Moclobemide side effects

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. 

MAOI/RIMA Panic disorder Social anxiety disorder PTSD Significant short- and long-term side-effects special dietary requirements moclobemide better tolerated Significant overdose toxicity (less with moclobemide) Reported... 

The side effects of antidepressants, sometimes very unpleasant, olten lead patients to interrupt their treatment or to reduce the drug dose, which involves a great risk in view of the high relapse rate and danger of suicide in depression. The newer antidepressants, such as trazodone, fluoxetine and other SSRIs and moclobemide, are characterized by better tolerability and lower toxicity and are therefore preferred in the treatment of outpatients and elderly patients (Rudorfer and Potter, 1989). A detailed list of general and specific common side effects associated with the newer generation of antidepressants is seen in Table 1.7. 

The side effects and cardiotoxicity of the tricyclic antidepressants have been discussed in detail elsewhere in this volume and, while there is ample evidence of their therapeutic efficacy, it seems difficult to justify their use, particularly in a group of patients who are most vulnerable to their detrimental side effects. Of the newer antidepressants, the reversible inhibitors of monoamine oxidase type A such as moclobemide may also be of value in the elderly depressed patient, particularly in those patients who fail to respond to the amine uptake inhibitor type of antidepressant. 

Monoamine-oxidase inhibitors (MAOIs) make up the second group and include, isocarboxazid, tranylcypromine and phenelzine, which are now used less commonly due to severe side-effects, especially through a potentially dangerous interaction with foodstuffs. A newer agent, moclobemide (a RIMA, reversible, selective type A monoamine-oxidase inhibitor) is said to give less dangerous interactions with foodstuffs. See monoamine-oxidase inhibitors. 

MAOIs can be classified into two groups the irreversible (older) MAOIs such as Parnate (tranylcypromine) and Nardil (phenelzine), and the reversible (newer) drugs such as Manerix (moclobemide) and Deprenyl (selegiline). Older MAOIs have more side effects associated with them since their action is less specific than newer MAOIs. 

Fewer adverse effects were reported among moclobemide-treated patients compared with selective serotonin reuptake inhibitor (SSRI)-treated patients. Since moclobemide does not induce orthostatic hypotension, does not possess anticholinergic properties, and is not cardiotoxic, it is very well suited among the MAOIs for the treatment of depression. Moclobemide has limited potential to elicit a hypertensive crisis, because the pressor effect of tyramine from food is only marginally potentiated compared with tranylcypromine. The pressor effect of tyramine is normalized within 3 days of cessation of treatment with moclobemide. The combination of SSRIs and moclobemide has good efficacy in cases of refractory depression, but there is controversy as to whether toxic side-effects such as serotonin syndrome can result from this combination. Currently, more studies are needed before this combination can be recommended. Acute overdose with MAOIs causes agitation, hallucinations, hyperpyrexia, hyperreflexia, convulsions, and death. The most dangerous MAOIs in overdose are the irreversible non-selective MAOIs. T2s-27... 

Moclobemide has a negligible capacity to increase dopaminergic neurotransmission, but studies so far have revealed no significant interactions or major adverse side-effects when moclobemide is co-administered with i-dopa. 

The SSRIs, due to their superior tolerability and side-effect profile, are currently considered the first-line treatment for the long-term treatment of dysthymic disorder. In the case of failure or intolerance to SSRIs, the TCAs amitriptyline, desipramine, and imipramine or the reversible MAOl moclobemide should be tried. The reversible MAOl phenelzine has shown superior effectiveness to imipramine in one double-blind study. However, it should be reserved as third-line therapy due to its less-favorable side-effect profile and dietary restrictions. 

Anise 2. Asian ginseng 3. Cereus 4. Ephedra 5. Ginseng 6. Parsley 7. Shepherds purse 8. Verbena (vervain) 9. Capsicum 1. Phenelzine 2. Tranylcypromine 3. Moclobemide May cause T blood pressure with anise and ephedra. T risk of side-effects such as psychosis and hallucinations with Asian ginseng. Headache, tremulousness and manic episodes have been reported with ginseng and phenelzine Unknown mechanism (anise, Asian ginseng) Inhibits metabolism of ephedra (MAOis inhibit the metabolism of ephedra) Avoid concomitant use... 

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