseases are usually not prescribed MAOIs.

Finally, despite carefully following all known precautions, potential side effects when taking MAOIs include:

  • insomnia
  • dry mouth
  • dizziness
  • lightheadedness
  • abnormal drop in blood pressure when standing up
  • constipation
  • weakness
  • erectile dysfunction
  • delayed or painful ejaculation (in men)
  • loss of sexual sensation (in men)
  • anorgasmia (inability to reach orgasm)
  • decreased libido (in women)
  • vaginal dryness

Less common side effects include:

  • chest pain
  • feelings of fear
  • flushing
  • headaches
  • nausea
  • rash
  • stiff neck
  • vomiting

A promising development for those for whom MAOIs is indicated, is the development of Emsam, a transdermal patch that delivers selegiline. Because this delivery system bypasses the gastrointestinal tract and liver, the chance of hypertensive crisis is reduced. Chocolate and caffeine, however, must still only be consumed in small amounts, and the danger of drug interactions remains.

If you or a loved one has suffered or is suffering from side effects after taking MAOIs, you may be entitled to compensation. To find out, you may wish to consult with a qualified pharmaceutical injury attorney.