There are several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.
• Download a handy MAOI card, which can be folded twice into an A6 size (or printed back-to-back) for people to carry, with dietary, over-the-counter and emergency advice

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

^{Updated 12.11}

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MAOIs can be used to help treat the symptoms of:

• Depression, particularly resistant depression, which is their main use these days

The MAOIs have also sometimes been used to help the symptoms of:

• Bipolar depression

• Eating disorders

• Social anxiety

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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The usual dose of tranylcypromine in adults is 10mg twice a day. This can then be increased up to 30mg a day. Higher doses can sometimes be used with extra care. 

The usual dose in the elderly should be lower. It is not usually recommended in people under 18 years of age.

^{Updated 10.11}

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This will rather depend on that you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Bipolar depression - main options, main medicines and handy chart
• Depression - main options, main medicines and handy chart
• Eating disorders - main options, main medicines
• Social anxiety - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

^{Updated 10.11}

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There are many chemical messengers (or "neurotransmitters") called "monoamines" which occur naturally in the body. One of the effects that monoamines have is on mood. If the levels of monoamines in the body are high we may feel 'high', and if they are low we may feel 'low'. MAOIs stop the breakdown of these monoamines. By stopping the breakdown of these, the MAOIs may bring back the amounts of monoamines to normal. This helps to improve mood in people who are feeling low or depressed.

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Take your MAOI as directed on the medicine label. Try to take it at regular times each day. If the label says to take them once a day this is usually best in the morning as although they make some people feel a bit sleepy, they can make you feel less sleepy. They are not, however, sleeping tablets. It is usually a good idea not to take your last dose of the day after teatime as they can cause insomnia.

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The tablets should be swallowed with at least half a glass of water whilst you are sitting or standing, so that they reach the stomach and do not stick in your throat.

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This may depend on what you are taking an MAOI for. Click the link below for the answer for that condition:

• Bipolar depression
• Depression
• Eating disorders
• Social anxiety

Generally it may take as long as two weeks or more before an MAOI starts to have an effect, and a further three or four weeks for this effect to be reaching its maximum. Unfortunately in some people the effect may take even longer to occur e.g. several months, especially if you are older.

^{Updated 10.11}

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This will depend on what you are taking it for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Bipolar depression
• Depression
• Eating disorders
• Social anxiety

This should be discussed with your doctor as people respond differently. Some people may need to continue taking them for months or even years.

^{Updated 10.11}

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The MAOIs are not "addictive" as such, but if you have taken them for eight weeks or more you may get some "discontinuation" effects if you stop them suddenly. These do not mean that the MAOI is addictive. For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. MAOIs have none of these and so are not addictive. If stopped suddenly, they may produce some "discontinuation" symptoms but these are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal". It would be fair to say that not everyone agrees with this.

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. Try not to take your last dose later than about 4pm as this may make it less easy to sleep. Missing the occasional dose (e.g. once a week) is not a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, in a car etc.

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It is unwise to stop taking an MAOI suddenly, even if you feel better (see above). Your symptoms can return if treatment is stopped too early. You might also get some mild "discontinuation" symptoms such as confusion.

If you get any discontinuation symptoms, you have a number of options:

• If they are not severe, you can wait for the symptoms to go - they usually only last for a few days or weeks

• Ask for something to help your symptoms in the short-term e.g. a sedative or sleeping tablet

• Start the medication again (the symptoms should go) and then try reducing the dose more slowly over a longer time e.g. reduce the dose by about a quarter (25%) every 4-6 weeks

• Switch to another antidepressant - this sometimes helps

When the time comes your doctor will usually withdraw the drug slowly e.g. by reducing the dose every few weeks. You should discuss this with your doctor.

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The table below will show you some of the main side effects you might get from an MAOI.

