Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA), categorized as a monoamine oxidase inhibitor (MAOI) antidepressant medication. Moclobemide is not available in the US but is prescribed in other parts of the world, including the UK, Canada, and Australia.

Moclobemide brand names (not available in the US)

  • Manerix
  • Auroxix
  • Clobemix

What is moclobemide prescribed for?

Moclobemide is prescribed to treat of major depressive disorder, anxiety disorders, and depressive episodes within bipolar disorder [1][2]. However, this medication is not generally prescribed to children under 18, as safety and effectiveness have not been established [3].

This medication is not available in the US but is prescribed elsewhere, such as in the UK, Canada, Australia, and Europe.

MAOIs were one of the first prescription treatments for major depression and have since been mostly replaced by newer antidepressant medications. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) were developed to be more effective and less harmful [4][5].

Moclobemide is a relatively new MAOI known to work more selectively, which means it can be an effective treatment with fewer harmful effects [6][7]. For example, it has been found to cause less impact on the heart than older MAOIs, making it a preferable treatment for elderly patients or those with heart conditions [5].

Recent clinical studies have also suggested that moclobemide is effective as a treatment for depression in those who have experienced little or no benefit from other antidepressant medications [4][5].

There has been relatively little research conducted in the US to discover the effectiveness and safety of moclobemide, which is why it is not currently available in this part of the world. However, many alternative medications can be very effective.

How does moclobemide work?

Moclobemide reduces the activity of a certain enzyme in the brain, which leads to a greater concentration of mood-enhancing neurotransmitters, noradrenaline, dopamine, and serotonin, thereby reducing the symptoms of depression [8][9].

Moclobemide works slightly differently in the brain than the older MAOI antidepressants. This reduces the risk of some of the serious side effects seen in older medications and fewer dietary restrictions [1][2].

How is moclobemide usually taken?

Moclobemide is available as 150mg and 300mg tablets, which must be swallowed without crushing.

Initially, moclobemide will be prescribed as 300mg per day, split into two or three doses. This will then be gradually increased to find an effective dose up to 600mg daily.

Your daily dose of moclobemide may depend on the severity of your condition, your age, and any other medications you are taking.

Your doctor will monitor any changes in your physical and mental health, particularly at the beginning of your treatment with moclobemide. You must tell your doctor about any physical or mental changes you experience, to ensure that your condition is being managed effectively and safely.

If you forget one dose, take it as soon as you remember, or if it is near your next dose, skip the missed dose and take the next. Never take double your prescribed dose, as this can cause adverse effects.

How long does moclobemide stay in your system?

When you start taking moclobemide, you may notice some improvements in your symptoms within the first week, and the medication should take full effect within 1-3 weeks. However, if you do not notice any improvements in your condition within four weeks, you may require a change of medication [9].

When moclobemide is stopped, it may take several days for the medication to entirely leave your system, depending on the dosage and length of your treatment.

Never stop taking moclobemide suddenly, even if you feel better, as this can cause unpleasant physical effects and could worsen your mental health. If your doctor advises that it is safe to stop this medication, they will slowly reduce your dose to prevent adverse effects and withdrawal symptoms.

Moclobemide side effects

When you start a new medication, you may experience some common side effects. These will likely reduce within the first couple of weeks, but if they continue or become problematic, consult your doctor, as you may need a dose reduction or a medication change.

Common side effects of moclobemide include:

  • Difficulty sleeping
  • Dizziness
  • Stomach upset, including nausea, vomiting, constipation, or diarrhea
  • Dry mouth
  • Headache
  • Nervousness
  • Tingling or numbness in the hands or feet
  • Low blood pressure
  • Change in appetite

Serious side effects and allergic reactions to moclobemide are less common but may still occur. If you experience any of the following, contact your doctor immediately:

  • Feeling very weak or tired
  • Seizures
  • Fever
  • Irregular heartbeat
  • Loss of consciousness
  • Vision changes
  • Confusion
  • Delusions
  • Mania
  • Thoughts of harming yourself or others

Moclobemide precautions

Moclobemide can sometimes cause suicidal ideation. This risk is higher in people under 25 years old [3]. If you or your family notice any concerning changes in your mental state or you experience any thoughts of harming yourself or ending your own life, seek medical attention immediately.

It is important that your doctor is aware of any past or present mental health conditions you have experienced to enable safe monitoring of your condition while on moclobemide or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Ensure you tell your doctor if you have experienced any thyroid, liver, or heart conditions, as you may not be able to take this medication, or you might need smaller doses. In addition, your doctor may wish to closely monitor your physical health during your treatment.

Tell your doctor about all medications you are taking or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Tell your doctor if you are pregnant or planning to become pregnant. There is currently not much research on the safety of this medication during pregnancy, but it is generally considered safe with careful monitoring [10].

Consult with your doctor if you are breastfeeding, as small amounts of moclobemide may be passed to your baby through breast milk if taken in high doses, so it is important that you are aware of the risks. However, it is generally considered safe to take moclobemide while breastfeeding, with careful monitoring of your baby [10].

