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Brand Name: Moclamine
Name: Moclobemide

This drug has not received FDA approval and is not available in the United States.
(Last revised 07/23/2004)

Pregnancy Category X

Drug classes

• MAO inhibitors
• Antidepressants

Mechanisms of action

Moclamine is an antidepressant which affects the brain monoaminergic neurotransmitter system through reversible inhibition of monoamine oxidase, preferentially of type A. The metabolism of norepinephrine, dopamine and serotonin is thus decreased, and this leads to increased extracellular concentrations of these neuronal transmitters. This results in its elevating effect on mood and psychomotor activity.

Indications

• Depressive syndromes
• Social phobias
• Acute confusional states

In most cases, MAOI's should not be the first treatment choice. Rather, these drugs are prescribed for people whose symptoms have failed to respond to other common antidepression drugs.

Contraindications/cautions

• Treatment may exacerbate the schizophrenic symptoms of depressive patients with schizophrenic or schizoaffective psychoses. If possible, therapy with long-acting neuroleptics should be continued in such patients.
• Since hypersensitivity to tyramine may exist in some patients, all patients should be advised to avoid the consumption of large amounts of tyramine-rich food. Do not eat food or drink beverages with tyramine while taking MAOI's. Among the foods that should be avoided are: Lox, Pickled Herring, Liver, Dry Sausage, Broad (fava) beans, Raisins, Figs, Avocados, Cheese (cottage and cream cheese are allowed), Yogurt, Beer, Wine, Hard Liquor, Sherry, Caffiene (coffee, tea, cocoa, or chocolate), Yeast Products, Pickles, Sauerkraut, Soy Sauce, Sour Cream, Snails or Licorice.
• As is usual in antidepressant therapy, patients with suicidal tendencies should be closely monitored.
• Hypersensitivity may occur in susceptible individuals. Symptoms may include rash and edema.
• MAO inhibitors may precipitate a hypertensive reaction in patients with thyrotoxicosis or pheochromocytoma.
• In patients receiving Moclamine, additional medicines that enhance serotonin (SSRIs), such as many other antidepressants, particularly in multiple combinations, should be given with caution.
• Impairment of performance in activities requiring complete mental alertness (e.g. driving a motor vehicle) is generally not to be expected with Moclamine.
• Co-administration of Moclamine with selegiline is contraindicated.

Drug interactions

• Co-administration of Moclamine with selegiline is contraindicated.
• Dextromethorphan
• SSRIs
• Sympathomimetic agents
• Cimetidine prolongs the metabolism of Moclamine
• MAOI's interact with tyramine
• Moclamine may potentiate the effects of opiates. A dosage adjustment may therefore be necessary for these medicines. The combination with pethidine is not recommended.

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Adverse effects

• CNS: Sleep disturbances, agitation, feelings of anxiety, irritability, dizziness, headache, paresthesia, visual disturbances, isolated cases of confusion have been seen; these have resolved quickly on discontinuation of therapy.
• GIT: Dry mouth, gastrointestinal complaints, raised liver enzymes.
• Dermatology: Skin reactions (such as rash, pruritus, urticaria and flushing).

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