Rapid conversion from one monoamine oxidase inhibitor to another

• Published in: The journal of clinical psychiatry Vol. 58; no. 7; pp. 307 - 310
• Main Authors: SZUBA, M. P, HORNIG-ROHAN, M, AMSTERDAM, J. D
• Format: Journal Article
• Language: English
• Published: Memphis, TN Physicians Postgraduate Press 01-07-1997
• Subjects: Adult; Aged; Biological and medical sciences; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Depressive Disorder - drug therapy; Depressive Disorder - psychology; Drug Administration Schedule; Female; Hospitalization; Humans; Male; Medical sciences; Middle Aged; Monoamine Oxidase - drug effects; Monoamine Oxidase Inhibitors - administration & dosage; Monoamine Oxidase Inhibitors - adverse effects; Monoamine Oxidase Inhibitors - therapeutic use; Neuropharmacology; Patient Compliance; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Serotonin - physiology; Substance Withdrawal Syndrome - etiology; Substance Withdrawal Syndrome - physiopathology; Treatment Failure; Treatment Outcome; Tyramine - adverse effects; Human; Mood disorder; Chemotherapy; Treatment; Psychotropic; MAO inhibitor; Antidepressant agent; Depression; Drug switching
• ISSN: 0160-6689; 1555-2101
• DOI: 10.4088/jcp.v58n0704

Numerous sources state that switching from one monoamine oxidase (MAO) inhibitor to another can be done only after a 14-day washout period. In hospitalized patients and severely depressed outpatients, such a wait may be impracticable.
We reviewed the case histories of eight consecutive and random patients whom we converted from one MAO inhibitor to another within less than the recommended waiting period.
Only one patient experienced troubling adverse effects, and these effects were brief and time-limited. The patient's symptoms were indicative of either withdrawal from tranylcypromine or a mild serotonin syndrome. All other patients tolerated the conversion well with minimal or no adverse effects. Four of the eight patients eventually responded to the new MAO inhibitor.
These results suggest that some patients can be cautiously but rapidly switched from one MAO inhibitor to another without prolonged drug-free periods. Unquestionably, this strategy should be used only when the clinical picture mandates a rapid conversion. Further, it should be reserved for those patients with established high compliance and should include close monitoring and the use of a low-tyramine diet. Extreme caution must still be undertaken in utilizing this approach until larger studies more accurately determine the frequency of serious adverse effects.