RIMA (Reversible Inhibitor of Monoamine Oxidase A) Pregnancy: §4.6: reproduction studies in animals have not revealed any risk to the foetus, but the safety of moclobemide in human pregnancy has not been established — the benefits of drug therapy during pregnancy should be weighed against possible risk to the foetus. Lactation: only a small amount passes into breast milk (approximately 1/30 of the maternal dose); the benefits of continuing therapy during nursing should be weighed against possible risks to the child.

Moclobemide

Brand names: Manerix

Moclobemide is a reversible inhibitor of monoamine oxidase type A (a RIMA) used in the treatment of depression and social anxiety disorder.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Major depression: initially 300 mg daily

Route: Oral

Frequency: Usually in 2-3 divided doses, taken at the end of a meal

Max: 600 mg/day

Source: UK SPC (eMC) for Manerix 150 mg Film-coated Tablets, §4.2 (https://www.medicines.org.uk/emc/product/10614/smpc). MAJOR DEPRESSION (adults): recommended initial dose 300 mg daily, usually administered in 2-3 divided doses; the dose may be increased up to 600 mg/day depending on the severity of the depression; individual response may allow a reduction of the daily dose to 150 mg. The dose should NOT be raised until after the first week, as bioavailability increases during this period. Treatment should continue for at least 4-6 weeks in order to assess efficacy. SOCIAL PHOBIA: recommended dose 600 mg/day given in 2 divided doses; start at 300 mg/day and increase to 600 mg/day on day 4 — continuing 300 mg/day for longer than 3 days is not recommended as the efficacious dose is 600 mg/day; treatment with 600 mg/day should continue for 8-12 weeks to assess efficacy; social phobia may be a chronic condition and continuation is reasonable in a responding patient, with periodic re-evaluation of the need for further treatment. ELDERLY: no special dose adjustment required. HEPATIC IMPAIRMENT: when hepatic metabolism is severely impaired by hepatic disease or by a drug that inhibits microsomal mono-oxygenase activity (e.g. cimetidine), normal plasma levels are achieved by reducing the daily dose to HALF or ONE THIRD. PAEDIATRIC (not expressed as a per-kg dose in the SPC): in view of the lack of clinical data available, moclobemide is NOT recommended for use in children, and §4.3 states it should not be administered to children for the time being as clinical experience in this category is lacking. Verify any under-18 use against a children's formulary. DIETARY ADVICE (§4.4): moclobemide is a reversible inhibitor of monoamine oxidase type A (RIMA) and causes less potentiation of tyramine than traditional irreversible MAOIs, so it does not generally necessitate the special dietary restrictions required for those agents; however, as a few patients may be especially sensitive to tyramine, all patients should be advised to avoid consuming large amounts of tyramine-rich food (mature cheese, yeast extracts and fermented soya bean products). METHOD OF ADMINISTRATION: oral; tablets should be taken at the end of a meal. §4.5 Interactions was not retrieved in this bundle — the interactions listed below are taken from the §4.3 Contraindications and §4.4 Warnings text; verify the full §4.5.

Dose adjustments

Renal

Patients with reduced renal function do not require a special dose adjustment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to the drug or to any component of the product
Acute confusional states
Phaeochromocytoma
Co-administration with selegiline, bupropion, triptans, pethidine, tramadol, dextromethorphan or linezolid
Co-administration with 5-HT re-uptake inhibitors (including those which are tricyclic antidepressants), to prevent precipitation of serotonergic overactivity — after stopping a 5-HT re-uptake inhibitor, a period equal to 4-5 half-lives of the drug or any active metabolite should elapse before starting moclobemide
Should not be administered to children for the time being, as clinical experience in this category is lacking

Side effects

Very common: sleep disorder; dizziness, headache; dry mouth, nausea
Common: agitation, anxiety, restlessness, irritability; paraesthesia
Common: hypotension; uncommon flushing
Common: vomiting, diarrhoea, constipation; common rash
Uncommon: suicidal ideation, confusional state (resolving quickly on discontinuation), visual impairment, oedema, pruritus, urticaria, asthenia, dysgeusia; rare suicidal behaviours, delusion, hyponatraemia, decreased appetite, serotonin syndrome (when co-administered with drugs that enhance serotonin) and increased hepatic enzymes

Interactions

Selegiline, bupropion, triptans, pethidine, tramadol, linezolid — must not be co-administered
Dextromethorphan (contained in many proprietary cough medicines) — must not be co-administered; isolated cases of severe central nervous system adverse reactions have been reported
5-HT re-uptake inhibitors including tricyclic antidepressants — must not be co-administered (risk of serotonergic overactivity); allow 4-5 half-lives of the previous drug/active metabolite before starting moclobemide
Buprenorphine — concomitant administration may result in serotonin syndrome, a potentially life-threatening condition; if clinically warranted, observe carefully, particularly during initiation and dose increases
Sympathomimetic agents such as ephedrine, pseudoephedrine and phenylpropanolamine (in many proprietary cough and cold medications) — patients should be advised to avoid them
Drugs inhibiting microsomal mono-oxygenase activity (e.g. cimetidine) — reduce the daily moclobemide dose to half or one third

Clinical monograph

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.

Reference: Manerix SPC; NICE CG90 (Depression); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways