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'''Reversible inhibitors of monoamine oxidase A''' (RIMAs) are a class of drugs which selectively and reversibly inhibit the enzyme monoamine oxidase A (MAO-A). They are used clinically in the treatment of depression and dysthymia, though they have not gained widespread market share due to limited efficacy relative to other antidepressants. Because of their reversibility and selectivity, RIMAs are safer than the older [[MAOI|monoamine oxidase inhibitors]] (MAOIs).<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833271/</ref>
{{For|irreversible monoamine oxidase inhibitors (MAOIs)|MAOI}}


While safer than general MAOIs, RIMAs still have highly dangerous and sometimes fatal interactions with many common drugs; in particular, they can cause [[serotonin#serotonin syndrome|serotonin syndrome]] or hypertensive crisis when combined with almost any antidepressant or [[stimulant]], common migraine medications, certain herbs, or even most cold medicines (including decongestants, [[antihistamines]], and cough syrup).
'''Reversible inhibitors of monoamine oxidase A''' (RIMAs) are a class of drugs which selectively and reversibly inhibit the enzyme monoamine oxidase A (MAO-A). They are used clinically in the treatment of depression and dysthymia, though they have not gained widespread market share due to limited efficacy relative to other antidepressants. Because of their reversibility and selectivity, RIMAs are safer than the older [[MAOI|monoamine oxidase inhibitors]] (MAOIs).<ref>{{cite journal | vauthors=((Fowler, J. S.)), ((Logan, J.)), ((Azzaro, A. J.)), ((Fielding, R. M.)), ((Zhu, W.)), ((Poshusta, A. K.)), ((Burch, D.)), ((Brand, B.)), ((Free, J.)), ((Asgharnejad, M.)), ((Wang, G.-J.)), ((Telang, F.)), ((Hubbard, B.)), ((Jayne, M.)), ((King, P.)), ((Carter, P.)), ((Carter, S.)), ((Xu, Y.)), ((Shea, C.)), ((Muench, L.)), ((Alexoff, D.)), ((Shumay, E.)), ((Schueller, M.)), ((Warner, D.)), ((Apelskog-Torres, K.)) | journal=Neuropsychopharmacology | title=Reversible Inhibitors of Monoamine Oxidase-A (RIMAs): Robust, Reversible Inhibition of Human Brain MAO-A by CX157 | volume=35 | issue=3 | pages=623–631 | date= February 2010 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833271/ | issn=0893-133X | doi=10.1038/npp.2009.167}}</ref>


==Interactions==
==Interactions==
{{mbox|type=notice|text=This page will never be complete since too many psychoactive substances interact with RIMAs, always check interaction with multiple sources.}}
{{Information/MAOIs and RIMAs}}
 
{{For|psychoactive MAO-A substance interactions (but not food interactions)|MAOI#Interactions}}
 
While safer than general MAOIs, RIMAs still have highly dangerous and sometimes fatal interactions with many common drugs; in particular, they can cause [[serotonin#serotonin syndrome|serotonin syndrome]] or hypertensive crisis when combined with almost any antidepressant or [[stimulant]], common migraine medications, certain herbs, or even most cold medicines (including decongestants, [[antihistamines]], and cough syrup).


{{For|psychoactive substance interactions (but not food interactions)|MAOI#Interactions}}
===Dangerous interactions===
{{DangerousInteractions/Intro}}
{{DangerousInteractions/MAOIs}}


==List of RIMAs==
==List of RIMAs==
{{see also|MAOI#List of MAOIs}}
{{see also|MAOI#List of MAOIs}}


