Formulary
Moclobemide: Indications, Dosing, Side Effects and Interactions
Moclobemide is reported to act by reversible inhibition of monoamine oxidase type A (it is therefore termed a RIMA).
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Moclobemide: Indications, Dosing, Side Effects and Interactions
Moclobemide is reported to act by reversible inhibition of monoamine oxidase type A (it is therefore termed a RIMA).
Drug action
Moclobemide is reported to act by reversible inhibition of monoamine oxidase type A (it is therefore termed a RIMA).
Indications and dose
**Depressive illness**
- **Adult** (By Mouth): Initially 300 mg daily in divided doses, adjusted according to response; usual dose 150-600 mg daily, dose to be taken after food.
**Social anxiety disorder**
- **Adult** (By Mouth): Initially 300 mg daily for 3 days, then increased to 600 mg daily in 2 divided doses continued for 8-12 weeks to assess efficacy.
Cautions
Avoid in agitated or excited patients (or give with sedative for up to 2-3 weeks); may provoke manic episodes in bipolar disorders; thyrotoxicosis
Contraindications
Acute confusional states; phaeochromocytoma
Side effects
Common or very common Anxiety; constipation; diarrhoea; dizziness; dry mouth; headache; hypotension; irritability; nausea; paraesthesia; skin reactions; sleep disorder; vomiting Uncommon Asthenia; confusion; flushing; oedema; suicidal behaviours; taste altered; visual impairment Rare or very rare Appetite decreased; delusions; hyponatraemia; serotonin syndrome
Interactions
**Severe interactions:**
- The daily dose of moclobemide should be reduced to half or one-third in patients whose hepatic metabolism is severely inhibited by a drug that blocks microsomal mixed function oxidase activity, such...
- Manerix should be used cautiously when co-administrated with buprenorphine as the risk of serotonin syndrome, a potentially life-threatening condition (see section 4.4).
**Other interactions (14):**
- Opiate analgesics, such as, Morphine, Codeine and fentanyl should be used with caution.
- The potentiation of the pressor effect was even lower or did not occur when moclobemide was administered after a meal.
- Care should be taken with concomitant use of drugs that are metabolised by CYP2C19 as moclobemide is an inhibitor of this enzyme.
- The plasma concentration of these drugs (such as proton pump inhibitors (e.g.
- Similarly, moclobemide inhibits the metabolism of omeprazole in CYP2C19 extensive metabolisers resulting in a doubling of the omeprazole exposure.
- Care should be taken with concomitant use of trimipramine and maprotiline as the plasma concentration of these monoamine reuptake inhibitors increases upon concomitant administration with moclobemide.
Pregnancy
Safety in pregnancy has not been established-manufacturer advises avoid unless there are compelling reasons.
Breast feeding
Amount too small to be harmful, but patient information leaflet advises avoid.
Hepatic impairment
Manufacturer advises caution in severe impairment (risk of decreased metabolism). Dose adjustments Manufacturer advises dose reduction to half or one-third of the daily dose in severe impairment.
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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