Deprenyl administration in man: a selective monoamine oxidase B inhibitor without the 'cheese effect'

The inhibition of tyramine oxidation and the tyramine hypertensive response ("cheese effect") may be independent phenomena

Although the selective monoamine oxidase (MAO) inhibitor, (-)-deprenyl, substantially inhibits tyramine-oxidizing ability in the pig, intravenous tyramine challenge after pretreatment with this drug failed to produce the characteristic pressor response ("cheese effect") associated with other irreversible MAO inhibitors. Conversely, pretreatment with the tyramine oxidation-sparing selective MAO inhibitor, clorgyline, followed by intravenous tyramine, paradoxically resulted in a profound pressor response. We suggest that the action of standard MAO-inhibiting drugs may be compounded of two separate actions, usually associated but, in fact, unreleated.

Antidepressant potentiation of 5-hydroxytryptophan by L-deprenil in affective illness

In an open trial study, L-Deprenil, an irreversible selective MAO-B inhibitor without 'chesse effect' was given to 14 patients with unipolar and bipolar depression receiving L-5-Hydroxytryptophan (L-5-HTP) and benzerazide. Ten out of 14 patients showed a good response to the combination of drugs and a correlation was found between the degree of platelet MAO inhibition and clinical response. In a double-blind controlled study, 18 affectively ill patients were randomly allocated to L-Deprenil plus L-5-HTP and benzerazide, 21 patients were treated with L-5-HTP and benzerazide and 19 patients with placebo only. Patients treated with the combination of L-Deprenil and L-5-HTP showed a significantly greater clinical improvement than placebo patients but this was not the case for patients treated with 5-HTP alone. A positive relationship was demonstrated between mood improvement and degree of platelet MAO inhibition in patients treated with L-Deprenil.

The effect of deprenyl, a selective monoamine oxidase B inhibitor, on sleep and mood in man

The effect of (-)-deprenyl, a rapidly acting selective monoamine oxidase (MAO) B inhibitor, on the sleep and mood of six healthy young male adults was investigated. The drug was administered double-blind in a balanced cross-over design. The dose (5-10 mg/day for 3 days) was chosen to cause complete inhibition of MAO, a process which usually takes 1-2 weeks with conventional MAO inhibitors. The inhibition was monitored by measuring platelet MAO activity and phenylethylamine excretion. Urinary phenylethylamine concentration was raised in all subjects. Subjects were unaware of any sleep disturbance due to the drug although the electroencephalogram (EEG) showed increased wakefulness. The onset of rapid-eye-movement (REM) sleep was delayed and the total amount reduced; the amount of stage 2 sleep was increased. The only effect of the drug on mood was to decrease the level of alertness prior to sleep. There was a slight but significant increase in the pre-sleep systolic blood pressure. There were no effects due to drug withdrawal.

Monoamine oxidase inhibitors as anti-depressant drugs and as adjunct to L-dopa therapy of Parkinson's disease

Monoamine oxidase inhibitors have been used in psychiatric disorders for many years. However, due to the toxic side effects of the drugs they are often replaced by the tri- and tetracyclic antidepressants. Selective monoamine oxidase inhibitors like deprenyl, however, have been tried with success as adjuvant therapy in Parkinson's disease and depression because of their ability to inhibit dopamine oxidation. Perhaps their greatest advantage is their lack of pressor response.

Dopamine oxidation and its inhibition by (-)-deprenyl in man

Dopamine is predominantly oxidized by a (-)-deprenyl sensitive form of MAO in the human striatum, and (-)-deprenyl, acting at some suitably low selective inhibitory concentration may, therefore, be of benefit in Parkinson's disease. 10(-6)M was the most effective (-)-deprenyl concentration in vitro for discriminating between the inhibition of MAO A and B. The correlation between the A/B ratio present in different human brain regions and the sensitivity of dopamine oxidation to 10(-6)M deprenyl was 0.84 (p<0.001). This suggests that all dopamine oxidation can be accounted for by the joint contribution of MAO A and B and that it is unnecessary to postulate a special form of the enzyme which metabolizes dopamine. In the brain, the striatum has the highest proportion of MAO B, and in several cortical regions, relatively more dopamine is oxidized by MAO A. In other human tissues also the deprenyl sensitivity of dopamine oxidation correlated with the known A/B ratio, the placenta, lung and jejeunum having the lowest sensitivity and being the richest in MAO A. Km values for dopamine for MAO A and B are similar, 130 and 140 uM respectively, so that the proportion oxidized by the two forms should not vary with substrate concentration.

Dopamine metabolism in human brain: effect of monoamine oxidase inhibition in vitro by (-)deprenyl and (+) and (-) tranylcypromine

The effects of the monoamine oxidase inhibitors (-)deprenyl and (+)-and (-)tranylcypromine on dopamine oxidation in human caudate have been investigated. Oxidation of dopamine has been found to exhibit both (-)deprenyl-sensitive and -insensitive components. The tranylcypromine isomers are both more sensitive towards dopamine than 5-hydroxytryptamine oxidation, (+) isomer being the more effective of the two. These results are discussed in terms of the in vivo action of the drugs and their therapeutic value.

Amphetamine and 2-phenylethylamine in post-mortem Parkinsonian brain after (-)deprenyl administration

Deprenyl is an inhibitor of monoamine oxidase type B, the enzyme responsible for 2-phenylethylamine oxidation, and is used in conjunction with L-Dopa therapy in Parkinson's disease. Post-mortem studies in human brain tissue have shown that after (-)deprenyl administration to parkinsonian patients amphetamine is present in concentrations up to 56 ng/g. It also could be shown that phenylethylamine concentrations are substantially increased in such patients. Phenylethylamine and amphetamine have been investigated using a gas chromatographic technique.

Absence of "cheese effect" during deprenyl therapy: some recent studies

Although the selective monoamine oxidase (MAO) B inhibitor, (-)deprenyl, has been shown to be free from the "cheese effect" in man after tyramine challenge, the reason for this is far from clear: it may well be independent of the selective inhibitory action of the drug, for during chronic administration there is some evidence to suggest that both A and B forms of the enzyme are equally inhibited. By-passing the putative MAO A gut barrier in the pig (chosen because it possesses MAO B alone in all other tissues) by intravenous tyramine administration into the deprenyl-pretreated animal failed to provoke a pressor response, despite substantial MAO inhibition. Conversely, clorgyline (MAO A inhibitor) pretreatment, which resulted in minimal MAO inhibition, produced a profound hypertensive response, resembling that observed with the non-MAO-inhibiting drug, isoniazid. The most parsimonious explanation for these findings may be that two separate but closely associated pharmacological effects are normally found with "orthodox" MAO inhibitors, enzyme inhibition proper and facilitation of noradrenaline release from its binding sites during tyramine challenge.