Venlafaxine moclobemide

CYP2D6 TCAs, SSRIs, haloperidol, mirtazepine, zuclopenthoxil, venlafaxine, sertraline CYP2C19 TCAs, mephenytoin, diazepam, moclobemid, venlafaxine... 

Postmortem segmental analysis of hair that was 20 cm long showed moclobemide, venlafaxine, and cocaine in all segments. The authors suggested that serotonin syndrome had been caused by the combination of moclobemide, venlafaxine, and cocaine. 

Maprotiline, Moclobemide, Mianserin, Fluoxetine (Prozac), Paroxetine, Sertraline, Fluvoxamine, Citalopram, Venlafaxin (generic IR formulation and the brand Venlafaxine XR), Mirtazapine, Flupentixol-melitracen (Deanxit), Tianeptine, Extract of St. John s Wort, Buspirone Depression and anxiety... 

Lorazepam is a short-acting benzodiazepine indicated for use in relieving anxiety and insomnia. Lorazepam may also be administered perioperatively to alleviate pain and in status epilepticus. Imipramine is a tricyclic antidepressant, paroxetine is a selective serotonin re-uptake inhibitor, venlafaxine is a serotonin and adrenaline re-uptake inhibitor and moclobemide is a reversible monoamine oxidase inhibitor. Imipramine, paroxetine, venlafaxine and moclobemide are all classified as antidepressants. 

Goldberg R. Antidepressant use in the elderly. Current status of nefazodone, venlafaxine and moclobemide. Drugs Aging 1997,11 119-131. 

Social phobia also has a component of avoidance and has been successfully treated with the RlMAs brofaromine and moclobemide (Keck and McElroy 1997]. However, the SSRls and venlafaxine have also shown efficacy in social phobia (Gorman and Kent 1999 Keck and McElroy 1997], suggesting that further divisions of anxiety diagnostic categories may result from future pharmacological research. 

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)... 

Interactions of moclobemide with venlafaxine, a potent serotonin re-uptake inhibitor, have been reported (27,36). 

A 34-year-old man took 2.625 g of venlafaxine (therapeutic dose 75-375 mg/day) and 3 g of moclobemide, plus an unknown amount of alcohol 1 hour before being admitted to hospital. Within 20 minutes of arrival his conscious level deteriorated and he had increased muscle tone, with clonus in all limbs. He was treated with intubation, paralysis, and ventilation, and sedated with midazolam and morphine. He regained consciousness after 2 days. 

Roxanas MG, Machado JF. Serotonin syndrome in combined moclobemide and venlafaxine ingestion. Med J Aust 1998 168(10) 523-4. 

In the 1980s an entirely new class of antidepressant arrived with the SSRIs, firstly fluvoxamine immediately followed by fluoxetine (Prozac). Within 10 years, the SSRI class accounted for half of antidepressant prescriptions in the United Kingdom. Further developments in the evolution of the antidepressants have been novel compounds such as venlafaxine, reboxetine, nefazodone and mirtazapine, and a reversible monoamine oxidase inhibitor, moclobemide. 

There are many other ways in which SSRIs can interfere with sexual function, for example by causing loss of sexual interest and erectile difficulties. In an open, prospective study of 1000 Spanish patients taking a variety of antidepressants, there was an overall incidence of sexual dysfunction of 59% (15). The highest rates, 60-70%, were found with SSRIs (including flu-voxamine) and venlafaxine. The lowest rates were found with mirtazepine (24%), nefazodone (8%), and moclobemide (4%). Spontaneous resolution of this adverse effect was uncommon - 80% of subjects had no improvement in sexual function over 6 months of treatment. 

Clinically important, potentially hazardous interactions with carbidopa, citalopram, doxepin, ephedra, ephedrine, escitalopram, fluoxetine, fluvoxamine, levodopa, meperidine, moclobemide, nefazodone, oral contraceptives, paroxetine, sertraline, venlafaxine... 

For MDD with melancholic features, paroxetine and venlafaxine are the first-line treatments. TCAs and moclobemide are the second-line treatments. Citalopram and fluoxetine are third-line treatments. 

For treatment-resistant patients who do not respond to SSRIs or TCAs, or to the combination of TCAs/SSRIs with benzodiazepines, other antidepressants have shown at least some beneficial effects in alleviating PD symptoms (e.g. mirtazapine, moclobemide, nefazodone, phenelzine, reboxetine, and venlafaxine). Other agents have also been reported to exert beneficial effects in PD, especially when combined with SSRIs/TCAs (lithium, pindolol, and propranolol). In cases where all treatments have failed, valproate or olanzapine should be considered.2 - ° In order to optimize treatment, patients should avoid or reduce the consumption of compounds that could potentially induce/exacerbate panic attacks (e.g. caffeine, alcohol, and nicotine) and should exercise regularly. i... 

Serious and potentially life-threatening reactions (the serotonin syndrome) can develop if venlafaxine and non-selective MAOIs (isocarboxazid, phenelzine, tranylcypromine) are given concurrently, or even sequentially if insufficient time is left in between. The situation with moclobemide, in therapeutic doses, is uncertain. 

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). ... 

A 21-year-old woman, who used cocaine regularly and occasionally other drugs of abuse, took moclobemide 1800 mg at 15.00 h and venlafaxine 1800 mg at 18.00 h. At 20.14 h she was conscious but restless and agitated. She had excessively clammy skin with a normal body temperature, increased symmetrical reflexes, ataxia, increased muscle tone, and dilated pupils her blood pressure was 180/120 mmHg, pulse rate 105/minute, and respiratory rate 16/minute. She deteriorated at around 23.30 h, with loss of verbal contact, severe agitation, hallucinations, periodic coma, continuously dilated pupils, a tachycardia of 124/minute and a blood pressure of 105/90 mmHg. Two hours later, her respiratory rate was 34/minute, and her temperature 41-42 °C. She had bloody respiratory secretions and loose bloody stools. Her heart rate increased to 170/minute and she developed ventricular fibrillation. Deflbrillation was unsuccessful and she died. 

Duvemeuil, C. de la Grandmaison, G.L. De Mazancourt, P. Alvarez, J.-C. A hi -performance liquid chromatography method with photodiode-array UV detection for therapeutic drug monitoring of the nontricyclic antidepressant drugs, Ther.Drug Monit.,2003,25,565-573. [LOD 2.5-10 ng/mL plasma fluoxetine norfluoxetine sertraline paroxetine citalopram fluvoxamine moclobemide mirtazapine milnacipran toloxatone venlafaxine viloxazine]... 

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