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Monoamine Oxidase Inhibitors Cheat Sheet by

Phenelzine Antidepressants


Selegiline (Trans­dermal MAOI)


These medica­tions block MAOI enzymes in the brain, thereby increasing the amount of norepi­nep­hrine, dopamine, serotonin, and tyramine available for transm­ission of impulses.
An increased amount of these neurot­ran­smi­tters at nerve endings intens­ifies responses and relieves depres­sion.
However, the increase in tyramine can cause heightened blood pressure or hypert­ensive crisis if dietary and medication restri­ctions are not implem­ented.
Onset of therap­eutic action is not immediate, and usually takes 2 to 4 weeks.
Less frequently used in comparison to other antide­pre­ssants due to food/drug intera­ctions and adverse effects.

Therap­eutic Uses

Bulimia Nervosa
Panic Disorder
Social Anxiety Disorder
Genera­lized anxiety Disorder
Obsessive Compulsive Disorder
Post-t­rau­matic Stress Disorder


CNS Depression
Nursing Action and Education
Anxiety, agitation, mania, or hypomania
Observe for effects and notify the provider if they occur
Orthos­tatic Hypote­nsion
Monitor blood pressure and heart rate for orthos­tatic changes. Hold medication and and notify the provider of signif­icant changes. Instruct the client to change positions slowly.
Hypert­ensive crisis (resulting from intake of dietary tyramine, which could lead to a cerebral vascular accident) Severe hypert­ension (as a result of intensive vasoco­nst­riction and stimul­ation of the heart), headache, nausea, increased heart rate, and increased blood pressure.
Administer phento­lamine IV (a rapid-­acting alpha-­adr­energic blocker) or nifedipine SL. Provide continuous cardiac monitoring and respir­atory support as indicated
Local rash with transd­ermal prepar­ation
Choose a clean, dry area for each applic­ation. Apply a topical glucoc­ort­icoid on the affected area

Contra­ind­ica­tions/ Precau­tions

MAOIs are a pregnancy risk category C. Not generally recomm­ended for use during pregnancy or breast­fee­ding. Notify the provider and they will determine if the risks of taking the medication out-weigh the benefits
Contra­ind­icated in clients taking SSRIs and in those who have pheoch­rom­ocy­toma, heart failure, cardio­vas­cular, and cerebral vascular disease, and serve renal insuff­ici­ency.
Use cautiously in clients who have diabetes and seizure disorders or those taking TCAs
Transd­ermal selegiline is contra­ind­icated for clients taking carbam­azepine or oxcarb­aze­pine, which can increase blood levels of the MAOIs


Client Education and Nursing Action
Indire­ct-­acting sympat­hom­imetic medica­tions (ephed­rine, amphet­amine) promote the release of norepi­nep­hrine and can lead to hypert­ensive crisis
Avoid over the counter decong­estants and cold remedies, which frequently contain medica­tions with sympat­hom­imetic action
Use of tricyclic antide­pre­ssants can lead to hypert­ensive crisis
Use MAOIs and TCAs cautiously
Use of SSRIs can lead to serotonin syndrome
Avoid concurrent use
Antihy­per­ten­sives have an additive hypote­nsive effects
Monitor blood pressure. Notify the provider if there is a signif­icant drop in blood pressure. A reduced dosage of antihy­per­tensive can be indicated
Use of meperidine can lead to hyperp­yrexia
Use an altern­ative analgesic
Tyramine rich foods (aged cheese, avocados, salami, figs, bananas) can lead to hypert­ensive crisis
Assess for ability to follow strict adherence to dietary restri­ctions. Provide clients with written instru­ctions regarding foods and beverages to avoid. Monitor for manife­sta­tions and notify the provider if they occur. Avoid taking any medica­tions without approval of the provider. Dietary and medication restri­ctions should be continued for 2 weeks after the MAOIs have been discon­tinued.
Concurrent use of vasopr­essors (pheny­let­hyl­amine, caffeine) can result in hypert­ension
Avoid foods that contain these agents (caffe­inated drinks, chocolate, fava beans, ginseng)
General anesth­etics
MAOIs should not be used within 10 to 14 days before or after surgery.


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