Phenelzine ( *** ) @ - Monoamine Oxidase inhibitors
Drug Name:Phenelzine ( *** ) @ - Monoamine Oxidase inhibitors
List Of Brands:
Indication Type Description:
Drug Interaction
Indication
Adverse Reaction
Contra-Indications
Dosages/ Overdosage Etc
Other Information
Patient Information
Pharmacology/ Pharmacokinetics
Interaction with Food
Pregnancy and lactation
Drug Interaction:
Indication:
Anxiety with depression
Monoamine Oxidase Inhibitors- include Phenelzine ,Tranylcypromine sulfate, Isocarboxazid. Refer - Phenelzine
Interacting drugs- summary
MAOIs +
Anesthetics incr MAOIs may be continued through surgery Antidepressants incr MAOIs not be administered together with TCA or SSRIs Antidiabetic agents incr MAOIs potentiate hypoglycaemic response to insulin Betablockers incr bradycardia may develop during concurrent use Dextromorphan incr Hyperpyrexia, hypotension and death associated with combn Guanethidine decr MAOIs may inhibit the hypotensive effects of guanethidine Levodopa incr hypertensive reactions, if levodopa is given to patients on MAOI Meperidine incr coadministration result in agitation, seizures, diaphoesis, fever Sympathomimetics incr MAOIs potentiates indirect or mixed acting sympathomimetic L-Tryptophan incr coadmin.may result in hyperthermia, hyperventilation,
EVIDENCE BASED MEDICINE (April 2003) Depression Comparitive effectiveness of various interventions Beneficial
1. Tricyclic and heterocyclic antidepressants
2. Selective serotonin reuptake inhibitors and related drugs
3. Monamine oxidase inhibitors
4. Interpersonal therapy (mild to moderate depression) Likely to be beneficial
1. St.Johns wort in mild to moderate depression
2. Problem solving therapy in mild to moderate depression
3. Combining drug psychological treatment in severe depression
4. Maintenance drug treatment may prevent recurrence Unknown efectiveness
1. Excercise
2. Bibliotherapy (advising patients to read material on mood therapy)
3. Non-directive counselling
4. Psychological treatment in severe depression
5. Clinician colloboration and patient education.
KEY POINTS
1. Several treatments are effective in the treatment of mild to moderate depression. These include anti-depression drugs, cognitive therapy and interpersonal therapy. Less robust RCTs have found that problem solving therapy and St Johns wort are also effective.Specific psychological treatments such as cognitive and interpersonal therapy have been shown to be as effective as drugs and there is no significant difference between anti-depressant drugs, although they vary in adverse effects and costs.
2. There is limited evidence that other treatments such as excercise, bibliography and non-directive counselling may be effective, but further research is needed.
3. There is no reliable evidence that one type of treatment (drug or non-drug) is superior to another. Limited evidence suggest that combing drug and psychological treatments may be effective in severe but not in moderate depression.
4. Of the interventions examined, anti-depressants drugs are the only treatment for which there is good evidence of effectivenes in severe psychotic depressive disorders. There are no trials comparing drug and non-drug treatments in severe depressive disorder.
5. Continuing anti-depressants drug treatment for four to five months after recovery reduces the risk of relapse, and maintenace therapy in recurrent depressive disorder reduces the risk of recurrence.
6. There is no evidence of a difference in long-term benefits between treatments
Adverse Reaction:
Contra-Indications:
Dosages/ Overdosage Etc:
Other Information:
EVIDENCE BASED MEDICINE (April 2003) Depression Comparitive effectiveness of various interventions Beneficial
1. Tricyclic and heterocyclic antidepressants
2. Selective serotonin reuptake inhibitors and related drugs
3. Monamine oxidase inhibitors
4. Interpersonal therapy (mild to moderate depression) Likely to be beneficial
1. St.Johns wort in mild to moderate depression
2. Problem solving therapy in mild to moderate depression
3. Combining drug psychological treatment in severe depression
4. Maintenance drug treatment may prevent recurrence Unknown efectiveness
1. Excercise
2. Bibliotherapy (advising patients to read material on mood therapy)
3. Non-directive counselling
4. Psychological treatment in severe depression
5. Clinician colloboration and patient education.
KEY POINTS
1. Several treatments are effective in the treatment of mild to moderate depression. These include anti-depression drugs, cognitive therapy and interpersonal therapy. Less robust RCTs have found that problem solving therapy and St Johns wort are also effective.Specific psychological treatments such as cognitive and interpersonal therapy have been shown to be as effective as drugs and there is no significant difference between anti-depressant drugs, although they vary in adverse effects and costs.
2. There is limited evidence that other treatments such as excercise, bibliography and non-directive counselling may be effective, but further research is needed.
3. There is no reliable evidence that one type of treatment (drug or non-drug) is superior to another. Limited evidence suggest that combing drug and psychological treatments may be effective in severe but not in moderate depression.
4. Of the interventions examined, anti-depressants drugs are the only treatment for which there is good evidence of effectivenes in severe psychotic depressive disorders. There are no trials comparing drug and non-drug treatments in severe depressive disorder.
5. Continuing anti-depressants drug treatment for four to five months after recovery reduces the risk of relapse, and maintenace therapy in recurrent depressive disorder reduces the risk of recurrence.
