Abstract
Synopsis
Unlike older monoamine oxidase inhibitors, which irreversibly and non-selectively bind monoamine oxidase (MAO), moclobemide is a reversible and selective inhibitor of the MAO-A isozyme. Moclobemide only weakly potentiates the pressor response induced by tyramine or other indirectly acting sympathomimetics; therefore, there is no need to avoid dietary tyramine or over-the-counter decongestants with moclobemide as there is with older MAO inhibitors.
Recent clinical trials and meta-analyses have confirmed the efficacy of moclobemide in the treatment of depressive disorders. Moclobemide has been shown to have similar efficacy to tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and nonselective, irreversible MAO inhibitors. Long term follow-up studies of 6 to 12 months’ duration have demonstrated that the antidepressant efficacy of moclobemide is maintained. Moclobemide, given alone or in combination with another antidepressant, has shown some efficacy in patients with refractory depression; however, comparative trials are required to confirm these findings. Data are also available to show clinical efficacy of moclobemide in the management of social phobia.
Comparative studies have established that moclobemide is better tolerated at therapeutic dosages and has less toxicity in overdose than TCAs and nonselective, irreversible MAO inhibitors. Moclobemide lacks the anticholinergic, sedative and cardiovascular effects associated with many of the older antidepressants. Compared with SSRIs, moclobemide has a similar overall tolerability, although it tends to cause fewer gastrointestinal effects than the SSRIs and has not been reported to interfere with sexual function.
In summary, recent data which confirm and extend its comparative therapeutic efficacy and low potential for adverse effects have established moclobemide as an effective treatment in depressive disorders. The drug is also effective in patients with a primary diagnosis of social phobia. Its lack of adverse anticholinergic, cardiovascular, cognitive and psychomotor effects makes moclobemide a particularly useful option in the elderly or patients with cardiac disease.
Pharmacodynamic Properties
The in vitro binding of moclobemide to monoamine oxidase (MAO)-A is weak but >167-fold more selective than for the MAO-B isozyme. However, its ex vivo activity against -A is more pronounced, perhaps indicating the existence of an as yet unidentified, more active metabolite. The ex vivo binding of moclobemide to MAO-A was demonstrated to be reversible, with recovery of enzyme activity within 16 hours. This is in contrast to older MAO inhibitors, which nonselectively and irreversibly bind to both MAO-A and MAO-B isozymes.
The effects of moclobemide on monoamine metabolism and/or activity of monoaminergic neurons have been indirectly demonstrated in humans by reductions in plasma levels of the catecholamine metabolites homovanillic acid, 3,4-dihydroxyphenylacetic acid, 3-methoxy-4-hydroxyphenylglycol and the serotonin (5-hydroxytryptamine) metabolite 5-hydroxyindoleacetic acid. In vitro, moclobemide has no appreciable affinity for muscarinic, dopaminergic, seroto-nergic, adrenergic, H1-histaminergic, benzodiazepine or opioid receptors.
In oral tyramine pressor tests moclobemide enhanced the hypertensive re-sponse to oral tyramine approximately 8- and 16-fold less than tranylcypromine and phenelzine, respectively. In addition, the pressor response induced by tyramine returned to baseline within 3 days of discontinuing moclobemide, whereas baseline sensitivity did not return until 4 and 8 weeks after discontinuing tranyl-cypromine and phenelzine, respectively.
In contrast to other antidepressants, moclobemide has minimal effect on REM sleep and is reported to have no effect on, or to improve, sleep continuity in depressed patients. Unlike tricyclic antidepressants (TCAs), moclobemide has no reported effect on cognitive or psychomotor function.
Pharmacokinetic Properties
After single-dose oral administration, moclobemide is almost completely absorbed; however, oral bioavailability ranges from 44 to 69% because of substantial first-pass metabolism. After multiple doses, moclobemide is associated with increased bioavailability (>80%), possibly due to saturation of first-pass metabolism. Moclobemide is approximately 50% bound to plasma proteins and the volume of distribution ranges from 76 to 134L.
