Reversible inhibitors of monoamine oxidase A (RIMAs) are a class of drugs which selectively and reversibly inhibit the enzyme monoamine oxidase A (MAO-A). They are used clinically in the treatment of depression and dysthymia, though they have not gained widespread market share due to limited efficacy relative to other antidepressants. Because of their reversibility and selectivity, RIMAs are safer than the older monoamine oxidase inhibitors (MAOIs).
While safer than general MAOIs, RIMAs still have highly dangerous and sometimes fatal interactions with many common drugs; in particular, they can cause serotonin syndrome or hypertensive crisis when combined with almost any antidepressant or stimulant, common migraine medications, certain herbs, or even most cold medicines (including decongestants, antihistamines, and cough syrup).
Although many psychoactive substances are reasonably safe to use on their own, they can quickly become dangerous or even life-threatening when taken with other substances. The following lists some known dangerous combinations, but cannot be guaranteed to include all of them. Independent research should always be conducted to ensure that a combination of two or more substances is safe to consume. Some interactions listed have been sourced from TripSit.
- 2c-t-x - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably, which could be dangerous given the unpredictability of the 2C-T-x series
- 2c-x - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably
- dox - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably
- ketamine - MAO-B inhibitors appear to increase the potency of Ketamine. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available
- nbomes - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably
- opioids - Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.
- alcohol - Tyramine found in many alcoholic beverages can have dangerous reactions with MAOIs, causing an increase in blood pressure.
- mxe - MAO-B inhibitors appear to increase the potency of MXE. MAO-A inhbitors have some negative reports associated with the combination but there isn't much information available
- amphetamines - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with amphetamine can lead to hypertensive crises.
- amt - aMT is an MAOI on its own. Using enzyme inhibitors can greatly reduce predictability of effects.
- cocaine - This combination is poorly explored
- dxm - High risk of serotonin syndrome
- mdma - MAO-B inhibitors can increase the potency and duration of phenethylamines unpredictably. MAO-A inhibitors with MDMA will lead to hypertensive crises.
- pcp - This combination is very poorly explored
List of RIMAs
- Naturally occurring sources
- Psychoactive substances
- Moclobemide (trade names: Apo-Moclob, Apo-Moclobemide, Auromid, Aurorix, Bei Su, Biorix, Depnil, Eutac, Hai Bei Lin, Langtian, Manerix, Mobemid, Moclamine, Moclo A, Moclobemid - 1 A Pharma, Moclobemid AL, Moclobemid HEXAL, Moclobemid ratiopharm, Moclobemida, Moclobemida Genedec, Moclobemida Teva, Moclobemide Actavis, Moclobemide Aurobindo, Moclobemide CF, Moclobemide Mylan, Moclobemide Sandoz, Moclobemide Sopharma, Moclobemide Teva, Moclobemid-neuraxpharm, Moclobemid-ratiopharm, Moclobeta, Moclod, moclodura, Moclostad, Mocrim, Modafinil Arrow, Moklar, Teva-Moclobemide, Tian Tai, Ya Zheng, and Zorix)
- Toloxatone (Humoryl) (available in France)
- Massaro, E. J. (2002). Handbook of Neurotoxicology. Totowa, NJ: Humana Press. p. 237. ISBN 0-89603-796-7.
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