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MAO-B inhibitor

• If BBB-crossing: ↑ brain dopamine → ↓ parkinsonian motor symptoms
• MAO-B selectivity is lost at higher exposure → dietary/drug interaction risk returns

Drugs with this mechanism (14)

• Isocarboxazid — Rarely used irreversible MAOI.
• Isoniazid — First-line tuberculosis drug; hepatotoxicity and pyridoxine-responsive neuropathy shape use.
• Linezolid — Oxazolidinone antibiotic for resistant gram-positives; a reversible MAOI (serotonin risk).
• Methylene blue — Methemoglobinemia antidote and reversible MAOI; serotonergic combinations can be dangerous.
• Moclobemide — Reversible MAO-A inhibitor (RIMA); safer tyramine profile; not marketed in the US.
• Phenelzine — Irreversible, nonselective MAOI for atypical or resistant depression; tyramine restrictions apply.
• Procarbazine — DNA-damaging chemotherapy used in lymphoma and brain-tumor regimens; weak MAO inhibition adds food and drug interaction concerns.
• Rasagiline — Selective MAO-B inhibitor for Parkinson; no tyramine diet at usual dose.
• Safinamide — Reversible MAO-B inhibitor; levodopa adjunct for wearing-off; can worsen dyskinesia.
• Selegiline — MAO-B-selective at low dose; the transdermal patch treats depression without diet at low strength.
• Selegiline transdermal — MAOI antidepressant patch; the 6 mg/24 h dose needs no tyramine diet, sparing gut MAO-A.
• Tedizolid — Once-daily oxazolidinone for acute bacterial skin infections, including MRSA; inhibits 50S protein synthesis.
• Tranylcypromine — Activating, amphetamine-like MAOI; dietary restrictions apply.
• Zonisamide — Broad anticonvulsant associated with weight loss.

Self-check

• What is required for MAO-B inhibition to improve parkinsonian motor symptoms?
  BBB penetration, increasing brain dopamine.
• What happens to MAO-B selectivity at higher exposure?
  It is lost; dietary and drug interaction risk returns.

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