Bovril and moclobemide: a novel therapeutic strategy for central autonomic failure.
The consumption of tyramine-containing foods is contraindicated in patients on classic monoamine oxidase (MAO) inhibitors. We report successful therapeutic use of moclobemide (a MAO-A selective inhibitor) plus controlled amounts of Bovril (a tyramine-rich yeast-extract available as a food) in a patient with pure central autonomic failure who was rendered bed-bound by severe postural hypotension. Standing blood pressure is now at least 90/45 mm Hg. The selectivity of moclobemide allows about a tenth of ingested tyramine to reach nerve endings and thus the modest hypertensive effect of this combination re-established day-to-day function by restoring normotension.
Karet
F E
FE
Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, UK.
Dickerson
J E
JE
Brown
J
J
Brown
M J
MJ
D000203:Activities of Daily Living; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001549:Benzamides / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D020912:Moclobemide; D008996:Monoamine Oxidase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014439:Tyramine / Q000494:pharmacology / Q000627:therapeutic use*; D015002:Yeast, Dried / Q000494:pharmacology / Q000627:therapeutic use*
D001549:Benzamides; D008996:Monoamine Oxidase Inhibitors; C008328:marmite; D020912:Moclobemide; D014439:Tyramine