* Naturally occurring sources
===Naturally occurring sources===
** [[Peganum harmala (botany)|Syrian rue (''Peganum harmala'')]]: [[Harmaline]]<ref>{{ cite book | author = Massaro, E. J. | title = Handbook of Neurotoxicology | publisher = Humana Press | location = Totowa, NJ | year = 2002 | isbn = 0-89603-796-7 | url = https://books.google.com/books?id=2c2K-epbCDQC&pg=PA237&lpg=PA237&dq=harmaline+antidepressant | page = 237 }}</ref> ''Peganum harmala'' also contains a [[MAOI]]s.
* [[Peganum harmala (botany)|Syrian rue (''Peganum harmala'')]] (note that it also contains a [[MAOI|MAO-A and MAO-B]] inhibitors)
** Turmeric (''Curcuma longa''): Curcumin<ref>{{cite journal |last1=Kulkarni |first1=SK |last2=Bhutani |first2=AK |last3=Bishnoi |first3=M. |title=Antidepressant activity of curcumin: involvement of serotonin and dopamine system. |journal=Psychopharmacology |date=3 September 2008 |volume=201 |issue=3 |pages=435–442 |doi=10.1007/s00213-008-1300-y |pmid=18766332 }}</ref><ref>{{cite journal |last1=Kulkarni |first1=S. K. |last2=Dhir |first2=A. |title=An Overview of Curcumin in Neurological Disorders |journal=Indian Journal of Pharmaceutical Sciences |date=March 2010 |volume=72 |issue=2 |pages=149–154 |pmc=2929771 |doi=10.4103/0250-474X.65012 |pmid=20838516}}</ref> (selectivity for MAO-A is disputed<ref>{{cite web |title=Curcumin and the MAO Inhibitor "Cheese Effect" from Tyramine Triggered Hypertension |url=https://emediahealth.com/2012/01/17/curcumin-and-the-mao-inhibitor-cheese-effect-from-tyramine-triggered-hypertension/ |website=EmediaHealth |date=17 January 2012 |accessdate=28 March 2017 |deadurl=no |archiveurl=https://web.archive.org/web/20170330014040/https://emediahealth.com/2012/01/17/curcumin-and-the-mao-inhibitor-cheese-effect-from-tyramine-triggered-hypertension/ |archivedate=30 March 2017 |df=dmy-all }}</ref>). Curcumin is commonly sold with piperine that enhances the effect of MAO inhibition.
** [[Harmaline]]<ref>{{ cite book | author = Massaro, E. J. | title = Handbook of Neurotoxicology | publisher = Humana Press | location = Totowa, NJ | year = 2002 | isbn = 0-89603-796-7 | url = https://books.google.com/books?id=2c2K-epbCDQC&pg=PA237&lpg=PA237&dq=harmaline+antidepressant | page = 237 }}</ref>
* Psychoactive substances
** Harmine
** [[5-IT]]<ref>{{cite journal |url=http://onlinelibrary.wiley.com/doi/10.1002/dta.1530/abstract |title=5-(2-Aminopropyl)indole (5-IT): a psychoactive substance used for recreational purposes is an inhibitor of human monoamine oxidase (MAO) |author =Tomás Herraiz |author2 =Simon D. Brandt |journal=Drug Testing and Analysis |date=July–August 2014 |volume=6 |issue=7–8 |pages=607–613 |doi=10.1002/dta.1530 |pmid=24115740}}</ref>
* Turmeric (''Curcuma longa''): Curcumin<ref>{{cite journal |last1=Kulkarni |first1=SK |last2=Bhutani |first2=AK |last3=Bishnoi |first3=M. |title=Antidepressant activity of curcumin: involvement of serotonin and dopamine system. |journal=Psychopharmacology |date=3 September 2008 |volume=201 |issue=3 |pages=435–442 |doi=10.1007/s00213-008-1300-y |pmid=18766332 }}</ref><ref>{{cite journal |last1=Kulkarni |first1=S. K. |last2=Dhir |first2=A. |title=An Overview of Curcumin in Neurological Disorders |journal=Indian Journal of Pharmaceutical Sciences |date=March 2010 |volume=72 |issue=2 |pages=149–154 |pmc=2929771 |doi=10.4103/0250-474X.65012 |pmid=20838516}}</ref> (selectivity for MAO-A is disputed<ref>{{cite web |title=Curcumin and the MAO Inhibitor "Cheese Effect" from Tyramine Triggered Hypertension |url=https://emediahealth.com/2012/01/17/curcumin-and-the-mao-inhibitor-cheese-effect-from-tyramine-triggered-hypertension/ |website=EmediaHealth |date=17 January 2012 |accessdate=28 March 2017 |deadurl=no |archiveurl=https://web.archive.org/web/20170330014040/https://emediahealth.com/2012/01/17/curcumin-and-the-mao-inhibitor-cheese-effect-from-tyramine-triggered-hypertension/ |archivedate=30 March 2017 |df=dmy-all }}</ref>). Curcumin is commonly sold with piperine that enhances the effect of MAO inhibition.
** [[AMT]]<ref>Studies of Monoamine Oxidase and Semicarbazide-Sensitive Amine Oxidase II. Inhibition by α-Methylated Substrate-Analogue Monoamines, α-Methyltryptamine, α-Methylbenzylamine and Two Enantiomers of α-Methylbenzylamine | https://www.jstage.jst.go.jp/article/jphs1951/41/2/41_2_191/_article</ref>
 