Moclobemide is rapidly and extensively metabolised to at least 19 different metabolites, two of which have moderate MAO-A inhibitory activity. The elimination half-life of moclobemide is approximately 1 to 2 hours and the drug is primarily excreted renally as metabolites. Age and renal function are reported to have no significant effect on the pharmacokinetics of moclobemide; however, elimination is impaired in patients with hepatic dysfunction.
Therapeutic Efficacy
Recent clinical trials and meta-analyses in patients with depressive disorders have confirmed that moclobemide generally has similar efficacy to TCAs, selective serotonin reuptake inhibitors (SSRIs), the MAO inhibitor tranylcypromine and maprotiline. Although results from a meta-analysis indicate that moclobemide is as effective as clomipramine, this was not the case in patients with severe depression when dosages of moclobemide of 400 mg/day or less were used. Data from meta-analyses also indicate that moclobemide has similar efficacy to TCAs when patients are classified according to severity of disease or when symptom clusters (psychic, somatic, retardation, agitation) of the Hamilton Depression Rating Scale (HDRS) are examined separately.
In studies comparing moclobemide 300 to 600 mg/day with fluoxetine 20 to 40 mg/day, the percentage of patients who responded to treatment (≥50% reduction in HDRS scores or either a ≥50% reduction in HDRS score or a final HDRS score <10) was similar (range 47 to 72% and 48 to 77%, respectively). One study reported that moclobemide and fluoxetine were associated with similar improvements in quality-of-life parameters after treatment for up to 12 weeks.
Long term follow-up studies have reported that moclobemide retains its antidepressant efficacy over treatment periods of up to 12 months. In elderly patients, moclobemide was generally at least as effective as comparator antidepressants and more effective than placebo. The use of moclobemide in patients with depression that is refractory to standard therapy is primarily limited to noncomparative studies. Preliminary data indicate that combination of moclobemide with a TCA or SSRI may be effective in these patients (although the coadministration of moclobemide with antidepressants with serotonergic properties should be undertaken only with great caution).
Moclobemide has been shown to be effective in the management of social phobia. Comparative 16-week data indicate moclobemide (approximately 580 mg/day) to be as effective as phenelzine (approximately 70 mg/day) in this disorder. In a subsequent study, moclobemide 600 mg/day was associated with significant global improvement relative to placebo on the Liebowitz Social Phobia Scale and on all subscales of the Clinical Impression of Change for social phobia after 12 weeks. Long-term data are also available from a nonblind trial to show clinical efficacy of moclobemide 600 to 750 mg/day over a 2-year period.
Tolerability
Based on pooled data from clinical trials involving over 1600 patients, the frequency of the most common adverse effects did not significantly differ between moclobemide and placebo. Only dizziness, nausea and insomnia/sleep disturbance were reported more frequently in moclobemide-treated patients than placebo recipients.
Moclobemide generally lacks the adverse effects associated with antidepressant drugs which bind to muscarinic (dry mouth, constipation, blurred vision, urinary retention), α1-adrenergic (hypotension) and histaminergic (sedation) receptors. In comparative trials with TCAs, moclobemide was associated with a lower frequency of adverse effects, primarily related to a lower propensity to produce anticholinergic and sedative effects. Moclobemide had a similar overall tolerability to SSRIs. However, SSRIs tended to cause more gastrointestinal adverse effects than moclobemide.
Moclobemide has a relatively low frequency of adverse effects during long term treatment and is reported to be as well tolerated in the elderly as in younger patients.
In cases of overdose when moclobemide was the sole ingestant, most symptoms have been relatively mild and reversible. However, several fatal cases of serotonin syndrome have been reported after multidrug overdose involving moclobemide in combination with clomipramine, citalopram or fluoxetine.
