Moclobemide drug overdose

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). 

A fatality has been reported with an overdose of moclobemide, sertraline and pimozide, with blood levels suggesting that none of the drugs individually would have been fatal. "... 

A severe case of the serotonin syndrome (including hyperthermia and muscle rigidity requiring mechanical ventilation) has been reported in a patient who took an overdose of moclobemide, clomipramine and buspirone , (p.l 149). Concurrent use of more than one serotonergic drug is thought to be a risk factor for the development of the serotonin syndrome , (p.9). 

The serotonin syndrome occurred in a patient who took an overdose of moclobemide and tranylcypromine. In this analysis of moclobemide overdoses, the risk of developing serotonin toxicity was increased 35-fold in patients who also took another serotonergic drug, of which this case with tranylcypromine was one of 11 mentioned. ... 

The concurrent use of MAOIs and phenothiazines is usually safe and effective. However, rarely, cases of possible neuroleptic malignant syndrome or hyperpyrexia have been reported with MAOIs and chlorpromazine, levomepromazine or trifluoperazine. Some of these cases were fatal Chiorpromazine has been successfully used for treatment of the serotonin syndrome occurring with MAOIs and other drugs. Moclobemide has been used with various phenothiazines without problem, but one case of fatal overdose is attributed to an interaction between moclobemide and perazine. 

Four patients died after taking moclobemide and ecstasy (MDMA, methylenedioxymethamfetamine). The clinical evidence is limited, but in each case the forensic pathologist concluded that the cause of death was the combined use of these drugs. It was suggested that what happened is consistent with the serotonin syndrome, although the evidence is fairly slim. Two patients had taken maximum therapeutic doses and two moderate overdoses of moclobemide. Note that moclobemide had not been prescribed to any of them. Post-mortem analysis also found the presence of dextromethorphan in one patient, which was thought to have contributed, see also MAOIs or RIMAs -i- Dextromethorphan , p.ll34. 

A 32-year-old man taking moclobemide 20 mg twice daily and diazepam developed the serotonin syndrome 40 minutes after taking a single 150-mg dose of venlafaxine. Serotonin toxicity (the serotonin syndrome) occurred in 4 patients who took an overdose of moclobemide with venlafaxine (just 150 mg in one case and 750 mg in another). In this analysis of moclobemide overdoses, the risk of developing serotonin toxicity was increased 35 times in patients who also took another serotonergic drug. Venlafaxine was taken in 4 of the 11 cases mentioned." Another man very rapidly developed the serotonin syndrome after taking considerable overdoses of moclobemide (3 g) and venlafaxine (2.625 g). ... 

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