===Psychoactive substances===
* [[5-IT]]<ref>{{cite journal |url=http://onlinelibrary.wiley.com/doi/10.1002/dta.1530/abstract |title=5-(2-Aminopropyl)indole (5-IT): a psychoactive substance used for recreational purposes is an inhibitor of human monoamine oxidase (MAO) |author =Tomás Herraiz |author2 =Simon D. Brandt |journal=Drug Testing and Analysis |date=July–August 2014 |volume=6 |issue=7–8 |pages=607–613 |doi=10.1002/dta.1530 |pmid=24115740}}</ref>
* [[AMT]]<ref>{{cite journal | vauthors=((Arai, Y.)), ((Toyoshima, Y.)), ((Kinemuchi, H.)) | journal=The Japanese Journal of Pharmacology | title=Studies of Monoamine Oxidase and Semicarbazide-Sensitive Amine Oxidase II. Inhibition by α-Methylated Substrate-Analogue Monoamines, α-Methyltryptamine, α-Methylbenzylamine and Two Enantiomers of α-Methylbenzylamine | volume=41 | issue=2 | pages=191–197 | date= 1986 | doi=10.1254/jjp.41.191}}</ref>
 
====Pharmaceuticals====
For an updated list of RIMAs, see: [https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#List_of_RIMAs List of RIMAs (Wikipedia)]
 
=====Moclobemide=====
Trade names: Apo-Moclob, Apo-Moclobemide, Auromid, Aurorix, Bei Su, Biorix, Depnil, Eutac, Hai Bei Lin, Langtian, Manerix, Mobemid, Moclamine, Moclo A, Moclobemid - 1 A Pharma, Moclobemid AL, Moclobemid HEXAL, Moclobemid ratiopharm, Moclobemida, Moclobemida Genedec, Moclobemida Teva, Moclobemide Actavis, Moclobemide Aurobindo, Moclobemide CF, Moclobemide Mylan, Moclobemide Sandoz, Moclobemide Sopharma, Moclobemide Teva, Moclobemid-neuraxpharm, Moclobemid-ratiopharm, Moclobeta, Moclod, moclodura, Moclostad, Mocrim, Modafinil Arrow, Moklar, Teva-Moclobemide, Tian Tai, Ya Zheng, and Zorix)<ref name=drugs.comINTMoclobemide>{{cite web|title=Moclobemide International Brands|url=https://www.drugs.com/international/Moclobemide.html|publisher=Drugs.com|accessdate=3 June 2017}}</ref>


===Pharmaceuticals===
======Tyramine interaction======
* Moclobemide (trade names: Apo-Moclob, Apo-Moclobemide, Auromid, Aurorix, Bei Su, Biorix, Depnil, Eutac, Hai Bei Lin, Langtian, Manerix, Mobemid, Moclamine, Moclo A, Moclobemid - 1 A Pharma, Moclobemid AL, Moclobemid HEXAL, Moclobemid ratiopharm, Moclobemida, Moclobemida Genedec, Moclobemida Teva, Moclobemide Actavis, Moclobemide Aurobindo, Moclobemide CF, Moclobemide Mylan, Moclobemide Sandoz, Moclobemide Sopharma, Moclobemide Teva, Moclobemid-neuraxpharm, Moclobemid-ratiopharm, Moclobeta, Moclod, moclodura, Moclostad, Mocrim, Modafinil Arrow, Moklar, Teva-Moclobemide, Tian Tai, Ya Zheng, and Zorix<ref name=drugs.comINTMoclobemide>{{cite web|title=Moclobemide International Brands|url=https://www.drugs.com/international/Moclobemide.html|publisher=Drugs.com|accessdate=3 June 2017}}</ref>)
With moclobemide doses above 900 mg/d the risk of interaction with ingested tyramine might become clinically relevant.<ref>https://pubmed.ncbi.nlm.nih.gov/12595913/</ref>


==References==
==References==
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[[Category:MAOI]]
[[Category:MAOI]]
[[Category:Antidepressant]]
[[Category:Antidepressant]]
[[Category:Pharmacology]]
{{#set:Featured=true}}

Latest revision as of 23:07, 21 April 2024

For irreversible monoamine oxidase inhibitors (MAOIs), see MAOI.

Reversible inhibitors of monoamine oxidase A (RIMAs) are a class of drugs which selectively and reversibly inhibit the enzyme monoamine oxidase A (MAO-A). They are used clinically in the treatment of depression and dysthymia, though they have not gained widespread market share due to limited efficacy relative to other antidepressants. Because of their reversibility and selectivity, RIMAs are safer than the older monoamine oxidase inhibitors (MAOIs).[1]

Interactions

There are no antidotes for MAOI toxicity.[2] Also, too many psychoactive substances interact with MAOI and even RIMAs, so it's not even possible to list all the drug families that interact with them. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption.
For psychoactive MAO-A substance interactions (but not food interactions), see MAOI#Interactions.

While safer than general MAOIs, RIMAs still have highly dangerous and sometimes fatal interactions with many common drugs; in particular, they can cause serotonin syndrome or hypertensive crisis when combined with almost any antidepressant or stimulant, common migraine medications, certain herbs, or even most cold medicines (including decongestants, antihistamines, and cough syrup).

Dangerous interactions

Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).

Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.