Drug Interactions
Although moclobemide has been combined with serotonin reuptake inhibitors in clinical trials without evidence of the serotonin syndrome, there have been isolated case reports of this occurring when moclobemide was combined with clomipramine or fluoxetine at therapeutic dosages. Thus, these drugs should be used together only with great caution. Similarly, pethidine (meperidine) or dextro-methorphan (both of which have serotonergic properties) should be avoided in patients receiving moclobemide.
Moclobemide has no reported interaction with directly acting sympathomimetic agents. Data indicate that the drug may be used with caution in combination with low dosages of indirectly acting sympathomimetics. The elimination of moclobemide is significantly reduced when it is coadministered with cimetidine.
Dosage and Administration
Moclobemide may be initiated at full therapeutic dosages of 300 to 450 mg/day. The maximum recommended dosage is 600 mg/day. Dietary restrictions are not required but consumption of large amounts of tyramine-rich food should be avoided. Washout periods when switching between moclobemide and other antidepressants are not required. Dosage adjustments are not needed in patients with renal dysfunction; however, moclobemide dosages should be reduced by one-third to one-half in patients with hepatic dysfunction.
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References
Fitton A, Faulds D, Goa KL. Moclobemide: a review of its pharmacological properties and therapeutic use in depressive illness. Drugs 1992 Apr; 43: 561–96
Da Prada M, Kettler R, Keller H, et al. Neurochemical profile of moclobemide, a short-acting and reversible inhibitor of monoamine oxidase type A. J Pharmacol Exp Ther 1989; 248(1): 400–14
Kettler R, Da Prada M, Burkard WP. Comparison of monoamine oxidase-A inhibition by moclobemide in vitro and ex vivo in rats. Acta Psychiatr Scand 1990; 82 Suppl. 360: 101–2
Da Prada M, Kettler R, Keller HH, et al. Neurochemical effects in vitro and in vivo of the antidepressant Ro 11-1163, a specific and short-acting MAO-A inhibitor. Mod Probl Phar-macopsychiatry 1983; 19: 231–45
Colzi A, d’Agostini F, Cesura AM, et al. Brain microdialysis in rats: a technique to reveal competition in vivo between endogenous dopamine and moclobemide, a RIMA antidepressant. Psychopharmacology 1992 Feb; 106 Suppl.: S17–20
Da Prada M, Kettler R, Keller HH, et al. Short-lasting and reversible inhibition of monoamine oxidase-A by moclobemide. Acta Psychiatr Scand 1990; 82 Suppl. 360: 103–5
Da Prada M, Kettler R, Keller HH, et al. Preclinical profiles of the novel reversible MAO-A inhibitors, moclobemide and brofaromine, in comparison with irreversible MAO inhibitors. J Neural Transm Gen Sect 1989; 28 Suppl.: 5–20
Keller HH, Kettler R, Keller G, et al. Short-acting novel MAO inhibitors: in vitro evidence for the reversibility of MAO inhibition by moclobemide and Ro 16-6491. Naunyn Schmiedebergs Arch Pharmacol 1987; 335: 12–20
Haefely W, Burkard WP, Cesura A, et al. Pharmacology of moclobemide. Clin Neuropharmacol 1993; 16 Suppl. 2: S8–18
Waldmeier PC, Stöcklin Binding of [p3H]brofaromine to monoamine oxidase A in vivo: displacement by clorgyline and moclobemide. Eur J Pharmacol 1990; 180: 297–304
Haefely W, Burkard WP, Cesura AM, et al. Biochemistry and pharmacology of moclobemide, a prototype RIMA. Psycho-pharmacology 1992 Feb; 106 Suppl.: S6–14
