BOVRIL AND MOCLOBEMIDE - A NOVEL THERAPEUTIC STRATEGY FOR CENTRAL AUTONOMIC FAILURE

The consumption of tyramine-containing foods is contraindicated in pat ients on classic monoamine oxidase (MAO) inhibitors. We report success ful therapeutic use of moclobemide (a MAO-A selective inhibitor) plus controlled amounts of Bovril (a tyramine-rich yeast-extract available as a food) in a patient with pure central autonomic failure who was re ndered bed-bound by severe postural hypotension. Standing blood pressu re is now at least 90/45 mm Hg. The selectivity of moclobemide allows about a tenth of ingested tyramine to reach nerve endings and thus the modest hypertensive effect of this combination re-established day-to- day function by restoring normotension.