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Isoniazid, tricyclics and the "cheese reaction"
1Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
Abstract:
Isoniazid is an antitubercular drug with some monamine oxidase (MAO) inhibition. Perhaps because this is only weak inhibition, a few clinicians consider dietary or drug restrictions for their patients on isoniazid. However recent reports suggest the combination of isoniazid and antidepressants may cause adverse events possibly related to isoniazid's MAO inhibition activity. The mechanism of the tyramine reaction and recommendations for cautious combinations of tricyclic antidepressants and isoniazid are discussed.
Insights
Isoniazid, an antitubercular drug, weakly inhibits monoamine oxidase (MAO). Combining isoniazid with antidepressants may cause adverse events due to MAO inhibition, necessitating cautious use.
Area of Science:
- Pharmacology
- Clinical Medicine
- Neuroscience
Background:
- Isoniazid is a primary antitubercular medication.
- Isoniazid exhibits weak monoamine oxidase (MAO) inhibitory properties.
- Clinicians often overlook potential drug interactions due to isoniazid's perceived weak MAO inhibition.
Purpose of the Study:
- To discuss the potential adverse events arising from the combination of isoniazid and antidepressants.
- To explore the mechanism of the tyramine reaction in the context of MAO inhibition.
- To provide recommendations for the safe co-administration of tricyclic antidepressants and isoniazid.
Main Methods:
- Literature review of reported adverse events.
- Pharmacological analysis of MAO inhibition by isoniazid.
- Discussion of the tyramine pressor response.
Main Results:
- Recent reports indicate adverse events when isoniazid is combined with certain antidepressants.
- These events are potentially linked to isoniazid's MAO inhibition.
- The tyramine reaction mechanism is relevant to these interactions.
Conclusions:
- The combination of isoniazid and antidepressants requires careful consideration.
- Clinicians should be aware of the risk of MAO inhibition-related adverse events.
- Recommendations are provided for managing patients on both isoniazid and tricyclic antidepressants to mitigate risks.