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Depression

MAOI wash-out

From Mr D. James, MRPharmS

I read with interest the article by Fraser et al on the drug treatment of depression.¹ However, I am concerned that in Figure 2 (summary of precautions needed when switching antidepressants), there is no mention of a recommended wash-out period when changing from one monoamine oxidase inhibitor to another. The absence of a wash-out period in this situation is at odds with the summary of product characteristics for Nardil (phenelzine) and Parnate (tranylcypromine) and a number of other publications.^2,3

It is generally recommended that, unless there are compelling clinical reasons otherwise, a two-week-wash out period should be observed whenever changing form a MAOI to another therapy, even another MAOI.

References

1. Fraser K, Martin SM, Hunter R, Hudson S. Pharmaceutical care: (12) Mood disorders: drug treatment of depression. Pharm J 2001; 266:433–42.

2. Stockley IH. Drug interactions (5th ed). London: Pharmaceutical Press; 2000.

3. British National Formulary (No 41). London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2001.

David James
Senior Medical Information Officer
Hansam Healthcare Ltd

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