Dingemanse J, Korn A, Pfefen J-P, et al. Biochemical effects of high single doses of moclobemide in man: correlation with plasma concentrations. Psychopharmacology 1992 Feb; 106 Suppl.: 46–8
Holford NHG, Guentert TW, Dingemanse J, et al. Monoamine oxidase-A: pharmacodynamics in humans of moclobemide, a reversible and selective inhibitor. Br J Clin Pharmacol 1994 May; 37: 433–9
Koulu M, Scheinin M, Kaarttinen A, et al. Inhibition of monoamine oxidase by moclobemide: effects on monoamine metabolism and secretion of anterior pituitary hormones and cortisol in healthy volunteers. Br J Clin Pharmacol 1989; 27: 243–55
Markianos M, Alevizos B, Hatzimanolis J, et al. Effects of monoamine oxidase A inhibition on plasma biogenic amine metabolites in depressed patients. Psychiatry Res 1994 Jun; 52: 259–64
Markianos M, Alevizos V, Stefanis C. Plasma sex hormones and urinary biogenic amine metabolites during treatment of male depressed patients with the monoamine oxidase inhibitor moclobemide. Neuroendocrinol Lett 1991; 13(1): 49–55
Scheinin M, Koulu M, Vakkuri et al. Moclobemide, an inhibitor of MAO-A, does not increase daytime plasma melatonin levels in normal humans. Prog Neuropsych Biol Psychiatry 1990; 14: 73–82
Simpson GM, Gratz SS. Comparison of the pressor effect of tyramine after treatment with phenelzine and moclobemide in healthy male volunteers. Clin Pharmacol Ther 1992 Sep; 52: 286–91
Bieck PR, Antonin K-H. Oral tyramine pressor test and the safety of monoamine oxidase inhibitor drugs: comparison of brofaromine and tranylcypromine in healthy subjects. J Clin Psychopharmacol 1988 Aug; 8(4): 237–45
Berlin I, Zimmer R, Cournot A, et al. Determination and comparison of the pressor effect of tyramine during long-term moclobemide and tranylcypromine treatment in healthy volunteers. Clin Pharmacol Ther 1989 Sep; 46: 344–51
Bieck PR, Antonin K-H. Tyramine potentiation during treatment with MAO inhibitors: brofaromine and moclobemide vs irreversible inhibitors. J Neural Transm Gen Sect 1989; 28 Suppl.: 21–31
Minot R, Luthringer R, Macher JP. Effect of moclobemide on the psychophysiology of sleep/wake cycles: a neuroelectro-physiological study of depressed patients administered with moclobemide. Int Clin Psychopharmacol 1993 Jan; 7: 181–9
Cohen RM, Pickar D, Garnett D, et al. REM sleep suppression induced by selective monoamine oxidase inhibitors. Psycho-pharmacology 1982; 78: 137–40
Dunleavy DLF, Brezinova V, Oswald I, et al. Changes during weeks in effects of tricyclic drugs on the human sleeping brain. Br J Psychiatry 1972; 120: 663–72
Kupfer DJ, Buysse DJ, Reynolds III CF. Antidepressants and sleep disorders in affective illness. Clin Neuropharmacol 1992; 15 Suppl. 1, (Pt A): 360A–1A
Monti JM. Effect of a reversible monoamine oxidase-A inhibitor (moclobemide) on sleep of depressed patients. Br J Psychiatry 1989; 155 Suppl. 6: 61–5
Monti JM, Alterwain P, Monti D. The effects of moclobemide on nocturnal sleep of depressed patients. J Affect Disord 1990; 20: 201–8
Hoff P, Golling H, Kapfhammer HP, et al. Cimoxaton and moclobemid, two new MAO inhibitors: influence on sleep parameters in patients with major depressive disorder. Phar-macopsychiatry 1986; 19: 249–50
Lavie P, Aharon-Peretz J, Klein F, et al. Sleep quality in geriatric depressed patients: comparison with elderly demented patients and normal controls and the effects of moclobemide. Dementia 1992 Sep-Oct; 3: 360–6