Moclobemide can cause withdrawal symptoms, particularly if taken in high doses for long periods. If you and your doctor decide to stop this medication, your doctor will reduce your prescription slowly to help prevent withdrawal symptoms from occurring.

Moclobemide interactions

As with all antidepressant medications, there is a risk of developing serotonin syndrome if moclobemide is taken with another antidepressant medication. However, unlike older MAOIs, the combination of moclobemide with another antidepressant can be safe if started in low doses and increased slowly, with careful monitoring [9].

Some medications may interact with moclobemide, increasing the risk of side effects or impacting the effectiveness of your medication. This includes medications for Parkinson’s, migraines, and heart conditions, antibiotics, opioid painkillers, antihistamines, diuretics, cough and cold medicines, St. John’s wort, and other mental health medications.

Always discuss your medications with your doctor or pharmacist before starting a new treatment.

Moclobemide storage

Always keep all medications out of reach of children.

Store moclobemide in its original packaging, in airtight containers, and at room temperature (never above 86°F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on moclobemide

It is unlikely that an overdose of moclobemide alone would have severe or fatal consequences [1]. However, an overdose could cause serious or even fatal effects if combined with other medications or substances.

If you overdose on moclobemide, call a medical professional, or Poison Control, at 1-800-222-1222, or in case of an emergency, call 911.

Symptoms of a moclobemide overdose could include stomach upset, irregular heartbeat, and changes in behavior.

Frequently asked questions about moclobemide

Why is moclobemide not available in the US?

Moclobemide is not available in the US, as the US Food and Drug Administration (FDA) has not yet determined the effectiveness and safety of the medication. This may be for several reasons, including financial restrictions and the availability of various other medications [4][5].

There is a range of research from around the world that has found moclobemide to be a useful and safe treatment for depression, which is why it is approved for prescription in various other countries.

What are the alternatives to moclobemide?

There are many medications available for the treatment of depression. Some of the available antidepressant medications include serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and citalopram; serotonin-noradrenalin reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine; and tricyclic antidepressants such as amitriptyline and desipramine [11][12].

You can discuss alternative medications with your doctor, who can advise you on the benefits and side effects of each medication so that you can make informed decisions about your treatment.

People tend to respond differently to certain medications, so what works well for one person might not work well for another. Therefore, you may need to try more than one medication before you find one that works well for you. Never start or stop a medication without professional advice.

It is also advised to combine medication with talking therapy, such as cognitive behavioral therapy, family therapy, or group therapy, to receive the most effective treatment and the best chance of recovery [11][12].

Resources:

  1. Bonnet, U. (2003). Moclobemide: Therapeutic Use and Clinical Studies. CNS Drug Reviews, 9(1), 97–140. Retrieved from https://doi.org/10.1111/j.1527-3458.2003.tb00245.x
  2. Fulton, B., & Benfield, P. (1996). Moclobemide. An Update of its Pharmacological Properties and Therapeutic Use. Drugs, 52(3), 450–474. Retrieved from https://doi.org/10.2165/00003495-199652030-00013
  3. Mylan Products Ltd. (Updated 2022). Manerix (Moclobemide) Patient Information Leaflet. Electronic Medicines Compendium (EMC). Retrieved from https://www.medicines.org.uk/emc/files/pil.6661.pdf
  4. Fiedorowicz, J.G., & Swartz, K.L. (2004). The Role of Monoamine Oxidase Inhibitors in Current Psychiatric Practice. Journal of Psychiatric Practice, 10(4), 239–248. Retrieved from https://doi.org/10.1097/00131746-200407000-00005
  5. Lotufo-Neto, F., Trivedi, M., & Thase, M. (1999). Meta-Analysis of the Reversible Inhibitors of Monoamine Oxidase Type A Moclobemide and Brofaromine for the Treatment of Depression. Neuropsychopharmacology, 20(3), 226–247. Retrieved from https://doi.org/10.1016/S0893-133X(98)00075-X
  6. Gagiano, C.A., Müller, F.G., de Kock, R.F., & Schall, R. (1995). Moclobemide in Continuation Treatment of Major Depressive Episodes. Journal of Clinical Psychopharmacology, 15(4 Suppl 2), 46S–50S. Retrieved from https://doi.org/10.1097/00004714-199508001-00009
  7. Tiller, J.W., Johnson, G.F., & Burrows, G.D. (1995). Moclobemide for Depression. Journal of Clinical Psychopharmacology, 15, 31S–34S. Retrieved from https://doi.org/10.1097/00004714-199508001-00006
  8. National Center for Biotechnology Information (2022). PubChem Compound Summary for CID 4235, Moclobemide. PubChem. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Moclobemide
  9. Sandoz Limited. (2014, revised 2020). Moclobemide 150mg Film-Coated Tablet. Retrieved from https://www.medicines.org.uk/emc/product/7295/smpc#gref
  10. Drugs and Lactation Database (LactMed) [Internet]. (2006, updated 2021). Moclobemide. Bethesda, MD: National Library of Medicine (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK501765/
  11. National Alliance on Mental Illness (NAMI). (Updated 2017). Depression. NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Treatment
  12. National Health Service (NHS). (Reviewed 2021). Overview – Antidepressants.NHS. Retrieved from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/