Posted by SalArmy4me on May 21, 2001, at 0:04:14
In reply to Manerix (moclobemide) question, posted by IanSFO on May 20, 2001, at 1:53:57
I think the worst thing you have to fear from moclobemide is a serotonin syndrome:
Lane, Roger MD. SSRI-Induced Serotonin Syndrome: Review. J of Clin Psychopharmacology. June 97:
"It has been suggested that moclobemide, a reversible MAOI preferentially selective for MAO-A inhibition (RIMA), may lack the potential to cause a serotonin syndrome when coadministered with SSRIs and that the combination of moclobemide with SSRIs may have utility in the management of refractory depression. However, concomitant administration of moclobemide (600 mg/day) and the potent SRI clomipramine (100 mg/day) has been shown to be poorly tolerated by healthy volunteers and resulted in a high incidence of orthostatic hypotension, nausea, and tremor. In an open study of 19 patients with refractory depression, patients receiving 20 mg/day of fluoxetine or paroxetine were coadministered increasing doses of moclobemide to a maximum of 600 mg/day. Of 77 reported adverse events, less than one third were mild. They included insomnia (68%), dizziness and ataxia (58%), nausea (37%), and myoclonic jerks (16%). Three patients reported serious adverse events of visual hallucinations and collapse. These findings, although open and uncontrolled, led the authors to challenge previous reports of a low potential for interaction between RIMAs and SSRIs. The combination seemed potentially toxic, and its use was only recommended if close monitoring procedures could be ensured.Spigset and colleagues [98] reported a case of the serotonin syndrome in a 76-year-old woman with depression and Parkinson's disease the day after the introduction of moclobemide (300 mg/day) after the discontinuation of clomipramine (50 mg/day). The patient presented with fever, myoclonus, confusion, and intermittent convulsive attacks. Neuvonen and coworkers reported five fatal cases of the serotonin syndrome after overdose with moclobemide. Two individuals took a combination of moclobemide, 1,000 mg to 1,500 mg, and clomipramine, 500 mg, to "get high." Two hours later they were euphoric, then had extreme tremor and convulsions, and eventually lost consciousness. Both died 9 to 10 hours after taking the drugs. Equivalent effects were induced in three individuals by overdoses of moclobemide and citalopram. A serotonin syndrome has also been reported in a 53-year-old woman receiving moclobemide (600 mg/day) who was coadministered sertraline (25 mg/day).
Animal experiments suggest that inhibition of both MAO-A and MAO-B is essential for the development of the serotonin syndrome. [18,100] However, the occurrence of the serotonin syndrome in combination treatment with SSRIs and selegiline would seem to challenge this evidence. Selegiline may only be selective for MAO-B at low doses. The scientific literature would only support the preferential selectivity of moclobemide for MAO-A. Moclobemide further loses selectivity for MAO-A at higher doses. Epidemiologic studies have reported treatment-emergent hypertension on moclobemide, including hypertensive reactions in response to the consumption of tyramine-rich food and hypertensive crises."
poster:SalArmy4me
thread:63681
URL: http://www.dr-bob.org/babble/20010515/msgs/63776.html