5-Minute Emergency Consult
Monoamine Oxidase Inhibitor Poisoning
Monoamine Oxidase Inhibitor Poisoning is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Primarily for depression
- Selegiline, a selective monoamine oxidase B inhibitor, is sometimes used to treat Parkinson disease, and also comes in a transdermal preparation
- Monoamine oxidase inhibitor (MAOI) pharmacologic actions:
- Disruption of equilibrium between endogenous monoamine synthesis and degradation, resulting in:
- Increased neural norepinephrine levels
- Downregulation of several receptor types
- Inhibition of irreversible (noncompetitive) enzyme
- Inhibition of other B6-containing enzymes
- Disruption of equilibrium between endogenous monoamine synthesis and degradation, resulting in:
- MAO: Principal inactivator of neural bioactive amines:
- MAO A:
- Present in the gut and liver
- Protects against dietary bioactive amines
- MAO B:
- Present in neuron terminals and platelets
- Sympathomimetic amines: Types of bioactive amines
- MAO A:
Etiology
Etiology
- MAOI overdose:
- Toxicopharmacology poorly understood
- MAO inhibitors: Amphetamine-like in structure:
- Early: Indirect sympathomimetic effect
- Late: Sympatholytic response (hypotension)
- MAOI hypertensive crisis syndrome:
- Results from impaired norepinephrine degradation and large norepinephrine release precipitated by an indirect- or mixed-acting sympathomimetic agent
- Common precipitants: Tyramine, cocaine, amphetamines
- Serotonin syndrome (SS):
- Commonly results from exposure to combinations of agents that affect serotonin metabolism or action
- Increases serotonin synthesis: Tryptophan
- Increase serotonin release:
- Indirect- and mixed-acting sympathomimetic agents and dopamine receptor agonists
- Decrease serotonin reuptake:
- Selective serotonin reuptake inhibitors
- Tricyclic antidepressants
- Newer antidepressants: Trazodone, nefazodone, venlafaxine
- Phenylpiperidine opioids: Meperidine, dextromethorphan, tramadol, methadone, propoxyphene
- Direct serotonin receptor agonists:
- Buspirone, sumatriptan, lysergic acid diethylamide
- Decrease serotonin breakdown:
- MAOIs
- Increases nonspecific serotonin activity:
- Lithium
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
Description
- Primarily for depression
- Selegiline, a selective monoamine oxidase B inhibitor, is sometimes used to treat Parkinson disease, and also comes in a transdermal preparation
- Monoamine oxidase inhibitor (MAOI) pharmacologic actions:
- Disruption of equilibrium between endogenous monoamine synthesis and degradation, resulting in:
- Increased neural norepinephrine levels
- Downregulation of several receptor types
- Inhibition of irreversible (noncompetitive) enzyme
- Inhibition of other B6-containing enzymes
- Disruption of equilibrium between endogenous monoamine synthesis and degradation, resulting in:
- MAO: Principal inactivator of neural bioactive amines:
- MAO A:
- Present in the gut and liver
- Protects against dietary bioactive amines
- MAO B:
- Present in neuron terminals and platelets
- Sympathomimetic amines: Types of bioactive amines
- MAO A:
Etiology
Etiology
- MAOI overdose:
- Toxicopharmacology poorly understood
- MAO inhibitors: Amphetamine-like in structure:
- Early: Indirect sympathomimetic effect
- Late: Sympatholytic response (hypotension)
- MAOI hypertensive crisis syndrome:
- Results from impaired norepinephrine degradation and large norepinephrine release precipitated by an indirect- or mixed-acting sympathomimetic agent
- Common precipitants: Tyramine, cocaine, amphetamines
- Serotonin syndrome (SS):
- Commonly results from exposure to combinations of agents that affect serotonin metabolism or action
- Increases serotonin synthesis: Tryptophan
- Increase serotonin release:
- Indirect- and mixed-acting sympathomimetic agents and dopamine receptor agonists
- Decrease serotonin reuptake:
- Selective serotonin reuptake inhibitors
- Tricyclic antidepressants
- Newer antidepressants: Trazodone, nefazodone, venlafaxine
- Phenylpiperidine opioids: Meperidine, dextromethorphan, tramadol, methadone, propoxyphene
- Direct serotonin receptor agonists:
- Buspirone, sumatriptan, lysergic acid diethylamide
- Decrease serotonin breakdown:
- MAOIs
- Increases nonspecific serotonin activity:
- Lithium
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Citation
Schaider, Jeffrey J., et al., editors. "Monoamine Oxidase Inhibitor Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307212/all/Monoamine_Oxidase_Inhibitor_Poisoning.
Monoamine Oxidase Inhibitor Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307212/all/Monoamine_Oxidase_Inhibitor_Poisoning. Accessed March 29, 2023.
Monoamine Oxidase Inhibitor Poisoning. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307212/all/Monoamine_Oxidase_Inhibitor_Poisoning
Monoamine Oxidase Inhibitor Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 March 29]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307212/all/Monoamine_Oxidase_Inhibitor_Poisoning.
* Article titles in AMA citation format should be in sentence-case
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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DB - Emergency Central
DP - Unbound Medicine
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