Moclobemide Clomipramine

Dardennes RM, Even C, Ballon N, Bange F. Serotonin syndrome caused by a clomipramine-moclobemide interaction. J Clin Psychiatry 1998 59(7) 382-3. 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

Larsen, J. K., Gjerris, A., Holm, P. etal. Moclobemide in depression a randomized, multicentre trial against isocar-boxazide and clomipramine emphasizing atypical depression. Acta Psychiatr. Scand. 84 564-570,1991. 

Antidepressants amitriptyline, clomipramine, imipramine, moclobemide, citalopram Antipsychotics olanzapine... 

Based on some intriguing case reports (Jenike et al. 1983), a trial with a monoamine oxidase inhibitor (MAOI) may be an option in OCD patients who have comorbid panic disorder. In a double-blind trial, both phenelzine and clomipramine were found to be effective in reducing symptoms in OCD, as reflected on two of four OC measures [Vallejo et al. 1992). None of the patients in this study had panic disorder. This study suggests that MAOIs may be helpful in some patients with OCD even in the absence of panic disorder. However, in an earlier comparison trial, clomipramine, but not the MAOI clorgiline, resulted in significant reduction in OC symptoms [Insel et al. 1983b). Additional studies are needed to evaluate the place of MAOIs (including the newer reversible inhibitors of monoamine oxidase A [RIMAs], such as moclobemide) in the pharmacotherapy of OCD. 

Other options - a non-specific MAOI (e.g. phenelzine), RIMA (e.g. moclobemide), clomipramine. 

Imipramine, desipramine, amitriptyline, nortriptyline, trimipramine, clomipramine, lofepramine, amoxapine, dosulepin, maprotiline, mianserin, setiptiline, trazodone, fluvoxamine, paroxetine, milnacipram, sulpiride, tandspirone, methylpheni-date, melitracen Amitriptyline, imipramine, trimipramine, clomipramine, citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, reboxetine, viloxazine, doxepin, maprotiline, mianserine, mirtazapine, moclobemide, trazodone, opipramol (and some metabolites)... 

Overdose of moclobemide by itself rarely appears to give rise to serious problems. This is in contrast to overdose with conventional monoamine oxidase inhibitors, which can cause fatal 5HT toxicity. However, if patients take moclobemide together with serotonergic antidepressants, such as SSRIs or clomipramine, 5HT toxicity is common. 5HT toxicity occurred in 11 of 21 patients who took overdoses of moclobemide and serotonergic agents but in only one of 33 patients who took moclobemide alone (13). Consistent with this, four patients died, presumably of 5HT toxicity, after co-ingesting 3,4-methyle-nedioxymethamphetamine (MDMA, ecstasy) and moclobemide (14). 

The adverse effects of moclobemide have been well reported in several studies, mainly comparisons of moclobemide with standard antidepressants. The consensus has been that moclobemide produces fewer anticholinergic effects and less orthostatic hypotension and dizziness than clomipramine or imipramine. The main problems... 

In a controlled multicenter study of 115 in-patients with relatively severe depression, moclobemide was better tolerated but had a weaker therapeutic effect than clomipramine. Nine of the patients taking moclobemide withdrew owing to worsening of depression and suicidality, although it is possible that the dosage of moclobemide (400 mg/day) was inadequate (SEDA-18, 15). 

Five fatal cases of serotonin syndrome after combined overdoses of moclobemide with citalopram and moclobemide with clomipramine have been reported (SEDA-18, 16). Several cases of this syndrome have been reported in patients taking moclobemide with drugs that potentiate serotonin function (24-31). 

Koczkas C, Holm P, Karlsson A, Nagy A, Ose E, Petursson H, Ulveras L, Wenedikter O. Moclobemide and clomipramine in endogenous depression. A randomized clinical trial. Acta Psychiatr Scand 1989 79(6) 523-9. 

Larsen JK, Holm P, Hoyer E, Mejlhede A, Mikkelsen PL, Olesen A, Schaumburg E. Moclobemide and clomipramine... 

Gillman PK. Serotonin syndrome—clomipramine too soon after moclobemide Int Clin Psychopharmacol 1997 12(6) 339 12. 

Francois B, Marquet P, Desachy A, Roustan J, Lachatre G, Gastinne H. Serotonin syndrome due to an overdose of moclobemide and clomipramine. A potentially life-threatening association. Intensive Care Med 1997 23(l) 122-4. 

Neuvonen PJ, Pohjola-Sintonen S, and Tacke U (1993) Five fatal cases of serotonin syndrome after moclobemide-citalopram or moclobemide-clomipramine overdoses (letter). Lancet 342 1419. 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

Extracted amoxapine, brompheniramine, chlorpheniramine, chlorpromazine, clomipramine, c5q)roheptadine, dsipramine, diphenhydramine, dothiepin, doxepin, fluoxetine, hal-operidol, imipramine, loxapine, maprotihne, meperidine, mesoridazine, methadone, metoclopramide, mianserin, moclobemide, nomifensine, nordoxepin, norfluoxetine, norpropoxyphene, northiaden, nortriptyline, pentobarbital, pheniramine, propojgrphene, propranolol, protriptyline, quinidine, quinine, sulforidazine, thioridazine, thiothixene, tranylcypromine, trazodone, trihe q)henidyl, triprolidine Nonintetfering dextromethorphan, norphetidine, pheno benzamine, prochlorperazine, trifluoperazine... 

---