Talk:Moclobemide

Taking with other antidepressants

The statement that Moclobemide should not be taken concurrently with other antidepressants is not correct: it is now prescribed in combination with a tricyclic such as amitryptiline or dothiepin, often with the tricyclic at its maximum dose. This prescribing plan is used by Profs. Paykel and Cowen of Cambridge and Oxford Universities respectively, presumably amongst others. I don't know about using it with other types of antidepressant, though, so presumably caution should still be exercised. Chris 21:24, 26 June 2006 (UTC)

Thanks for updating the main page, Outriggr. Chris 09:36, 27 June 2006 (UTC)

I have used in concurrently with reboxetine, amongst other things. There is potentiation, but that is to be expected.

The warning is based on the fact that MAO-A-inhibition can cause potentially fatal reactions to drugs that elevate serotonin, and that NE/DA drugs can be potentiated 4-8 times (IIRC).

Similarly, EpiPens are potentiated, etc. Zuiram 18:54, 24 November 2006 (UTC)

Good results have also been obtained with SSRI combinations (I'm currently having good results myself). See for example Moclobemide and Specific Serotonin Re-uptake Inhibitor Combination Treatment of Resistant Anxiety and Depressive Disorders (Bakish et al. 1994). Certainly there is a strong synergy, so doses are necessarily much lower, but much of the previously assumed risk is based on the established danger of combining non-reversible MAOs moclobemide. I'm too inexpert, pressed for time, and crap with wiki citation to incorporate any of this information 131.172.4.44 (talk) 01:51, 7 April 2008 (UTC)snaxalotl

MDMA

Someone should add on the possible lethal/quite dangerous interaction with MDMA.

http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showAbstract&doi=10.1046/j.1360-0443.2003.00292.x

Any MAOI will have a potentially lethal interaction with MDMA ;)

Moclobemide doesn't have less potential for interaction than the traditional MAOIs, it just has less dietary restrictions, and a less complicated metabolism. Zuiram 18:55, 24 November 2006 (UTC)

Dietary restrictions

Like much of this article, the section on dietary restrictions is wrong; I'll put it on my TODO list, and see if I can get around to fixing it eventually.

At a the recommended maximum dose of 600mg day, the TYR30 is about 150mg, which is why that dose was chosen as the highest recommended dose: it's virtually impossible for a person with a normal diet to consume enough tyramine in a single sitting to cause a dangerous reaction at that dose.

At higher doses, regular tyramine restrictions should be adhered to, and the drug has been in clinical use up to 1200mg/day.

Even at the lower doses, you should avoid yeast extracts like Bovril and Marmite, as these are a fairly reliable way to get a dangerous tyramine dose in a single serving.

Standard MAOIs comparison

The following text:

Unlike standard MAOIs, possible side effects do not include cardiovascular complications (hypertension) with encephalopathy, liver toxicity or hyperthermia.

Is a bit misleading. First off, hepatotoxicity and such complications are linked to the older MAOIs that are no longer in use. Of the current generation, only Nardil carries any significant potential for hepatotoxicity. Hypertension and hyperthermia are related to dietary and drug interactions, and remain an issue with moclobemide, although it will take more of the offending substance to cause it with typical doses of moclobemide. And someone should elaborate on what kind of encephalopathy they feel is common with the unselective MAOIs. Zuiram 19:04, 24 November 2006 (UTC)

Information on legal status in U.S.

Does anyone know whether this drug is under review by the FDA for approval? (I sent an email to the manufacturer.) Also, does anyone know *why* it's not approved in the U.S.? Historian932 (talk) 15:43, 28 June 2008 (UTC)

Interactions with Serotonergics

"In general, combination of an MAOI with any serotonergic substance is not advised, due to the possibility of dangerous increases in blood pressure."

While taking substances that release serotonin in combination with an MAO-A inhibitor is obviously a major risk of serotonin syndrome and death - substances like DMT, LSD, Psilocin, Mescaline, etc work directly at the serotonin receptor and so I cant see how an MAOI would increase the pressor effects of these 5-HT2A agonists enough to produce significant hypertension. Admittedly as these substances are metabolized by MAO Moclobemide will raise their plasma levels but if this was an issue then taking less would prevent the problem. I also don't think that even absurdly high levels of any 5-HT2A agonist could produce hypertension via that receptor, it is not that uncommon for people to take shockingly high doses of the classical psychedelics without suffering any effect on their physical health. The toxicity of the classical 5-HT2A agonists is such that you can take 1000 times the normal dose without any risk to health. This is not the case for 2C-B though and many others as they have a much higher toxicity. I heard a report of 2C-B in combination with the MAO-B inhibitor Deprenyl causing sub-clinical hypertension (140/100 or similar). The only reason 2C-B has the capacity to elevate blood pressure that much is that it is an alpha1-adrenaline agonist(1) like amphetamine/cocaine. Deprenyl is known to potentiate the pressor response to alpha1-adrenaline(2) so this probabley had nothing to do with the MAO inhibition anyway. To conclude - all of the classical serotonergic psychedelics (DMT, LSD, psiloc[yb]in, mescaline) are clearly safe in combination with moclobemide - while the safety of combining the newer synthetic psychedelics - 2C-B, 2C-E, 2C-I, DOB, DOI, AMT, AET, etc - is less certain. Personally I would feel comfortable taking moclobemide in combination with 2C-B, 2C-E or 2C-I but not with any of the other research chemicals.

I'm going to remove that sentance as it is misleading.

Note: subsequent research has shown that alpha2c is the relevant adrenaline receptor for 2c-b's stimulatory effects, not alpha1 as is noted - source = psychedelics and the human receptorome, also i have combined selegiline with moclobemide (5mg and 150mg respectively) w/o complication —Preceding unsigned comment added by 64.131.209.208 (talk) 07:20, 27 February 2010 (UTC)

1: http://www.ncbi.nlm.nih.gov/pubmed/1362550 2: http://www.ncbi.nlm.nih.gov/pubmed/2509682 —Preceding unsigned comment added by 87.242.158.175 (talk) 09:00, 14 August 2008 (UTC)