Riedel WJ, van Praag HM. Avoiding and managing anticholinergic effects of antidepressants. CNS Drugs 1995; 3(4): 245–59
Pancheri P, Delle-Chiaie R, Donnini M, et al. Effects of moclobemide on depressive symptoms and cognitive performance in a geriatric population: a controlled comparative study versus imipramine. Clin Neuropharmacol 1994; 17 Suppl. 1: S58–73
Fairweather DB, Hindmarch I. The behavioral toxicity of reversible inhibitors of monoamine oxidase A: laboratory and clinical investigations. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 68S–75S
Anand R, Wesnes KA. Cognition-enhancing effects of moclobemide, a reversible MAO inhibitor, in humans. Adv Neurol 1990; 51: 261–8
Wesnes KA, Simpson PM, Christmas L, et al. The effects of moclobemide on cognition. J Neural Transm Gen Sect 1989; 28 Suppl.: 91–102
Allain H, Lieury A, Brunet-Bourgin F, et al. Antidepressants and cognition: comparative effects of moclobemide, viloxazine and maprotiline. Psychopharmacology 1992 Feb; 106 Suppl.: S56–61
Ramaekers JG, Swijgman HF, O’Hanlon JF. Effects of moclobemide and mianserin on highway driving, psychometric performance and subjective parameters, relative to placebo. Psychopharmacology 1992 Feb; 106 Suppl.: S62–67
Dingemanse J, Berlin I, Payan C, et al. Comparative investigation of the effect of moclobemide and toloxatone on monoamine oxidase activity and psychometric performance in healthy subjects. Psychopharmacology 1992 Feb; 106 Suppl.: S68–70
Hindmarch I, Kerr J. Behavioural toxicity of antidepressants with particular reference to moclobemide. Psychopharmacology 1992 Feb; 106 Suppl.: S49–55
Guentert TW, Tucker G, Korn A, et al. Pharmacokinetics of moclobemide after single and multiple oral dosing with 150 milligrams 3 times daily for 15 days. Acta Psychiatr Scand 1990; 82 Suppl. 360: 91–3
Raaflaub J, Haefelfinger P, Trautmann K Single-dose pharmacokinetics of the MAO-inhibitor moclobemide in man. Arzneimittel Forschung 1984; 34(1): 80–2
Schoerlin Mayersohn M, Korn A, et al. Disposition kinetics of moclobemide, a monoamine oxidase-A enzyme inhibitor: single and multiple dosing in normal subjects. Clin Pharmacol Ther 1987 Oct; 42: 395–404
Schoerlin M-P, Mayersohn M, Hoevels B, et al. Effect of food intake on the relative bioavailability of moclobemide (Ro 11-1163). J Neural Transm Gen Sect 1988; 26: 115–21
Wiesel F-A, Raaflaub J, Kettler R. Pharmacokinetics of oral moclobemide in healthy human subjects and effects on MAO-activity in platelets and excretion of urine monoamine metabolites. Eur J Clin Pharmacol 1985; 85: 89–95
Maguire K, Pereira A, Tiller J. Moclobemide pharmacokinetics in depressed patients: lack of age effect. Hum Psychopharm 1991; 6: 249–52
Schoerlin M-P, Horber FF, Frey FJ, et al. Disposition kinetics of moclobemide, a new MAO-A inhibitor, in subjects with imipaired renal function. J Clin Pharmacol 1990; 30: 272–84
Stoeckel K, Pfefen JP, Mayersohn M, et al. Absorption and disposition of moclobemide in patients with advanced age or reduced liver or kidney function. Acta Psychiatr Scand 1990; 82 Suppl. 360: 94–7
Goodnick PJ. Pharmacokinetic optimisation of therapy with newer antidepressants. Clin Pharmacokinet 1994 Oct; 27: 307–30
Guentert TW, Banken L, Hilton S, et al. Moclobemide: relationships between dose, drug concentration in plasma, and occurrence of adverse events. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 84S–94S
