Talk:Moclobemide

Taking with other antidepressants

The statement that Moclobemide should not be taken concurrently with other antidepressants is not correct: it is now prescribed in combination with a tricyclic such as amitryptiline or dothiepin, often with the tricyclic at its maximum dose. This prescribing plan is used by Profs. Paykel and Cowen of Cambridge and Oxford Universities respectively, presumably amongst others. I don't know about using it with other types of antidepressant, though, so presumably caution should still be exercised. Chris 21:24, 26 June 2006 (UTC)

Thanks for updating the main page, Outriggr. Chris 09:36, 27 June 2006 (UTC)

I have used in concurrently with reboxetine, amongst other things. There is potentiation, but that is to be expected.

The warning is based on the fact that MAO-A-inhibition can cause potentially fatal reactions to drugs that elevate serotonin, and that NE/DA drugs can be potentiated 4-8 times (IIRC).

Similarly, EpiPens are potentiated, etc. Zuiram 18:54, 24 November 2006 (UTC)

Good results have also been obtained with SSRI combinations (I'm currently having good results myself). See for example Moclobemide and Specific Serotonin Re-uptake Inhibitor Combination Treatment of Resistant Anxiety and Depressive Disorders (Bakish et al. 1994). Certainly there is a strong synergy, so doses are necessarily much lower, but much of the previously assumed risk is based on the established danger of combining non-reversible MAOs moclobemide. I'm too inexpert, pressed for time, and crap with wiki citation to incorporate any of this information 131.172.4.44 (talk) 01:51, 7 April 2008 (UTC)snaxalotl

MDMA

Someone should add on the possible lethal/quite dangerous interaction with MDMA.

http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showAbstract&doi=10.1046/j.1360-0443.2003.00292.x

Any MAOI will have a potentially lethal interaction with MDMA ;)

Moclobemide doesn't have less potential for interaction than the traditional MAOIs, it just has less dietary restrictions, and a less complicated metabolism. Zuiram 18:55, 24 November 2006 (UTC)

@Zuiram I think a warning is a good idea, but I question the idea that it doesn't have less potential for interaction than traditional MAOIs. From the article: "Serotonin syndrome has been reported when moclobemide has been taken in combination with other serotonin enhancing drugs; however, due to moclobemide's reversible MAO inhibition, serotonin syndrome is significantly less likely to occur with moclobemide than with older irreversible MAOIs." Yeltommo (talk) 07:01, 27 March 2023 (UTC)

Dietary restrictions

Like much of this article, the section on dietary restrictions is wrong; I'll put it on my TODO list, and see if I can get around to fixing it eventually.

At a the recommended maximum dose of 600mg day, the TYR30 is about 150mg, which is why that dose was chosen as the highest recommended dose: it's virtually impossible for a person with a normal diet to consume enough tyramine in a single sitting to cause a dangerous reaction at that dose.

At higher doses, regular tyramine restrictions should be adhered to, and the drug has been in clinical use up to 1200mg/day.

Even at the lower doses, you should avoid yeast extracts like Bovril and Marmite, as these are a fairly reliable way to get a dangerous tyramine dose in a single serving.

The article states "However, as a precaution moclobemide has been suggested to be taken pre-prandially (on an empty stomach)" but the cited study actually suggests post-prandial consumption of moclobemide (i.e., right after eating--not on an empty stomach). This should be fixed. — Preceding unsigned comment added by 68.45.163.83 (talk) 22:49, 11 February 2013 (UTC)

@68.45.163.83

It seems to have been fixed, but an explanation for why thst rather counterintuitive suggestion might be helpful would be nice. Yeltommo (talk) 07:10, 27 March 2023 (UTC)

Standard MAOIs comparison

The following text:

Unlike standard MAOIs, possible side effects do not include cardiovascular complications (hypertension) with encephalopathy, liver toxicity or hyperthermia.

