Clinical Overview
Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA) indicated for the treatment of major depressive disorder and social anxiety disorder. Important Note: This medication is not available in the United States but is prescribed in Canada, Europe, Australia, and other countries as an alternative to traditional MAOIs with fewer dietary restrictions.
Primary Clinical Applications
Moclobemide is indicated for major depressive disorder, particularly atypical depression, and social anxiety disorder. It is often used when SSRIs or other antidepressants have failed, offering MAOI benefits with improved safety and tolerability compared to irreversible MAOIs.
Mechanism and Clinical Benefits
As a reversible and selective MAO-A inhibitor, moclobemide increases levels of serotonin, norepinephrine, and dopamine while allowing normal tyramine metabolism. This reversibility significantly reduces the risk of hypertensive crisis and allows for more flexible dietary guidelines.
Safety Advantages
Compared to traditional MAOIs, moclobemide has fewer dietary restrictions, shorter washout periods when switching medications, and lower risk of dangerous drug interactions. However, it still requires caution with serotonergic medications and certain drug combinations.
Prescribing Information
Dosing & Administration
Major Depressive Disorder:
- Initial: 300 mg daily in divided doses after meals
- Maintenance: 300-600 mg daily
- Severe depression: Up to 600 mg daily
- Administration: After meals to reduce nausea
Social Anxiety Disorder:
- Initial: 300 mg daily
- Range: 300-600 mg daily
Elderly:
- Start with lower doses
- Increase gradually as tolerated
Indications
- Major depressive disorder
- Social anxiety disorder (social phobia)
- Off-label: Atypical depression, panic disorder
Contraindications
- Hypersensitivity to moclobemide
- Acute confusional states
- Pheochromocytoma
- Concurrent use with serotonergic drugs (SSRIs, clomipramine)
Warnings & Precautions
- Serotonin syndrome: Risk with concurrent serotonergic drugs
- Hypertensive reactions: Lower risk than irreversible MAOIs but still possible
- Suicidal thoughts: Monitor especially in young adults
- Bipolar disorder: May precipitate mania
- Surgery: Discontinue before elective surgery
Drug Interactions
- SSRIs/SNRIs: Contraindicated – risk of serotonin syndrome
- Clomipramine: Contraindicated
- Sympathomimetics: Use with caution
- Meperidine: Contraindicated
- Dextromethorphan: Avoid concurrent use
Dietary Considerations
- Tyramine restrictions: Less strict than traditional MAOIs
- Moderate tyramine foods: Limit large quantities
- High tyramine foods: Still avoid (aged cheeses, fermented products)
Adverse Reactions
Common:
- Nausea, dizziness, headache, insomnia, dry mouth
Less Common:
- Agitation, confusion, tremor, visual disturbances
Special Populations
- Availability: Not available in United States
- Pregnancy: Use only if benefits outweigh risks
- Elderly: Start with lower doses, monitor closely
- Hepatic Impairment: Reduce dose by 50% in severe impairment
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.
