MAO Inhibitor

Mono-Amine-Oxidase is an enzyme which breaks down certain poisons in our diet. It also breaks down goodies like psilocybin and DMT. An MAO Inhibitor such as Syrian Rue or the ayahuasca vine (B. Caapi) allows these drugs to become orally active.
MAOIs are also used as antidepressants. If you are on an MAOI, stay the hell away from:

• DXM (Robitussin). You don't want to die, do you?
• Bananas.
• Anything fermented, such as cheese or wine.

Yohimbine and Nardil are two prescription drugs with MAO inhibiting effects.

Tyramine can cause serious side effects for patients who take monoamine oxidase inhibitors. A more complete list of foods to avoid when MAO inhibitors are in your system:

alcohol
red wine
beer, even nonalcoholic beer
champagne
sherry

food
aged or fermented cheese
avacado
beef extracts
broad bean pods
fermented meat
fermented sausage (bologna, salami, pepperoni)
overripe fruit
sauerkraut
smoked or pickled fish, meat, poultry
yeast extracts
soy sauce

Use foods and drinks containing caffeine in moderation:
cola
coffee
tea
chocolate

MAO inhibitors, or monoamine oxidase inhibitors, are a class of drugs used to treat depression and occasionally Parkinson's or Hodgkin's disease. Some studies suggest that MAOIs are more effective than the tricyclics or the SSRIs, particularly for forms of depression that are resistant to treatment or that involve unusual symptoms; however, as described above, patients taking these drugs must obey certain dietary restrictions.

Here is a list of some common MAOIs and their generic names:

Brand Name.....Generic Name

Carbex.........selegiline.......Parkinson's
Marplan........isocarboxazid....depression
Matulane.......procarbazine.....Hodgkin's
Nardil.........phenelzine.......depression
Parnate........tranylcypromine..depression

Note: Please make sure you understand the limitations of E2 drug nodes.

The MAO Inhibitors can be further categorized based on their reversibility and their selectivity.

Selectivity
There are two MAO enzymes that are involved when people discuss MAO inhibitors. Like LDL and HDL cholesterols, they have been somewhat inappropriately labeled, "good" and "bad" MAO enzymes. The first enzyme, MAO-A, is known as the "good" one. The inhibition of this enzyme is responsible for some of the desirable anti-depressant activity as it allows a greater amount of neurotransmitters, specifically norepinephrine, serotonin and dopamine, to accumulate unmolested at the receptor sites in the synaptic cleft. The second enzyme, MAO-B, is known as the "bad" one. This enzyme degrades only dopamine from the neurotransmitter group. Selectivity refers to the ability of an MAO inhibitor to target a specific MAO enzyme while not disturbing the other. The majority of the current MAO inhibitors non-selectively target both "good" and "bad" MAO enzymes. Both MAO enzymes disable tyramine, so selectively inhibiting one of the two (usually MAO-A) leaves one to manage tyramine and greatly reduces the danger associated with traditional non-selective MAO inhibitors. From this, it should be clear that "good" and "bad" are misnomers and only serve as arbitrary labels.

Reversibility
The reversibility of the MAO inhibitors is based upon the mechanism by which the MAO inhibitors act on the MAO enzymes. Non-reversible MAO inhibitors form bonds with the MAO enzymes that are very difficult to sever. For all intents and purposes, once the MAO inhibitor has bonded to the MAO enzyme, it is out of the game for the duration. Further synthesis of MAO enzymes is required to rebuild the MAO enzyme population. The reversible MAO inhibitors can be displaced from the MAO enzymes by tyramine so that the danger of the so-called "cheese effect" (the heightened risk from tyramine which is often found in aged cheeses, among other foods) is significantly reduced.

It should be noted that not all cheeses contain tyramine in levels that should cause concern. Cream cheese, ricotta and generally any processed cheese or unaged cheese is "safe" when using MAO inhibitors of any type. Also, despite common misconception, bananas are relatively safe, whereas banana peels are not as the peels contain significant amounts of tyramine.

