Phenelzine is an irreversible inhibitor of both MAO-A and MAO-B, whereas moclobemide is a reversible inhibitor of only MAO-A.1,2 Moclobemide therefore has less potential for tyramine interactions.1,2 The combination of MAOIs with other serotonergic agents such as SSRIs, SNRIs, or tricyclic antidepressants can result in potentially fatal serotonin toxicity.1,2
Different tricyclic antidepressants have distinct pharmacological characteristics.1,2 Whereas imipramine acts in a similar to an SNRI, clomipramine acts in a similar way to an SSRI.1,2 Most TCAs also exhibit antimuscarinic properties.1,2
References:
1. McLaughlin P, Cleare A. Chapter 7: Drugs to treat depression. In: Haddad P, Nutt DJ. Seminars in Clinical Psychopharmacology. 3rd edition. Cambridge: Cambridge University Press; 2020.
2. Chamberlain SR, Baldwin DS. Monoamine oxidase inhibitors (MAOIs) in psychiatric practice: how to use them safely and effectively. CNS Drugs 2021; 35 (7): 703‒716.
3. Fayez R, Gupta V. Imipramine. StatPearls [internet]. 2023.
4. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. World J Biol Psychiatry 2023; 24 (2): 79–117.
5. Tatsumi M, Groshan K, Blakely RD, Richelson E. Pharmacological profile of antidepressants and related compounds at human monoamine transporters. Eur J Pharmacology 1997; 340: 249‒258.
6. Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacology 2007; 151 (6): 737‒748.