Side effect	What happens	What to do about it
COMMON (more than about 1 in 10 people might get these)
Postural hypotension	Feeling dizzy or faint after standing up	Don't stand up too quickly. Don't drive. Talk to your doctor about this if it goes on for more than a few weeks.
Sleepiness	Feeling sleepy, drowsy or sluggish for a few hours after each dose	Don't drive or use machinery. Ask your doctor if you can take your MAOI at a different time.
Constipation	When you want to poop but can't (the opposite of diarrhoea). You can't pass a motion.	Make sure you eat enough fibre, cereal or fruit and drink enough fluid. Make sure you keep active and get some exercise e.g. walking. If this does not help, ask your doctor or pharmacist for a mild laxative.
Dry mouth	Not much saliva or spit.	Suck sugar-free boiled sweets or use a mouth spray.
UNCOMMON (less than about 1 in 10 people might get these)
Urinary retention	Not much urine passed.	Contact your doctor now.
Insomnia	Not being able to get to sleep at night.	Make sure you take your dose in the morning. It may be possible to change the time of your dose, or reduce the dose a little.
Headache	Your head is painful.	Try paracetamol. Your pharmacist will be able to advise if this is safe to take with any other medicines you may be taking. If a headache is sudden or unexpected, this could be dangerous (see below).
RARE (less than about 1 in 100 people might get these)
Skin rashes	Blotches seen anywhere.	Stop taking and contact your doctor now
Blurred vision	Things look fuzzy and you can't focus properly.	Do not drive with blurred vision. This should wear off after a few weeks. If it does not wear off, see your doctor if you are worried.
Sweating	Feeling hot and sticky, particularly at night.	Let your doctor know next time you meet. It is not dangerous but he or she may be able to adjust your dose(s).
RARE AND IMPORTANT
Hypertensive crisis	Headache, light-headedness, dizziness, flushing of the face, pounding of the heart, stiff neck, or nausea and vomiting	It usually occurs about two hours after eating or drinking something with tyramine in it. You should not take any more doses. Contact your doctor straight away. If not available, go to casualty at your nearest general hospital.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

^{Updated 12.11}

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The MAOIs can cause some people to feel drowsy or sleepy. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as it may affect your reaction times or reflexes. Some people find MAOIs makes them feel more alert or awake so it is a good idea not to take your last dose of the day later than about 4pm.

^{Updated 11.11}

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Although some people can lose weight on MAOIs, some gain weight can happen, particularly with isocarboxazid and phenelzine. This is usually due to an increase in appetite and/or a craving for sweet food. It is impossible to know what the effect on your weight may be because each person will be different. If you do start to put on weight or have problems with your weight, your doctor can arrange for you to see a dietician for advice. Any weight you put on can be controlled while you are still taking an MAOI, with expert advice about diet. In some people this weight gain can be a serious problem. If it causes you distress make sure your doctor knows about this. A change in medicine or dose may be needed in extreme cases.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. However, it is not thought that the MAOIs have any negative effect on any of these. Not only that, but if you are taking an MAOI for depression, two studies have shown that having depression is more likely to affect your sex-life than an antidepressant ^{(eg Lanza di Scalea 2009)}.

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Please see the separate medicines.

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MAOIs act by blocking the enzyme that breaks down a group of chemicals in the body called monoamines. Tyramine is an "amino-acid". It is also a monoamine and is found in many foods. If these foods are eaten by somebody taking an MAOI, the MAOI stops tyramine from being broken down. Tyramine levels in the body then build up and cause a reaction (see under side-effects for warning signs of such a reaction). There are a few general rules listed below that you should follow to help you avoid this reaction occurring.

• Avoid foods which are matured or might be "going off"

• Avoid the food listed below.

• Generally, the more "convenience" the food, the safer it is e.g. packet soups are safe. Although many foods have only small amounts of tyramine, it is possible to have local "concentrations" which might give you a reaction.

FOODS which MUST be avoided include:

• Dairy products e.g. hard cheeses, soft cheeses and cheese spreads (e.g. Philadelphia) must be avoided. Foods containing cheese (e.g. pizzas, pies, etc.) must also be avoided. Small amounts of cottage cheese and "Dairylea" cheese are probably safe.

• Game, meat and fish e.g. pickled or salted dried herrings and any hung or badly stored game, poultry or other meat which might be "going off" must be avoided.    

• Offal - avoid chicken liver pâté, liver pâté, and any other liver which is not fresh. Fresh chicken liver, fresh beef liver and fresh pâté‚ should be safe.

• Fruit and vegetables: Broad bean pods (but the beans are safe) and banana skins (but the banana itself is safe) must be avoided. Avocado pears have been reported to produce a reaction and should be avoided if possible.

• Yeast and meat extracts: "Oxo", "Marmite", "Bovril" and other meat or yeast extracts must be avoided. An alternative is that gravy made with "Bisto" (i.e. "Original", "Powder", "Rich Gravy Granules" "Onion Gravy Granules" and "Gravy Granules for Chicken") is safe. Gravy made from juices of the roast or fresh meat should also be safe. Bread is safe. "Twiglets" are sprayed with "Marmite" and a 50g bag could be enough to cause an unpleasant reaction.