6. There is no evidence of a difference in long-term benefits between treatments
Patient Information:
Monoamine Oxidase Inhibitors- include Phenelzine ,Tranylcypromine sulfate, Isocarboxazid. Refer - Phenelzine
1.Do not discontinue this medication or adjust dosage, except on advise of physician. Consult physician before taking any medication including OTC drugs.
2. Avoid tyramine-containg foods and certain OTC products.
3. May cause drowsiness, weakness or fainting may occur when arising from a horizontal or sitting position.
4. Effects may delayed a few weeks. take as directed.
5. Notify physician if severe headache, skin rash, darkening of the urine,pale stools, jaundice or other unusual symptoms occur.
6. Allergies- Tell your doctor if you had any allergic reactions to Monoamine oxidase inhibitors. Tell your doctor if you are allergic to any other substances such as foods, or drinks.
7. Diet- Foods that have a high tyramine content ( aged or fermented foodstuff tend ( to increase their flavour) such as cheese, broad bean pods yeast or meat should be avoided Alcoholic beverages or alcohol free or reduced alcohol beer and wine Large amounts of caffeine or tea cola or chocolate should be avoided.
8. Pregnancy- MAO inhibitors caused a slowing of growth and increased excitability in the newborn when large doses were given to mother during pregnancy
9. Breast feeding- Problems with nursing babies have been reported.
10. Children- Animal studies have shown that these medicines may slow growth in the young
11. Elderly- Dizziness and lightheadedness may occur in elderly patients
12. Other medicines-Tell your doctor if you are taking any of the following medicines- Amphetamines- or Antihypertensives or appetite stimulants or Cyclobenzaprine or Fluoxetine or Levodopa or Maprotilline or Medicines foe asthma or Medicines for colds,sinus problems or hay fever or other allergies or Meperidine or Methylphenidate or Monoamine oxidase (MAO inhibitors ) other including furazolidine eg furoxone, procarbazine or selegine or Paroxetine or Seretraline or Tricyclic antidepressants Use of these medicines while you are taking or within 2 weeks of taking MAO inhibitors may cause serious side effects such as rise in body temperature, extremely high pressure, severe convulsions and death . However some of these medicines may be used with MAO inhibitors under close medical supervision. Antidiabetes oral or Insulin - MAO inhibitors may change the amount of antidiabetic medicine you need to take. Bupropion - using buprion while you are taking or within 2 weeks of takinh MAO inhibitors may cause serious side effects suchas seizures Carbamazepine - use with MAO inhibitors may increase seizures CNS depressants - using these medicines with MAO inhibitors may increase the cNS and other depressant effects Cocaine- use by persons taking MAO inhibitors including furazolidine and pro carbazine may cause a severe increae in blood pressure Dextromethorphan- use with MAO inhibitors may cause excitement.high blood pressure and fever Trazodine or Trytophan use as food supplement or sleep aid- use of these medicines by persons taking MAO inhibitors including furazolidone and procarbazine may cause mental confusion, excitement, shivering trouble in breathing or fever.
13. Other medical problems- Tell your if you have any other medical problems- Alcohol abuse- drinking alcohol while you are taking MAO inhibitors may cause serious effects. Angina or chest pain or Headaches severe or frequent - may interfere with warning signs of serious side efects of MAO inhibitors Asrhama or bronchitis- some medicines used to treat these conditions may cause serious side effects while on MAO inhibitors Diabetes mellitus- these medicines may change the amonut of insulin or oral antidiabetic medicines that you may need Epilepsy- seizures may occur often Heart or blood vessel disease or Liver disease or Mental illness or history of Parkinsons disease Recent heart attack or stroke- MAO inhibitors may make the conditions worse High blood pressure-- conditions affected by these medicines Kidney disease- higher blood levels of MAO inhibitors may occur, with incresed side effects. Overactive thyroid or Pheochromocytoma- PCC - serious side effects may occur
14. Missed dose- if you miss a dose of this medicine take it as soon as possible However if it is within 2 hours of your next dose skip the next dose and go back to your regular dosing schedule Do not double doses.
15. Storage- Keep out of reach of children. Overdose of this medicine is too dangerous for children. Store away from heat and direct light. Do not store the tablet or capsule form of this medicine in the bathroom,near the kitchen sink or in other damp places Keep the liquid formof this medicine from freezing Do not keep outdated medicines. Be sure that discarded medicine is out of reach of children
Pharmacology/ Pharmacokinetics:
Pharmacology: Monoamine oxidase is a complex enzyme system, widely distributed through out the body, which is responsible for the metabolic decomposition of biogenic amines, thus terminating the activity.Drugs that inhibit this enzyme system (MAOIs) cause an increase in the concentration of endogenous epinephrine, norepinephrine and serotonin (5HT) in storage sites throughout the nervous system. The increase in the concentration of monoiamines in the CNS system is the basis for the antidepressant activity of these agents.
Pharmacokinetics: Phenelzine and tranylcypromine are well absorbed orally. The clinical effects of phenelzine may continue for upto 4 weeks after discontinuation of therapy. When tranylcypromine is withdrawn, MAO activity is recovered in 3 to 5 days (possibly upto 10 days) although the drug is excreted in 24 hours.
Interaction with Food:
Reports not availble
Pregnancy and lactation:
Pregnancy: Safety for use in pregnancy has not been established. Use only if needed. Lactation: Safety for use during lactation has not been established Tracylcypromine is excreted in breast mlilk. Use with caution in nursing mothers.
Children- Not recommended for patients < 16 years of age.