Is a bit misleading. First off, hepatotoxicity and such complications are linked to the older MAOIs that are no longer in use. Of the current generation, only Nardil carries any significant potential for hepatotoxicity. Hypertension and hyperthermia are related to dietary and drug interactions, and remain an issue with moclobemide, although it will take more of the offending substance to cause it with typical doses of moclobemide. And someone should elaborate on what kind of encephalopathy they feel is common with the unselective MAOIs. Zuiram 19:04, 24 November 2006 (UTC)

@Zuiram I agree that it's misleading at best. But doesn't isocarboxazid, as a hydrazine derivative, also have the potential for hepatotoxicity? In any case. tranylcypromine does not. Frankly, the article comes across a little like an advertisement, excessively influenced by manufacturer marketing and/or initial hopes and enthusiasm. Maybe I should create a separate topic. Yeltommo (talk) 07:05, 27 March 2023 (UTC)

Information on legal status in U.S.

Does anyone know whether this drug is under review by the FDA for approval? (I sent an email to the manufacturer.) Also, does anyone know *why* it's not approved in the U.S.? Historian932 (talk) 15:43, 28 June 2008 (UTC)

Interactions with Serotonergics

"In general, combination of an MAOI with any serotonergic substance is not advised, due to the possibility of dangerous increases in blood pressure."

While taking substances that release serotonin in combination with an MAO-A inhibitor is obviously a major risk of serotonin syndrome and death - substances like DMT, LSD, Psilocin, Mescaline, etc work directly at the serotonin receptor and so I cant see how an MAOI would increase the pressor effects of these 5-HT2A agonists enough to produce significant hypertension. Admittedly as these substances are metabolized by MAO Moclobemide will raise their plasma levels but if this was an issue then taking less would prevent the problem. I also don't think that even absurdly high levels of any 5-HT2A agonist could produce hypertension via that receptor, it is not that uncommon for people to take shockingly high doses of the classical psychedelics without suffering any effect on their physical health. The toxicity of the classical 5-HT2A agonists is such that you can take 1000 times the normal dose without any risk to health. This is not the case for 2C-B though and many others as they have a much higher toxicity. I heard a report of 2C-B in combination with the MAO-B inhibitor Deprenyl causing sub-clinical hypertension (140/100 or similar). The only reason 2C-B has the capacity to elevate blood pressure that much is that it is an alpha1-adrenaline agonist(1) like amphetamine/cocaine. Deprenyl is known to potentiate the pressor response to alpha1-adrenaline(2) so this probabley had nothing to do with the MAO inhibition anyway. To conclude - all of the classical serotonergic psychedelics (DMT, LSD, psiloc[yb]in, mescaline) are clearly safe in combination with moclobemide - while the safety of combining the newer synthetic psychedelics - 2C-B, 2C-E, 2C-I, DOB, DOI, AMT, AET, etc - is less certain. Personally I would feel comfortable taking moclobemide in combination with 2C-B, 2C-E or 2C-I but not with any of the other research chemicals.

I'm going to remove that sentance as it is misleading.

Note: subsequent research has shown that alpha2c is the relevant adrenaline receptor for 2c-b's stimulatory effects, not alpha1 as is noted - source = psychedelics and the human receptorome, also i have combined selegiline with moclobemide (5mg and 150mg respectively) w/o complication —Preceding unsigned comment added by 64.131.209.208 (talk) 07:20, 27 February 2010 (UTC)

1: http://www.ncbi.nlm.nih.gov/pubmed/1362550 2: http://www.ncbi.nlm.nih.gov/pubmed/2509682 —Preceding unsigned comment added by 87.242.158.175 (talk) 09:00, 14 August 2008 (UTC)

Cleanup

This article needs to be cleaned up. The same things are being repeated over and over again and the article is neither well structured or formatted. — Preceding unsigned comment added by 83.227.15.37 (talk) 03:07, 11 March 2013 (UTC)

In addition, there is some contradictory information: "Adverse events occur more often in females than in males" vs "The tolerability of moclobemide is similar in woman and men". SelfishSeahorse (talk) 16:45, 3 November 2013 (UTC)

