Blood Pressure Effects of Monoamine Oxidase Inhibitors — the Highs and Lows*

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Abstract
Clinical guidelines for the management of the most common side effects associated with monoamine oxidase inhibitors (postural hypotension and hypertensive episodes) are offered. When non-pharmacological interventions fail to alleviate MAOI induced postural hypotension, the use of volume expanders (salt tablets or fludrocortisone) may be effective alternatives to drug discontinuation. Phentolamine and chlorpromazine are traditional drug treatments for MAOI hypertensive emergencies. The newer drug treatments evolved in the last decade for treating hypertensive emergencies is not reflected in the psychiatric or emergency medicine literature on treating MAOI induced hypertensive states. Nifedipine, diazoxide, or sodium nitroprusside appear to be more rational choices for this problem.