Monoamine oxidase inhibitors work by binding to the enzyme monoamine oxidase, thus inhibiting the breakdown of monoamines at the synaptic junction which increases the concentration of the neurotransmitters epinephrine, norepinephrine, and dopamine at various sites in the central nervous system (CNS) and sympathetic storage sites. Therapeutic effect takes 2-4 weeks. Patients prescribed these agents should avoid foods high in tyramine such as cheeses, yeast supplements, and red wines. Meperidine (Demerol®®) must be avoided because of risk of serotonin syndrome and malignant hyperpyrexia.
Isocarboxacid (Marplan®®): 30-50 mg/day (10 mg tablets) Phenelzine (Nardil®®): 45-90 mg/day (15 mg tablets) Tranylcypromine (Parnate®®): 20-60 mg/day (10 mg tablets)
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