General Description
Isocarboxazid is a hydrazine derivative and a non-selective, irreversible monoamine oxidase inhibitor (MAOI). Its structure consists of a benzyl ring linked to a carboxamide group and a hydrazine moiety that forms a covalent bond with the flavin adenine dinucleotide (FAD) cofactor of MAO. The drug is a member of the hydrazine class of antidepressants, chemically related to phenelzine but with a distinct side chain that may influence its pharmacokinetics.
Mechanism of Action
Isocarboxazid irreversibly inhibits both MAO-A and MAO-B enzymes in the brain and peripheral tissues, preventing the oxidative deamination of monoamine neurotransmitters such as serotonin, norepinephrine, dopamine, and tyramine. The resulting increase in synaptic concentrations of these amines is believed to underlie its antidepressant and anxiolytic effects. Because the inhibition is irreversible, new enzyme synthesis is required for recovery of MAO activity.
Application
Isocarboxazid is indicated for the treatment of major depressive disorder, particularly atypical, nonendogenous, or treatment-resistant depression. It is also used for panic disorder, social anxiety disorder, and bulimia nervosa off-label.