Irreversible nonselective monoamine oxidase inhibitors
Irreversible nonselective monoamine oxidase inhibitors (MAOIs) (eg phenelzine, tranylcypromine) can be used under the supervision of a psychiatrist for patients with treatment-resistant major depression, or if the patient has responded well to them previously. However, use of MAOIs is restricted to specialists or practitioners familiar with managing the dietary restrictions and drug interactions (see Principles of using irreversible nonselective monoamine oxidase inhibitors [MAOIs]).
A baseline electrocardiogram (ECG) and close monitoring for postural dizziness using lying and standing blood pressure in the first 2 weeks and after dosage changes is recommended.
An appropriate regimen in adults and young people is:
1 phenelzine 45 mg orally, daily in 2 divided doses (the last dose each day should be given no later than early afternoon to minimise the risk of insomnia)1 . Increase as tolerated every 3 to 4 days to a target dose of 60 mg daily in 2 divided doses. If response is inadequate, further dose increases may be needed to a maximum dose of 90 mg daily major depression phenelzine phenelzine phenelzine
OR
1 tranylcypromine 10 mg orally, twice daily (the last dose each day should be given no later than early afternoon to minimise the risk of insomnia). If response is inadequate, increase the daily dose by 10 mg no more often than every 7 days to a maximum daily dose of 60 mg. major depression tranylcypromine tranylcypromine tranylcypromine