Clinical pharmacology of reversible monoamine oxidase-A inhibitors

Traditional monoamine oxidase inhibitors (MAOIs) have long been associated with tyramine-related hypertension--the cheese effect. Despite their undoubted clinical efficacy, this problem has restricted their use. New, selective, and reversible MAO-A inhibitors--which act only on the A isoenzyme--appear not to have this effect. Our investigations of these drugs, exemplified by brofaromine, have shown a reduced and more rapidly reversed tyramine pressor sensitivity. Moreover, we were unable to detect any clinically significant food interaction, following ingestion of a quantity of cheese containing sufficient tyramine to increase systolic blood pressure by at least 30 mm Hg. These results confirm the improved safety of brofaromine, and other drugs in this class, when compared with classic MAOIs.