Moclobemide: Uses And Side Effects Of This Psychotropic Drug
Moclobemide was the first RIMA antidepressant (Reversible Inhibitor of Monoamine oxidase Atype), that is, the first reversible MAOI type A, which increases the concentrations of serotonin, dopamine and serotonin.
This drug is mainly used for depression and social anxiety. In this article we will learn about its characteristics, adverse effects and therapeutic indications, among others.
Moclobemide is an antidepressant from the group of MAOIs (monoamine oxidase inhibitor), specifically it is a benzamide (solid organic compound).
This medication is mainly used to treat major depression and, to a lesser extent, social anxiety. Although clinical trials with moclobemide began in 1977, it is not currently approved for use in the United States.
The toxicity of moclobemide is low and it is very well tolerated. It is metabolized by the pancreas practically completely; Less than 1% is excreted in urine.
Unlike traditional MAOIs, with moclobemide no sign of liver toxicity has been detected and to date there is no sign that suggests that moclobemide causes cardiotoxic effects (toxic to the heart).
Mechanism of action
As we have said, moclobemide is a reversible monoamine oxidase inhibitor, mainly of subtype A; that is to say, reversibly and selectively inhibits monoamine oxidase type A
This means that it decreases the metabolism of norepinephrine, serotonin and dopamine, and therefore increases the extracellular concentrations of these neurotransmitters.
So, The mechanism of action of moclobemide is similar to that of classic MAOIs but unlike these, its effect on the aforementioned enzyme basically modifies noradrenergic and serotonergic transmission with little effect on dopaminergic transmission.
Moclobemide is indicated (and used) for major depression (major depressive episodes) (mainly) and social anxiety.
Contraindications
Moclobemide It is contraindicated in acute confusional states, in children, when there is hypersensitivity and as concomitant use with selegiline.
Dose
In adults, the initial dose is usually 300 mg, and its administration is divided into several doses after meals. The tablets are administered orally If necessary, the daily dose can be increased to 600 mg/day.
Treatment duration
Treatment with moclobemide should be administered for at least 4-6 weeks in order to evaluate the effectiveness of moclobemide. Normally, treatment is intended to continue for an asymptomatic (symptom-free) period of 4-6 months.
We know that antidepressants, especially MAOIs, should be withdrawn gradually to reduce the risk of withdrawal symptoms
Precautions
It should be noted that moclobemide may exacerbate symptoms in depressed patients with schizophrenic or schizoaffective psychoses (Therefore, if possible, it is recommended to continue treatment with long-term neuroleptics).
On the other hand, it is warned that if moclobemide is used, no more than 100 mg/day of foods containing tyramine should be consumed, especially in hypertensive patients. Tyramine is found in some foods such as Cheddar cheese, broad beans or Chianti wine. This is done in order to prevent an increase in blood pressure
Additionally, the use of moclobemide should be monitored in suicidal patients, and its administration with 5-HT reuptake inhibitors (SSRIs) is not recommended.
Side effects
According to the World Health Organization (WHO), an adverse reaction to a drug is “any unintentional harmful reaction that appears at doses normally used in humans for prophylaxis, diagnosis or treatment or to modify physiological functions.”
In the case of moclobemide, their adverse reactions (which appear rarely) can be: agitation; sleep disorders; feelings of anxiety, confusion, irritability; dizziness; headaches; paresthesia; Vertigo; visual disorders; blush; gastrointestinal discomfort; increased liver enzymes; rash; pruritus; urticaria.
Effectiveness
Moclobemide has been evaluated in numerous clinical trials and has demonstrated its antidepressant efficacy superior to placebo and similar to that of tricyclic antidepressants and serotonin reuptake inhibitors (SSRIs).
In terms of tolerance, it has good tolerance and practically no interactions with other drugs.
On the other hand, it is safe in overdose (due to its reduced toxicity), and is considered a good alternative (first choice) to current treatments for depression, especially in polymedicated patients and in whom a non-sedating drug is required