Pons G, Schoerlin MP, Tarn YK, et al. Moclobemide excretion in human breast milk. Br J Clin Pharmacol 1990; 29: 27–31
Fritze J, Laux G, Sofic E, et al. Plasma moclobemide and metabolites: lack of correlation with clincial response and biogenic amines. Psychopharmacology 1989; 99: 252–6
Jauch R, Griesser E, Oesterhelt G, et al. Biotransformation of moclobemide in humans. Acta Psychiatr Scand 1990; 82 Suppl. 360: 87–90
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987
Carney MWP, Sheffield BF. Depression and the Newcastle Scales: their relationship to Hamilton’s scale. Br J Psychiatry 1972; 121: 35–40
Joffe RT, Bakish D. Combined SSRI-moclobemide treatment of psychiatric illness. J Clin Psychiatry 1994 Jan; 55: 24–5
Bakish D, Hooper CL, West DL, et al. Moclobemide and specific serotonin re-uptake inhibitor combination treatment of resistant anxiety and depressive disorders. Hum Psychopharm 1995 Mar-Apr; 10: 105–9
Alevizos B, Hatzimanolis J, Markianos M. Clinical, endocrine and neurochemical effects of moclobemide in depressed patients. Acta Psychiatr Scand 1993 Apr; 87: 285–90
Moll E, Stabl M, Wegscheider R. Long-term treatment with moclobemide — an open-label, non-comparative, multiple-distributed study in patients with a major depressive episode as defined by DSM-III. Psychopharmacology 1992 Feb; 106 Suppl.: 120–2
Amrein R, Schmid-Burgk W. Moclobemide in the longterm treatment of depression [abstract]. Neuropsychopharmacology 1994 May; 10 Suppl. 2: 63S
Gagiano A, Müller FGM, Fourie R, et al. Moclobemide in continuation treatment of major depressive episodes: an open follow-up study over six months. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 46S–50S
Angst J, Scheidegger P, Stabl M. Efficacy of moclobemide in different patient groups. Results of new subscales of the Hamilton Depression Rating Scale. Clin Neuropharmacol 1993; 16 Suppl. 2: S55–62
Bakish D, Bradwejn J, Nair N, et al. A comparison of moclobemide, amitriptyline and placebo in depression: a Canadian multicentre study. Psychopharmacology 1992 Feb; 106 Suppl.: S98–101
Evans L, George T, O’Sullivan B, et al. An Australian multicentre study of moclobemide versus amitriptyline in the treatment of depression. Aust N Z J Psychiatry 1992 Sep; 26: 454–8
Danish University Antidepressant Group. Moclobemide: a reversible MAO-A-inhibitor showing weaker antidepressant effect than clomipramine in a controlled multicenter study. J Affect Disord 1993 Jun; 28: 105–16
Guelfi JD, Payan C, Fermanian J. Moclobemide versus clomipramine in endogenous depression. A double-blind randomised clinical trial. Br J Psychiatry 1992 Apr; 160: 519–24
Kragh-Srensen P, Müller B, Andersen JV, et al. Moclobemide versus clomipramine in depressed patients in general practice. A randomized, double-blind, parallel, multicenter study. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 24–30
Larsen JK, Gjerris A, Holm P, et al. Moclobemide in depression: a randomized, multicentre trial against isocarboxazide and clomipramine emphasizing atypical depression. Acta Psychiatr Scand 1991 Dec; 84: 564–70
Lecrubier Y, Pedarriosse A-M, Payan C, et al. Moclobemide versus clomipramine in nonmelancholic, nonpsychotic major depression. Acta Psychiatr Scand 1995; 92: 260–5
Beaumont G, Gringras M, Hobbs FD, et al. A randomized, double-blind, multicentre, parallel-group study comparing the tolerability and efficacy of moclobemide and dothiepin hydrochloride in depressed patients in general practice. Int Clin Psychopharmacol 1993 Jan; 7: 159–65
