Moclobemide

How it works

It reversibly and selectively inhibits monoamine oxidase type A, reducing the breakdown of serotonin, noradrenaline and dopamine and thereby increasing their availability in the brain.

Prescribing in practice

• Combining moclobemide with serotonergic drugs such as SSRIs, other antidepressants, opioids like pethidine, or other MAO inhibitors risks serotonin syndrome, so adequate washout periods and avoidance of combinations are essential.
• Although the tyramine reaction is much weaker than with irreversible MAOIs, patients should avoid consuming large amounts of tyramine-rich food and should not take indirect sympathomimetics.
• Caution is needed in agitated or excited patients and in those with phaeochromocytoma or thyrotoxicosis.

Monitoring

Monitor blood pressure, mood and for features of serotonin syndrome, particularly when other serotonergic agents have recently been used.

Counselling the patient

• Take this medicine after food and avoid eating large amounts of tyramine-rich foods such as mature cheese and yeast extracts.
• Tell any healthcare professional that you take moclobemide before starting new medicines, including over-the-counter cough and cold remedies.
• Report severe headache, agitation, sweating or a racing heart promptly.

Evidence & guidelines

Moclobemide is a licensed antidepressant whose dietary and interaction precautions, milder than those of irreversible MAOIs, are set out in current prescribing references.