  • 2C-T-x - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series
  • 2C-x - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably
  • DOx - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably
  • Ketamine - MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available
  • Mescaline
  • NBOMes - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably
  • Opioids - Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.
  • Alcohol - Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.
  • MXE - MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available
  • 5-MeO-xxT
  • Amphetamines - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.
  • aMT - aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.
  • Cocaine - This combination is poorly explored
  • DXM - High risk of serotonin syndrome
  • MDMA - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.
  • PCP - This combination is very poorly explored
  • SSRIs
  • Tramadol

List of RIMAs

See also: MAOI § List of MAOIs

Naturally occurring sources

Psychoactive substances

Pharmaceuticals

For an updated list of RIMAs, see: List of RIMAs (Wikipedia)

Moclobemide

Trade names: Apo-Moclob, Apo-Moclobemide, Auromid, Aurorix, Bei Su, Biorix, Depnil, Eutac, Hai Bei Lin, Langtian, Manerix, Mobemid, Moclamine, Moclo A, Moclobemid - 1 A Pharma, Moclobemid AL, Moclobemid HEXAL, Moclobemid ratiopharm, Moclobemida, Moclobemida Genedec, Moclobemida Teva, Moclobemide Actavis, Moclobemide Aurobindo, Moclobemide CF, Moclobemide Mylan, Moclobemide Sandoz, Moclobemide Sopharma, Moclobemide Teva, Moclobemid-neuraxpharm, Moclobemid-ratiopharm, Moclobeta, Moclod, moclodura, Moclostad, Mocrim, Modafinil Arrow, Moklar, Teva-Moclobemide, Tian Tai, Ya Zheng, and Zorix)[9]

Tyramine interaction

With moclobemide doses above 900 mg/d the risk of interaction with ingested tyramine might become clinically relevant.[10]

References

  1. ↑ Fowler, J. S., Logan, J., Azzaro, A. J., Fielding, R. M., Zhu, W., Poshusta, A. K., Burch, D., Brand, B., Free, J., Asgharnejad, M., Wang, G.-J., Telang, F., Hubbard, B., Jayne, M., King, P., Carter, P., Carter, S., Xu, Y., Shea, C., Muench, L., Alexoff, D., Shumay, E., Schueller, M., Warner, D., Apelskog-Torres, K. (February 2010). "Reversible Inhibitors of Monoamine Oxidase-A (RIMAs): Robust, Reversible Inhibition of Human Brain MAO-A by CX157". Neuropsychopharmacology. 35 (3): 623–631. doi:10.1038/npp.2009.167. ISSN 0893-133X. 
  2. ↑ Garcia, Eddie; Santos, Cynthia (2022). "Monoamine Oxidase Inhibitor Toxicity". StatPearls. StatPearls Publishing. 
  3. ↑ Massaro, E. J. (2002). Handbook of Neurotoxicology. Totowa, NJ: Humana Press. p. 237. ISBN 0-89603-796-7. 
  4. ↑ Kulkarni, SK; Bhutani, AK; Bishnoi, M. (3 September 2008). "Antidepressant activity of curcumin: involvement of serotonin and dopamine system". Psychopharmacology. 201 (3): 435–442. doi:10.1007/s00213-008-1300-y. PMID 18766332. 
  5. ↑ Kulkarni, S. K.; Dhir, A. (March 2010). "An Overview of Curcumin in Neurological Disorders". Indian Journal of Pharmaceutical Sciences. 72 (2): 149–154. doi:10.4103/0250-474X.65012. PMC 2929771 Freely accessible. PMID 20838516. 
  6. ↑ "Curcumin and the MAO Inhibitor "Cheese Effect" from Tyramine Triggered Hypertension". EmediaHealth. 17 January 2012. Archived from the original on 30 March 2017. Retrieved 28 March 2017. 
  7. ↑ Tomás Herraiz; Simon D. Brandt (July–August 2014). "5-(2-Aminopropyl)indole (5-IT): a psychoactive substance used for recreational purposes is an inhibitor of human monoamine oxidase (MAO)". Drug Testing and Analysis. 6 (7–8): 607–613. doi:10.1002/dta.1530. PMID 24115740. 
  8. ↑ Arai, Y., Toyoshima, Y., Kinemuchi, H. (1986). "Studies of Monoamine Oxidase and Semicarbazide-Sensitive Amine Oxidase II. Inhibition by α-Methylated Substrate-Analogue Monoamines, α-Methyltryptamine, α-Methylbenzylamine and Two Enantiomers of α-Methylbenzylamine". The Japanese Journal of Pharmacology. 41 (2): 191–197. doi:10.1254/jjp.41.191. 
  9. ↑ "Moclobemide International Brands". Drugs.com. Retrieved 3 June 2017. 
  10. ↑ https://pubmed.ncbi.nlm.nih.gov/12595913/

See also


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