MAOIs

[randomdoc1]

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Anyone have any recommended texts about guidelines for prescribing these? During residency, I have only used it once, and it was the 6mg/24h selegiline patch. All I remember is being mindful of drug drug interactions and my patient did not follow the low tyramine diet. I'd love to have other MAOIs in my toolbox though (especially after seeing how an MAOI can really transform a case). I'm looking into ways of 1) coming up with a systematic way of determining which patients may be good candidates and 2) looking into monitoring parameters. Especially if the patient will need a low tyramine diet, the only option I can think of to make sure the patient really has a thorough understanding is to work together with the PCP and RD in addition to getting a medical bracelet for the patient. Have any of you had much experience with MAOIs and/or have recommended texts? Thanks!

 

[thoffen]

Hopefully your 6mg patch was for Parkinson's because you weren't treating depression, but thankfully you weren't in need of a low tyramine diet at that point either.

I don't have a great reference text. I've not had occasion to use them, but I want to. This is just largely due to not willing to really do a washout and always having something else to try. I think I would do it on the right patient if they were doing ECT during the washout.

Wish the FDA had moclobemide approved, though.

 

[clausewitz2]

Hopefully your 6mg patch was for Parkinson's because you weren't treating depression, but thankfully you weren't in need of a low tyramine diet at that point either.

I don't have a great reference text. I've not had occasion to use them, but I want to. This is just largely due to not willing to really do a washout and always having something else to try. I think I would do it on the right patient if they were doing ECT during the washout.

Wish the FDA had moclobemide approved, though.

I feel like our pharmacopoeia would basically double if we ever got the FDA to accept approvals by peer agencies (say the EU or Japan). Moclobemide, Valdoxan, tianeptine (with caution)...

 

[OldPsychDoc]

...
Wish the FDA had moclobemide approved, though.

You can always get it mail order from Canada...

 

[randomdoc1]

I thought per Stahl the transdermal dosing for depression is 6-12mg/24h? Either way, patient found himself in remission so I figured I wouldn't try to fix what wasn't broke, sure didn't want to deal with the low tyramine diet. Thanks for the replies folks 🙂.

 

[HarryMTieboutMD]

For pragmatic tips (dosing, side effects, etc) Stahl's is actually pretty good. I use Nardil the most because it's the (relatively) the most well tolerated. However I am trying to convince anothe rpatient to take parnate because 1) her depression is treatment resistant and 2) she could use the stimulant like effects.

Low tyramine diet isn't as strict as it's made out to be. One of my attendings is approaching 80o and has more experience using MAOIs than anyone else and said that he has only had one hypertensive crisis because the patient didn't heed is warning and had a fondness for aged cheeses.

Sleep tends to be the biggest issue in my patients who take them but I've found Seroquel to be useful for that.

 

[thoffen]

I thought per Stahl the transdermal dosing for depression is 6-12mg/24h? Either way, patient found himself in remission so I figured I wouldn't try to fix what wasn't broke, sure didn't want to deal with the low tyramine diet. Thanks for the replies folks 🙂.

Doing a little research looks like I was wrong.

 

[PistolPete]

I had never started an MAO-I and have only ever continued a selegiline patch for a geri patient at the VA. I have only ever started one patient on a TCA and continued it for a handful. Definitely feel rusty with these 2 classes and want to use them more if the opportunity presents itself.