A selection of currently available MAO inhibitors:

Non-selective, non-reversible MAO inhibitors
• isocarboxazid - Marplan
• phenylzine - Nardil
• tranylcypromine - Parnate

Selective, reversible MAO inhibitors¹
• brofaromine - Consonar
• moclobemide - Manerix
• toloxatone - Humoryl

WARNING - Regarding the dietary restrictions associated with taking MAO inhibitors, consult your physician or psychiatrist if you have one. If you are in it for recreational purposes then you've already decided to fly solo and should be as thoroughly educated on the topic as possible.

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1. The reversible MAO inhibitors, aka. RMAIs, are currently available in Europe and Canada but not in the United States.

Antidepressants --Monoamine Oxidase (MAO)Inhibitors
Whats the deal with MAO Inhibitors?

Antidepressants are used to treat mood disorders: bipolar disorder and depressive disorders. The MAO inhibitors inhibit the enzyme MAO. This enzyme metabolizes epinephrine, *norepinephrine, and *serotonin. The result is an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin), where serotonin deficiencies may be related to depression.

phenelzine / Nardil
Phenelzine is a MAO inhibitor which functions in increasing the levels of serotonin in the brain. This drug is available by mouth (PO) only with the onset beginning at approximately 7-10 days.
tranylcypromine / Parnate
Parnate is a MAO inhibitor, similar to Nardil.

Serotonin
Serotonin is known as a biogenic amine; it has shown to be a mood regulator. Interestingly, the relationship between depression and this disorder was linked during treatment for hypertension. Patients were being treated with a biogenic amine-depleting agent reserpine, and they became depressed. Patients who were being treated for tuberculosis with ipronazid, a biogenic enhancing agent became euphoric.
Serotonin generally serves inhibitory functions in the brain, and disturbances in its functioning may underlie the irritability, anxiety, and sleep disturbances common in depression.

Norephinephrine
Norephinephrine is also a biogenic amine. Norepinephrine is involved in maintenance of arousal, alertness, and euphoria. Disturbances in norepinephrine function are thought to underlie lack of energy and depressed mood.

Good drug? Bad drug?... Side effects and interactions
There are a number of side-effects and drug interactions with MAO inhibitors. It makes sense if you think about the role that ex. norepinephrine plays in regulation of blood pressure, and heart rate. Consider the role of an anti-hypertensive beta-blocker, where the beta receptors in the myocardium receive norepinephrine and epinephrine. When blocked, the result is a decrease in heart rate, a decrease in contractility thus decreasing cardiac output and peripheral resistance ultimately decreasing blood pressure. Therefore it is logical to consider that MAO inhibits in combination with beta-blockers can cause bradycardia and hypotension.
MAO inhibitors interact with other MAO inhibitors because the risk of hypertension related to the excess of norepinephrine.
MAO inhibitors essentially interact with every kind of drug for one reason for another so it is important to be informed regarding the use of MAO inhibitors with other medications (both Rx and OTC).
Side Effects – the relevant
agitation, sedation, bradycardia, hypertensive crisis, tachycardia, elevated LFT’s, hypernatremia

So…
Monitor cardiovascular status for hypertension, changes in heart rate and palpitations. Keep phentolamine readily available to treat hypertensive crisis without causing excessive hypotension.
Instruct patients with their diet restrictions as some foods contain tyramine or other pressor amines ex. aged cheese; beer; beans; cured meat or sausage; liqueurs; overripe fruit; red and white wine; sauerkraut; sherry; smoked or pickled fish; meats and poultry; year or protein extracts. The effect is an increased risk of sudden hypertension.

Am I hypertensive?
Chest pain? Headache? Neck Stiffness? Palpitations?
Patients: seek immediate medical attention if experiencing any of the signs of a hypertensive episode.