DRUG-INTERACTIONS WITH REVERSIBLE MONOAMINE OXIDASE-A INHIBITORS

The use of monoamine oxidase inhibitors (MA01s) in the treatment of de pression has been bedeviled by reports of potentially dangerous or eve n fatal interactions with dietary amines and other drugs together with reports of more conventional toxicity to organs such as the liver. As a result, these otherwise very important and useful drugs have not be en employed clinically as much as their effectiveness as antidepressan ts would indicate. Many of these unwanted actions were due partially o r entirely to the fact that the older MAOIs all inhibited MAO irrevers ibly. The introduction of reversible inhibitors of monoamine oxidase-A (RIMAs) has greatly reduced both the number and severity of these int eractions and, in particular, the risk of hypertensive crises followin g the ingestion of tyramine (the ''cheese effect''). Potential interac tions may remain with inhibitors of the uptake of 5-hydroxytryptamine, including pethidine and rapid release formulations of nasal decongest ant amines. Potential interactions between RIMAs and other drugs that compete for the same metabolic pathways may still occur but should onl y result in changes in duration of action.