Monoamine Oxidase Inhibitor Switching Strategies

Polnak, John F.; Finegan, Amber; Ji, Hyun; Crouse, Ericka L. Breden; Rosenblatt, Adam; Weitzner, Michael A.; Gardner, Kristen N.

doi:10.1097/jcp.0000000000000809

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…• Successful treatment with very high MAOI doses (that exceed the typically recommended maximum doses)-eg, 120 to 170 mg tranylcypromine 63 or 120 mg phenelzine. 64 • Successful cross-taper 65 (or even abrupt switch) 66 from MAOI to MAOI (note that additional research is required; this strategy remains highly controversial).…”

Section: 63mentioning

confidence: 99%

“… Successful, albeit cautious, coadministration of methadone without serious adverse events. Successful, albeit cautious, comedication with either lisdexamphetamine or methamphetamine to remedy phenelzine-induced daytime somnolence that did not adequately respond to methylphenidate or modafinil. Successful treatment with very high MAOI doses (that exceed the typically recommended maximum doses)—eg, 120 to 170 mg tranylcypromine 63 or 120 mg phenelzine 64 Successful cross-taper 65 (or even abrupt switch) 66 from MAOI to MAOI (note that additional research is required; this strategy remains highly controversial). Note that these are treatment strategies used by experts; they are not to be used without great caution and consideration (and a second opinion). In summary, this document is a detailed introduction to the use of classic MAOIs in clinical settings; it is meant merely to guide— not to restrain experienced practitioners, whose insights and intuitions may overrule these general considerations. In the past, combining MAOIs with other pharmaceuticals was considered “too risky”—often without a solid clinical or pharmacological basis 67 . Assuming proper adherence to the discussed considerations, there is no sound reason to categorically exclude potentially effective combination therapies.…”

Section: Maois: Introductionmentioning

confidence: 99%

Section: Maois: Introductionmentioning

confidence: 99%

“…Successful cross-taper 65 (or even abrupt switch) 66 from MAOI to MAOI (note that additional research is required; this strategy remains highly controversial).…”

Section: Maois: Introductionmentioning

confidence: 99%

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The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression

Eynde¹,

Abdelmoemin

Abraham³

et al. 2022

CNS Spectr.

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This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.

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Section: 63mentioning

confidence: 99%

Section: Maois: Introductionmentioning

confidence: 99%

Section: Maois: Introductionmentioning

confidence: 99%

“…Successful cross-taper 65 (or even abrupt switch) 66 from MAOI to MAOI (note that additional research is required; this strategy remains highly controversial).…”

Section: Maois: Introductionmentioning

confidence: 99%

See 2 more Smart Citations