Course Description
About AAPP Toolkits
AAPP toolkits highlight both the evidence base available as well as strategies of clinical decision making used by expert psychiatric pharmacist clinicians. The content reflects the views and practice of the authors as substantiated with evidence-based facts as well as opinion and experience. Toolkits are peer reviewed by psychiatric pharmacists. Authors and AAPP review and update toolkits annually and strive to use up-to-date, non-stigmatizing language. Terminology does evolve rapidly and often regionally such that there may be differences between reader experiences and expectations and those of the author(s). AAPP members receive complimentary, continuous access to toolkits. Non-members can purchase for a fee for a period of 3 months.
Monoamine oxidase inhibitors (MAOIs) were the first antidepressants found to be effective in clinical use. Their discovery was serendipitous; the anti-tuberculosis agent, iproniazid, was noted to improve depressive symptoms in patients with tuberculosis. It was found that the antidepressant effect was related to inhibition of monoamine oxidase (MAO) (1-3). Currently, four MAOIs are approved and marketed for treatment of depression in the United States: phenelzine, tranylcypromine, transdermal selegiline, and isocarboxazid. Off-label “high-dose” selegiline is also considered a classic MAOI (4). Rasagiline, safinamide, and “low-dose” oral selegiline (10mg daily or less) are selective MAO Type B inhibitors approved for treatment of Parkinson’s disease. Iproniazid, while widely used initially, was removed from the market because of hepatotoxicity. An additional MAOI, moclobemide, is approved for the treatment of depression in Europe, Canada, and Australia. While methylene blue, linezolid, and procarbazine also have MAOI properties, further discussion is outside the scope of this toolkit. The toolkit provides information on:
- Role of MAOIs in Pharmacotherapy
- Significant Drug-Drug/Drug-Food Interactions with MAOIs
- Potential Adverse Effects: Monitoring, Prevention and Management
- Dosing and Administration
- References