Livingston M G, Livingston H M
Department of Psychological Medicine, University of Glasgow, Scotland.
Drug Saf. 1996 Apr;14(4):219-27. doi: 10.2165/00002018-199614040-00002.
After initial enthusiasm, the use of monoamine oxidase inhibitors (MAOIs) has been limited by the wide range of MAOI-drug and MAOI-food interactions that are possible, particularly with sympathomimetic medications or tyramine-containing foods, resulting in hypertensive reactions. Despite their clinical benefits, this has led to a reduction in use of such medications. Discovery of the 2 main subgroups of monoamine oxidase, types A and B, led to the synthesis of MAOIs selective for one or other of these isoenzymes. Consequently, selegiline (deprenyl), a selective MAO-B inhibitor, was developed for the treatment of idiopathic Parkinson's disease. This drug is useful in the treatment of the early stages of the disease and later on as an adjunct to other drug therapies. Although the selective MAO-A inhibitor, clorgiline (clorgyline), was found to be effective in the treatment of depression, it still retained the potential to cause hypertensive reactions. Recently, agents that are not only selective, but reversible in their inhibition of MAO-A (RIMAs) have been synthesised (e.g. moclobemide and toloxatone), and have proven antidepressant efficacy. Whilst they are less likely to induce hypertensive reactions with the concomitant administration of sympathomimetic drugs or with tyramine-rich foodstuffs, it still seems wise to advocate care in co-prescribing potentially interacting medications and to advise a degree of caution with regard to the dietary intake of foodstuffs likely to contain a high tyramine content. Although these newer drugs represent an advance in safety, their use has, as yet, only been established in the treatment of depression. RIMAs also retain a potential for adverse interaction with other drugs. Concomitant prescription of serotonin-enhancing drugs should only be undertaken with caution for patients on moclobemide, toloxatone or selegiline. Coprescription of sympathomimetic drugs should also be avoided with these newer MAOIs and patients should be advised against purchasing over-the-counter preparations that may contain sympathomimetic drugs.
在经历了最初的热情之后，单胺氧化酶抑制剂（MAOIs）的使用受到了广泛存在的MAOI与药物及MAOI与食物相互作用的限制，尤其是与拟交感神经药物或含酪胺食物的相互作用，会引发高血压反应。尽管它们具有临床益处，但这导致了此类药物使用的减少。单胺氧化酶A和B这两个主要亚组的发现，促使了对其中一种或另一种同工酶具有选择性的MAOIs的合成。因此，选择性MAO - B抑制剂司来吉兰（丙炔苯丙胺）被开发用于治疗特发性帕金森病。这种药物对疾病早期治疗有用，后期可作为其他药物治疗的辅助药物。尽管选择性MAO - A抑制剂氯吉兰被发现对治疗抑郁症有效，但它仍有引发高血压反应的可能性。最近，不仅具有选择性，而且对MAO - A的抑制作用是可逆的药物（RIMAs，如吗氯贝胺和托洛沙酮）已被合成，并且已证实具有抗抑郁疗效。虽然它们在与拟交感神经药物同时给药或与富含酪胺的食物一起食用时引发高血压反应的可能性较小，但联合开具可能相互作用的药物时谨慎行事，并就可能含有高酪胺含量的食物的饮食摄入给予一定程度的告诫似乎仍是明智之举。尽管这些新药在安全性方面有所进步，但它们的用途目前仅在抑郁症治疗中得到确立。RIMAs与其他药物也存在潜在的不良相互作用。对于服用吗氯贝胺、托洛沙酮或司来吉兰的患者，与5 - 羟色胺增强药物联合处方时应谨慎。这些新型MAOIs也应避免与拟交感神经药物联合处方，并且应建议患者不要购买可能含有拟交感神经药物的非处方制剂。
