Modern day use of Moclobemide...?

Under_Graduate

I believe, vastly underprescribed, due to the confusion with irreversible MAOI's.

Basically, little to no dietary precautions need be taken, as is the case with irreversible MAOI's - restrict intake of tyrosine etc - given its reversible nature.

Most pharmacists report never having handed it out.

And it's side effect profile is minimal.
Little to no weight gain, sexual dysfunction, anti-colinergic side effects.
All absent.

Though I believe there are drug interactions with the likes of ritalin, and other adjuncts such as mirtazipine.

But carrying the efficacy of an MAOI; is this something which a lot of GP's and/or consultants overlook, possibly due to being considered an "old" drug, and outdated by SSRI's, first line treatments, which are known amongst aficionados of pharmacology and neuroscience, to be significantly less efficacious than drugs targeting multiple receptors, such as the more old school products.

Perhaps it's the toxic nature in overdose of older psychoactives, that encourages the more widespread use of non toxic newer neurotransmitter implicating drugs.

Opinions?

Wesser

Or maybe it is because there's no drug reps pushing it/ no awareness/ no advertising?

Under_Graduate

The way of the world, isn't it...

Does anyone have any actual experience or direct knowledge of the use of moclobemide??

pokkii

I was on Moclobemide for 2 weeks for severe depression as an appointment with the Psychiatrist takes 6 months to come. I requested to be put on it myself and my Dr had never heard of it. As has been pointed out, Moclobemide is a reversible MAOI and as such doesn't carry the risks of typical MAOIs when it comes to tyramine containing foods, its also pretty inexpensive, I didn't have a medical card at the time as I was waiting for mine to be renewed and it cost me 12.50. I also want to add that I did need a time out period once I stopped it before I began taking Effexor, according to my Psychiatrist, the reason why Moclobemide is usually not prescribed is due to it not being very effective. I thought that was strange as I remember reading clinical studies that showed it to be as effective as newer antidepressants with the added benefit of less occurrence of unwanted side effects. Personally I didn't get anything from it good or bad... But I'm only 23 and have been on various different psychiatric medications so no surprise there.

Under_Graduate

pokkii wrote: »

I was on Moclobemide for 2 weeks for severe depression as an appointment with the Psychiatrist takes 6 months to come. I requested to be put on it myself and my Dr had never heard of it. As has been pointed out, Moclobemide is a reversible MAOI and as such doesn't carry the risks of typical MAOIs when it comes to tyramine containing foods, its also pretty inexpensive, I didn't have a medical card at the time as I was waiting for mine to be renewed and it cost me 12.50.

2 weeks?

Does it even take effect in such a short period of time?

Why did you stay on it so short?
And how did you find it impact your condition?

pokkii

Under_Graduate wrote: »

2 weeks?

Does it even take effect in such a short period of time?

Why did you stay on it so short?
And how did you find it impact your condition?

Apparently yes, MAOIs actually have a quicker onset of action that the more commonly used SSRIs and SNRIs, the reason why they are no longer commonly used is because of their reputation. The reason why I was taken of it so quick though was because my GP spoke to a psychiatrist and he told him Moclobemide was too mild for my case. It had absolutely no effect on me positive or negative so I'd say I can attest for its torelability as I usually get side effects within the first few weeks.

Under_Graduate

So - throwing it out there, generally - efficacy of something like moclobimide in comparison to more modern drugs...?

Apparently, it can also be underprescribed due to the confusion with non-reversible MAOI's.

One other interesting thing about this drug is that, with chronic use it can raise hormone levels.
i.e. testosterone, which is of course positive in aging men.

Could hardly be considered a performance enhancer in that case...... could it?

pokkii

Under_Graduate wrote: »

So - throwing it out there, generally - efficacy of something like moclobimide in comparison to more modern drugs...?

Apparently, it can also be underprescribed due to the confusion with non-reversible MAOI's.

One other interesting thing about this drug is that, with chronic use it can raise hormone levels.
i.e. testosterone, which is of course positive in aging men.

Could hardly be considered a performance enhancer in that case...... could it?

In clinical studies moclobemide has been shown to be as effective as modern SSRI drugs with less side effects. Here's one such study: http://www.ncbi.nlm.nih.gov/pubmed/17168253

I think the view in regards to its efficacy has to do with the mean dose (the dose at which it is considered most effective in most patients). For example the mean dose for Prozac is 20mg, for moclobemide its 300mg. This is not to say that Moclobemide doesn't fall victim to the general perception regarding MAOIs, it absolutely does. With that said, the manufacturer's of moclobemide do advise against eating too many tyramine rich foods as cases of hypertension have been reported.
Here's the usage leafleft for Moclobemide (brand name Manerix) detailing this:
http://www.medicines.ie/medicine/14872/SPC/Manerix+150+mg+Film-coated+Tablets/#INDICATIONS

The only indication for Moclobemide in Ireland is for moderate to severe depression, and it doesn't seem to have off-label uses. Outside of Ireland it is used for other conditions, none of which includes performance enhancement.

Under_Graduate

The usual scripted dosage of 300 to 600 mg, seems to be regarded as low, and potentially weak in terms of efficacy.
Significantly so when compared to non-reversible MAOI's.

????