MAOI Hypertensive Crisis
Definition
Monoamines (MA) = neurotransmitters (Adrenaline, NA, serotonin, etc)
MAOxidase = deactivators of MA
Cause of depression (hypotheses) = ↓ circulation of MA
MAOI = prevent deactivation of MA, thus ↑ MA levels
3 subtypes:
Aetiology
Symptoms:
Signs
Investigations
Management
Source
Medscape
Monoamines (MA) = neurotransmitters (Adrenaline, NA, serotonin, etc)
MAOxidase = deactivators of MA
Cause of depression (hypotheses) = ↓ circulation of MA
MAOI = prevent deactivation of MA, thus ↑ MA levels
3 subtypes:
- Actual poisoning (overdose)
- Drug-food interaction (tyramine reaction or cheese reaction.) = hypertensive crisis
- Drug-drug interaction
Aetiology
- Tyramine-containing foods
- Aged cheeses
- Aged, pickled, or smoked meats (eg, salami) or fish (eg, herring)
- Yeast extracts
- Beer (dark more than light, on tap more than in bottles because tyramine is adsorbed to glass)
- Red wine more than white wine
- Avocado
- Sauerkraut
- Ginseng
- Potential drug interactions
- Meperidine (most infamous)
- Dextromethorphan
- SSRIs – Fluoxetine, paroxetine, Sertraline
- Tramadol, (due to MAOI effects)
- Triptans
- All serotonergic agents
- Linezolid (antibiotic)
- Methylene blue
Symptoms:
- Early mild
- Irritability
- Anxiety
- Flushing
- Sweating
- Headache
- Moderate
- Anxiousness
- Restlessness
- Fever
- Severe
- Severe fever
- Seizures
- Sleepiness
Signs
- Mild symptoms
- Agitation
- Confusion
- Flushing
- Diaphoresis
- Moderate symptoms
- Altered mental status
- Hallucination
- Fever
- Diplopia
- Hypertension, which can be very high and precipitate rhabdomyolysis, myocardial infarction, intracranial hemorrhage, renal failure, and other hypertensive emergency complications
- Tachycardia
- Tachypnea
- Severe symptoms
- Severe hyperpyrexia
- Seizures
- CNS depression
- Coma
- Cardiorespiratory depression
- Malignant hyperthermia
- Muscle rigidity
Investigations
- Tox screen
- UEC with lactic acid (hypoperfusion)
- Levels of MAOI not useful
Management
- Gastric lavage, charcoal
- Reduce hyperthermia (wet skin, constant airflow, ice bath)
- Fluids
- IV benzo (for agitation)
Source
Medscape