moclobemide: clinical use

Prescribing considerations

• Confirm the product-specific licensed indication.
• Assess suicide risk, bipolar history, agitation, psychotic illness and interacting medicines before initiation.
• Review hepatic disease and medicines that inhibit hepatic metabolism.
• Advise against large quantities of tyramine-rich food.
• Not recommended for children or adolescents because clinical data are lacking.
• Patients should tell the anaesthetist before surgery.

Contraindications and cautions

• Hypersensitivity to moclobemide or product excipients
• Acute confusional states
• Phaeochromocytoma
• Concurrent selegiline, linezolid, triptans, pethidine, tramadol, bupropion or dextromethorphan
• Concurrent serotonin-reuptake inhibitors or other specified antidepressants

Monitoring

• Monitor mental state, suicidality and unusual behavioural change, particularly early in treatment and after treatment changes.
• Watch for mania or hypomania, worsening psychosis and marked agitation.
• Assess urgently for serotonin syndrome when compatible symptoms occur.
• Consider hyponatraemia if drowsiness, confusion or seizures develop.
• Review blood pressure in people with hypertension and assess cardiac or QT-risk factors where relevant.

Clinical pharmacology

Moclobemide is a selective, reversible MAO-A inhibitor that increases extracellular serotonin, noradrenaline and dopamine. It undergoes extensive hepatic metabolism, inhibits CYP2C19 and has little unchanged renal excretion.

Formulation and product differences

• Both selected products are film-coated tablets containing lactose.
• The selected generic tablet is scored on both sides and explicitly described as divisible into equal halves.
• The selected Manerix tablet is scored on one side; excipients and marketed pack sizes differ between products.

Tablet

Route: Oral

Strengths: 150 mg, 300 mg