MAOIs to RIMAs in anaesthesia--a literature review.

Monoamine oxidase inhibitors (MAOIs) are widely accepted as effective antidepressants. Unfortunately their use has been limited by their capacity to potentiate dietary tyramine (the so called "cheese effect") and their interaction with other drugs. The latter poses a particular problem for patients undergoing anaesthesia. Traditional advice has been to stop MAOI therapy 2 weeks prior to anaesthesia. With the advent of reversible, specific inhibitors of MAO-A (RIMAs) there is less potential for dietary and drug interaction. While experience with these newer drugs is limited so far, this review suggests that combination of modern anaesthetic techniques and newer, specific reversible MAOIs should allow safe anaesthesia with maintenance of antidepressant therapy.