MAOI & Injectable opiates
Monoamine oxidase inhibitors (MAOIs) are a class of drugs that play a crucial role in the treatment of depression among other disorders.
MAOIs inhibit the activity of one or both of the monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). By inhibiting these enzymes, MAOIs prevent the breakdown of monoamine neurotransmitters such as serotonin, norepinephrine, and dopamine, leading to an increase in their concentrations. This elevation in neurotransmitter levels can help alleviate symptoms of certain disorders, particularly depression.
Reversible Inhibitors of Monoamine Oxidase A (RIMAs): RIMAs are a subclass of MAOIs that selectively and reversibly inhibit the MAO-A enzyme. Due to their reversible nature, they are considered safer in single-drug overdose scenarios compared to older, irreversible MAOIs. They are used clinically in the treatment of depression and dysthymia.
Injectable opiates are a class of drugs derived from the opium poppy plant. They are primarily used for pain management. Opiates primarily bind to the mu-opioid receptors in the central nervous system. This binding results in a decrease in the release of neurotransmitters like substance P, which is involved in pain transmission. Opiates also affect the reward centers in the brain, leading to feelings of euphoria. This is one of the reasons they have a huge potential for recreational use.
Types of Injectable Opiates:
- Morphine: One of the oldest and most commonly used injectable opiates.
- Fentanyl: A synthetic opioid that is many times more potent than morphine. It's used in surgical settings and for breakthrough pain in cancer patients.
- Hydromorphone (Dilaudid): Another synthetic opioid that is more potent than morphine. It's used for moderate to severe pain.
- Meperidine (Demerol): Less commonly used nowadays due to its side effects, but it's an option for short-term pain management.
The interaction between MAOIs and injectable opiates is a complex one that can have significant clinical implications. The body has intricate mechanisms to maintain blood pressure, and drugs can interfere with these mechanisms at various points. A drug acting at one point might be potentiated by another drug that blocks a compensatory reflex, which would otherwise minimize the effect of the first drug. This can be particularly relevant when combining drugs that affect the sympathetic efferent vasomotor pathway, such as MAOIs.
MAOIs can greatly increase sensitivity to pressor amines. Pressor amines that act indirectly by releasing noradrenaline might be ineffective in the presence of drugs that deplete or insulate the stores of the transmitter in adrenergic nerve endings.
One of the most significant dangers of combining MAOIs with certain other drugs, including some opiates, is the risk of a hypertensive crisis. This is a sudden and severe increase in blood pressure that can be life-threatening.
Both MAOIs and some opiates can increase serotonin levels. When combined, there's a risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, hallucinations, rapid heartbeat, fever, muscle stiffness, and other symptoms.
Opiates can cause respiratory depression, which is a slowing or stopping of breathing. Combining them with other drugs that depress the central nervous system, like MAOIs, can increase this risk.
Combining MAOIs with specific opioids has occasionally led to serious and sometimes lethal side effects. Two distinct interactions seem to emerge: one that stimulates and another that depresses. Signs of the stimulating response can encompass restlessness, migraines, sweating, elevated body temperature, reddening of the skin, chills, muscle spasms, stiffness, shakes, loose stools, high blood pressure, rapid heart rate, convulsions, and unconsciousness. In certain instances, this has resulted in fatalities.
All things considered, we recommend avoiding this combination under any conditions.
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