Bias

Frankly, the article comes across a little like an advertisement, excessively influenced by manufacturer marketing and/or initial hopes and enthusiasm. One example: "Reversible selective MAOIs such as moclobemide are widely underprescribed due to the misconception that the side effect profiles are analogous to that of the irreversible and non-selective MAOIs." The cited article is from 1997. Psychiatrists aren't the brightest bunch, but it's not credible that they (still) wouldn't understand that there's a significant difference between irreversible and reversible MAOIs. The more likely reason it hasn't been prescribed much in the 25+ years since that article was written is that it's not very effective, especially when used alone, despite the RCTs suggesting otherwise. RCTs can be manipulated or interpreted to show all kinds of things that aren't observed in clinical practice. This is just one example. The article is chock full of enthusiastic claims. Yeltommo (talk) 07:18, 27 March 2023 (UTC)

Social phobia

There is much conflicting information about the use of moclobemide in social phobia which is not conveyed in this Wikipedia article. Here are two examples:

• "Moclobemide has been found to be effective for the treatment of social anxiety disorder in both short and long-term placebo controlled clinical trials"

• "The use of moclobemide in the treatment of social anxiety disorder has given mixed results with a tendency of response at higher doses (>300 mg/d) compared with placebo."

I have looked at multiple sources and they generally seem to either slightly prefer moclobemide or there is no difference compared to placebo. I think this section needs to be tidied up and a disclaimer be put that research on social phobia is inconclusive. Huragok97 (talk) 19:11, 15 June 2023 (UTC)

"Promotional tone"

@Sappygang:, in this edit, you added the {{Promotional tone}} template, but didn't post here explaining why. What parts read to you as promotional? Kimen8 (talk) 16:09, 3 April 2024 (UTC)

The whole "Medical uses" section borders on promotional, language seems overly positive and with dubious neutrality as I see it.

In Adverse effects:

"Side effects of moclobemide are exceptionally low," - subjective language

"The incidence of adverse events is not correlated with age; however, adverse events occur more often in females than in males." and "The tolerability of moclobemide is similar in women and men and it is also well tolerated in the elderly." seemingly contradict each other, although this is not related to promotional language per se.

I understand now before adding such a template it is required to post your reasoning here correct?

I assumed it would be alright since this has been said before on this talk page (Bias), but it is understandable that it's preferred for the editor to mention the exact issues. ~~~~ Sappygang (talk) 16:28, 3 April 2024 (UTC)

No that seems perfectly appropriate, I just was curious which parts it referred to since that template generally asks you to post on the talk page saying which parts are being referred to, so they can be addressed. That language does look "too positive".

Do you want to try to rework some of those sections? If not I'll add it to my list but with no guarantee of when I'd look at it (that is, I'm interested in this article but spreading myself thin). Kimen8 (talk) 17:50, 3 April 2024 (UTC)

I think I want to get a bit more experience with easier edits before attempting one like this. It's quite disorganised in addition to a lot of instances of what I think is inappropriate language. Feels a bit daunting right now haha ~~~~ Sappygang (talk) 18:27, 3 April 2024 (UTC)

In the § Medical uses section, I have just removed several clinical trials and case reports. I removed the entire "bipolar depression" section because there is nothing left for reference after removing the clinical trials and case reports. I toned down some of the language (removed some "very"s that didn't come from the referenced source). It could still use another pass, as I didn't check every reference. I did not touch the special populations (pregnant, elderly, &c) sections, as they are frankly out of my area of interest.

In the § Adverse effects section, all I have done is remove the unjustified use of the word "exceptionally". It needs a review of its references.

I want to note that at least one of these complaints was raised as far back as 2013, above.

Kimen8 (talk) 18:20, 3 April 2024 (UTC)

Some of the removed content can likely be recovered and either: (1) put a proper source if I can find one, or (2) tag with {{citation needed}} if it seems almost certainly true. Moreover, some of the content I removed that was clinical trials may have a place in a Research section. Kimen8 (talk) 12:24, 4 April 2024 (UTC)