MAOIs and transdermal delivery.
Although not currently considered a first-line treatment for depression due to safety and tolerability concerns, MAOIs are effective antidepressants, particularly for atypical or treatment-resistant depression. FDA-approved oral MAOIs inhibit both MAO-A and MAO-B; inhibition of MAO-A in the brain is required for an antidepressant effect, but inhibition in the intestinal tract can allow excessive absorption of tyramine, which can lead to hypertensive crisis. A transdermal formulation of selegiline delivers the medication directly into the circulatory system, bypassing the first-pass metabolism of the GI system and substantially reducing the risk for tyramine-related adverse events. The skin patch allows for a lower dose of the drug to achieve an antidepressant effect, maintains a steady dose of the medication over 24 hours, and avoids the need for dietary restrictions at the minimum effective dose of 6 mg/24 hours. MAOIs are useful treatment options for patients who have not responded to first-line treatments, and understanding their mechanism of action can help clinicians to accurately and safely prescribe these medications.
Department of Pharmacy Practice and the Center for Clinical Research, Mercer University College of Pharmacy and Health Sciences, Atlanta, Georgia, USA.
Chad M
CM
Vandenberg
D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D003863:Depression / Q000188:drug therapy; D004347:Drug Interactions; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D057968:Transdermal Patch
D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors