Moclobemide (Arima, Aurorex, Aurorix, Feraken, Manerix, Mobemide, Moclamine, Mohexal)

Purpose of Medication and Method of Action

Moclobemide is used as an antidepressant and to treat social phobia. The drug may also be helpful in helping people to stop smoking. It works by increasing the amount of norepinephrine and serotonin by reversibly inhibiting monoamine oxidase (MAO) type A. It is different from other MAOIs in that it inhibits only type A and the inhibition is reversible. Moclobemide has similar efficacy to tricyclic antidepressant (TCA) drugs and selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression, but may have better tolerability. Moclobemide appears to have the best efficacy for unipolar depression followed by bipolar, neurotic, and reactive depression. The drug may also have utility for the treatment of refractive depression when used with an SSRI or TCA.

Side Effects

Headache, dry moth, anxiety, sleep disturbances, dizziness, rapid heart beat, and nausea may occur. Moclobemide has little effect on the cardiovascular system, and does not have the profound anticholinergic, sedative, and weight gaining effects associated with many TCAs. As compared with SSRIs, moclobemide is associated with fewer gastrointestinal effects and no sexual dysfunction.

Drug Interactions

Medicines containing sympathomimetics like caffeine and pseudoephedrine may increase sleeplessness and blood pressure. Cimetidine can slow the removal of moclobemide from the body so the combination should be used cautiously. Drugs that can increase the amount of serotonin such as lithium, dextromethorphan, meperidine, tricyclic antidepressants, and SSRIs should, in general, be avoided with moclobemide to avoid the serotonin syndrome (too much serotonin). Moclobemide inhibits the liver enzyme CYP 2D6, which can increase the amount of other drugs such as some TCAs broken down by this enzyme.

Cautions and Contraindications

Medicines containing sympathomimetics like caffeine and pseudoephedrine may increase sleeplessness and blood pressure. Cimetidine can slow the removal of moclobemide from the body so the combination should be used cautiously. Drugs that can increase the amount of serotonin such as lithium, dextromethorphan, meperidine, tricyclic antidepressants, and SSRIs should, in general, be avoided with moclobemide to avoid the serotonin syndrome (too much serotonin). Moclobemide inhibits the liver enzyme CYP 2D6, which can increase the amount of other drugs such as some TCAs broken down by this enzyme.

Usual Dose

300 mg orally each day for 3 days, then 300 mg twice daily after food for the treatment of social phobia. Assess efficacy after 8-12 weeks. 300 mg to 450 mg orally a day in divided doses is the recommended dose for the treatment of depression. The dose may be increased up to 600 mg daily, but a maintenance dose of 150 mg daily may be adequate. Doses in patients with severe hepatic impairment may need to be reduced by one-third to one-half. It is recommended to take moclobemide at the end of a meal. No washout period is needed when stopping moclobemide and starting another antidepressant. Moclobemide should not be started until at least a week following cessation of a TCA, a non-selective MAOI, or a SSRI [(2 weeks in the case of paroxetine (Paxil®) and sertraline (Zoloft®); at least 5 weeks in the case of fluoxetine (Prozac®)].

Note

This drug is not available in the USA.

Reference

Fulton B Moclobemide: an update of its pharmacological properties and therapeutic use. Drugs 1996;52:450-474.

Patient Medication Information

These information sheets do not list all known side effects of the medications, only the most common side effects. For a complete list of side effects please contact your local pharmacy or the actual drug manufacturing company.