Posted by Tomatheus on July 27, 2015, at 22:45:28
In reply to MAOI question, posted by paulb on July 20, 2015, at 2:45:25
Paul,
Thank you for your questions. In response to the first question that you ask, I haven't read of any reports documenting any adverse reactions resulting from smoking cigarettes or using other tobacco products while taking an MAOI, but there is evidence that alkaloids in tobacco (the beta-carboline alkaloids) actually inhibit the monoamine oxidase enzymes (Herraiz & Chaparro, 2005). Unlike phenelzine (Nardil), isocarboxazid (Marplan), and probably also tranylcypromine (Parnate), the beta-carboline alkaloids in tobacco inhibit the monoamine oxidase enzymes reversibly, so instead of remaining more or less permanently bound to the enzymes, they bind more transiently. Whether the use of tobacco products might affect a tobacco user's responsiveness to MAOI antidepressants doesn't seem to be clear, but as I said, I haven't come across any reports that have documented adverse reactions associated with using tobacco products in combination with MAOIs.
Regarding your second question, there were many individuals (at least 150, according to an activism group that dealt with the Nardil formulation issue) who felt that Nardil was less effective, less tolerable, or both after the medication's formulation was changed in the fall of 2003. But even though there are some who seem to have been affected by the formulation change, there also seem to be some who didn't notice a difference between the old and new versions of Nardil. So, is Nardil less effective than it used to be? I don't know for sure. Perhaps there are some who would be less responsive to the current version of Nardil than they would have been to the older version, but it's now been almost 12 years since the formulation was changed. Fortunately, as far as I know, there are currently three versions of phenelzine available in the U.S.: the Pfizer-brand version, as well as generic versions marketed by Gavis Pharmaceuticals, LLC (which I see has just been acquired by a company called Lupin) and Greenstone LLC. Although I think it's possible that the version of Nardil that's currently marketed may be less effective than it used to be, there really isn't any evidence to suggest that isocarboxazid or tranylcypromine would be more effective than phenelzine for social anxiety. I would also keep in mind that Parnate's (tranylcypromine's) formulation was also changed during the early 1990s and that Marplan (isocarboxazid) might be made with different excipients than it used to be, so to the extent it's possible that Nardil might be less effective than it used to be, the same might be true of the other irreversible, nonselective MAOIs. As far as scientific evidence is concerned, we basically just have older studies to go by when looking at the efficacy of MAOIs for various psychiatric conditions, and my understanding is that Nardil has more evidence to support its use for social anxiety than any other MAOI.
Well, I hope that you'll find my response to be of some help, but if you have any questions on what I wrote, feel free to ask. Take care, and I apologize for my late reply.
Tomatheus
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REFERENCE
Herraiz, T., & Chaparro, C. (2005). Human monoamine oxidase is inhibited by tobacco smoke: Beta-carboline alkaloids act as potent and reversible inhibitors. Biochemical and Biophysical Research Communications, 326, 378-386. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/15582589
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poster:Tomatheus
thread:1080635
URL: http://www.dr-bob.org/babble/20150629/msgs/1080807.html