Monoamine Oxidase Inhibitor Toxicity Treatment & Management

Updated: Jul 21, 2017
  • Author: Eddie Garcia, MD; Chief Editor: Michael A Miller, MD  more...
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Treatment

Prehospital Care

Prehospital care for MAOI toxicity may include the following:

  • Stabilization of vital signs - Intravenous fluids
  • Treatment of seizure activity - Benzodiazepines
  • Attention to airway maintenance
  • Attention to temperature control
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Emergency Department Care

Because of the potential for severe toxicity and lack of antidotes, aggressive decontamination is important, as follows:

  • Consider gastric lavage, particularly in patients with recent ingestion (within an hour), or within several hours for patients with life-threatening ingestion.
  • Administer charcoal: Secure unprotected airway prior to lavage and charcoal administration if needed.
  • Because of its pharmacokinetics, extracorporeal removal such as hemodialysis or repeat doses of activated charcoal is likely less effective to reduce its level.

Frequent measurements of temperature is recommended. If the patient is hyperthermic, decreasing the temperature rapidly (within 20-30 min) is imperative. Considerations include the following:

  • Antipyretics and use of a cooling blanket are generally inadequate.
  • The best methods for cooling patients include increasing evaporative losses by wetting their skin with warm water and maintaining airflow over them with fans.
  • Removing the patient's clothing and exposing the patient to room air may help.
  • In extreme cases (temperature greater than 106ºF [41.1ºC], rigidity, altered mental status), packing the individual in ice or in a bath of ice water may prove lifesaving. [30]

Fluid therapy is of paramount importance. Patients may be significantly dehydrated from hyperthermia.

Treating the associated hypertension is usually not necessary and may actually be dangerous, because it may exacerbate the eventual hypotensive phase. If antihypertensive therapy is deemed necessary, use of a short-acting antihypertensive agent, such as nitroprusside, nitroglycerine, or phentolamine, is advisable. Avoid beta-blockers because they leave unopposed alpha stimulation.

Intravenous benzodiazepines are useful for agitation and seizure control. They also may help control the hypertension.

Hospital admission is recommended in a patient with a tyramine reaction if symptoms do not resolve within 6 hours of onset or if it was an intentional MAOI overdose.

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Consultations

Consult the regional poison control center or a local medical toxicologist (certified through the American Board of Medical Toxicology and/or the American Board of Emergency Medicine) to obtain additional information and patient care recommendations. Critical care management may be required for cardiovascular complications.

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