There have been a few reports of people being a bit more jittery or jumpy when taking an MAOI and drinking lots of caffeine e.g. in tea, coffee, colas, Dr Pepper, energy drinks etc.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

It is best to avoid alcohol if you are taking an MAOI. If you want a drink, you need to follow the guidelines below:

• You should totally avoid Chianti, and be very careful with home made beers and wines, real ales and red wines
• White wines and non-alcoholic beers and lagers should be OK, but make sure you do not drink more than one or two units a day (i.e. one or two glasses or up to a pint of beer or lager). Canned and bottle beers from the big brewers tend to have less tyramine 
• Gin, vodka and other clear spirits are the safest, but should only be taken in true moderation i.e. one or two measures a day

It is not safe to drive after drinking alcohol, with or without an MAOI. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

^{Updated 11.11}

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The MAOIs can "interact" with a number of other medicines:

• MAOIs can cause drowsiness so you should be careful with antipsychotics, benzodiazepines and any sedating medicine
• The effects of MAOIs can sometimes be increased by amantadine, beta-blockers, sympathomimetic amines (eg. ephedrine, metaraminol, pseudoephedrine and phenylpropanolamine and phenylephrine, which are is found in many cough and cold remedies and can cause a massive rise in blood pressure), tricyclics, SSRIs, trazodone, venlafaxine, duloxetine
• MAOIs can increase the effect of amfetamines, atomoxetine, barbiturates (drowsiness), carbamazepine and opiates (drowsiness and respiratory depression)
• Great care is needed when MAOIs are used with anaesthetics, antipsychotics, buspirone, amphetamines, dextromethorphan (in cough mixtures), ecstasy, ginseng, indoramin, pethidine, triptans (for migraine)
• There has been much concern about the safety of St. John's wort with antidepressants. Until more information is available, you should avoid taking St. John's wort along with any other antidepressant.

There are a number of medicines which you could buy "over-the-counter" from a Pharmacy, Chemists, Supermarket shelves, Newsagents etc. Many are VERY dangerous to take if you are also taking an MAOI. For example many cough and cold cures could be dangerous e.g. 'Benylin', 'Lemsip', 'Night Nurse' etc.

You should follow these simple rules :-

1. Only buy medicines from a Pharmacy.

- Do not buy from supermarket shelves, drug stores, newsagents etc.
- Do not take medicines given to you by friends or relatives, however well-meaning they may be.
- Do not take medicines you got before the MAOI was prescribed unless you have asked your doctor or pharmacist first.

2. Carry your MAOI card
- show it to any Doctor, Dentist or Pharmacist who may treat you.

3. Take special care over any medicines for coughs, colds, flu, hay fever, asthma and catarrh.
- these could be particularly dangerous.
- if in doubt, ask your pharmacist.

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It just that you may need to follow your doctor’s instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

^{Updated 1.12}

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with any of the MAOIs.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with any of the MAOIs.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, you should not take cocaine and an MAOI. Your blood pressure might go up a lot, which can be very dangerous. This could be a problem, especially if you have a heart problem.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with the MAOIs and ecstasy, but this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). It is known that the MAOIs can increase the effects of opiates (e.g. heroin, methadone, codeine). This can lead to more sedation and more chance of not being able to breathe properly.

^{Updated 1.12}

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You should have no problems with "The Pill" and any of the MAOIs.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking an MAOI, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

^{Reviewed 9.11}

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily MAOIs don't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

The MAOIs are all classified as "C". There is a little evidence of a teratogenic effect and some problems have been reported, including possibly slower growth. You should seek personal advice from your GP, who may then if necessary seek further specialist advice.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We think that some tranylcypromine gets into breast milk and that this is probably at a low level. This is probably at too low a level to have any effect in the baby. But we don't know for sure so it is best to avoid an MAOI and breast-feeding or get some personal expert advice.

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The MAOIs can affect your driving in two ways. Firstly, you may feel drowsy and/or suffer from blurred vision at first when taking any of the MAOIs. Secondly, MAOIs can slow down your reactions or reflexes. This is especially true if you also have a dry mouth, blurred vision, constipation etc. (the so-called "anticholinergic side effects"). Until these wear off, or you know how your MAOI affects you, do not drive or operate machinery. You should be careful as they may affect your reaction times or reflexes even though you feel well.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

^{Updated 11.11}

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You will not usually need to have a lot of blood tests to check on your MAOI. Very rarely the MAOIs can affect someone's liver so your doctor may do some checks on your blood to make sure that your liver is working well.

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