Philipp M, Kohnen R, Benkert O. A comparison study of moclobemide and doxepin in major depression with special reference to effects on sexual dysfunction. Int Clin Psychopharmacol 1993 Jan; 7: 149–53
Baumhackl U, Bizière K, Fischbach R, et al. Efficacy and tolerability of moclobemide compared with imipramine in depressive disorder (DSM-III): an Austrian double-blind, multicentre study. Br J Psychiatry 1989; 155 Suppl. 6: 78–83
Rimon R, Jääskeläinen J, Kaartinen P, et al. Moclobemide versus imipramine in depressed out-patients: a double-blind multi-centre study. Int Clin Psychopharmacol 1993 Jan; 7: 141–7
Silverstone T, Abou-Saleh MT, Pathak R. A multicentre comparative trial of moclobemide, imipramine and placebo in major depressive disorder. Int Clin Psychopharmacol 1994; 9(2): 109–13
Versiani M, Oggero U, Alterwain P, et al. A double-blind comparative trial of moclobemide v. imipramine and placebo in major depresssive episodes. Br J Psychiatry 1989; 155 Suppl. 6: 72–7
Nair NPV, Amin M, Holm P, et al. Moclobemide and nortriptyline in elderly depressed patients: a randomized, multicentre trial against placebo. J Affect Disord 1995 Jan 11; 33: 1–9
Angst J, Amrein R, Stabl M. Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 16S–23S
Angst J, Delini-Stula A, Stabl M, et al. Is a cut-off score a suitable measure of treatment outcome in short-term trials in depression? A methodological meta-analysis. Hum Psychopharm 1993 Sep-Oct; 8: 311–7
Altamura AC, Aguglia E. Moclobemide vs fluoxetine in elderly out-patients with major depression or dysthymia: a double blind-trial [abstract]. Eur Psychiatry 1994; 9 Suppl. 1: 163
Gattaz WF, Vogel P, Kick H, et al. Moclobemide versus fluoxetine in the treatment of inpatients with major depression. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 35S–40S
Geerts S, Bruynooghe F, De Cuyper H, et al. Moclobemide versus fluoxetine for major depressive episodes. Clin Neuropharmacol 1994; 17 Suppl. 1: S50–7
Lonnqvist J, Sintonen H, Syvälahti E, et al. Antidepressant efficacy and quality of life in depression: a double-blind study with moclobemide and fluoxetine. Acta Psychiatr Scand 1994 Jun; 89: 363–9
Reynaert C, Parent M, Mirel J, et al. Moclobemide versus fluoxetine for a major depressive episode. Psychopharmacology 1995 Mar; 118(2): 183–7
Williams R, Edwards RA, Newburn GM, et al. A double-blind comparison of moclobemide and fluoxetine in the treatment of depressive disorders. Int Clin Psychopharmacol 1993 Jan; 7: 155–8
Barrelet L, Blajev B, Bolzani L, et al. Multicenter study comparing efficacy and tolerance of moclobemide and fluvoxamine in in- and outpatients with a severe depressive episode [in French]. Schweiz Rundsch Med Prax 1991; 80(19): 524–8
Bougerol T, Uchida C, Gachoud J-P, et al. Efficacy and tolerability of moclobemide compared with fluvoxamine in depressive disorder (DSM III). A French/Swiss double-blind trial. Psychopharmacology 1992 Feb; 106 Suppl.: 102–8
Dönbak S, Türkçapar MH, Öztürk E, et al. A comparison of moclobemide and sertraline in the treatment of depressive disorders [abstract]. Eur Psychiatry 1994; 9 Suppl. 1: 165s
Lonnqvist J, Sihvo S, Syvälahti E, et al. Moclobemide and fluoxetine in atypical depression: a double-blind trial. J Affect Disord 1994 Nov; 32: 169–77
Lonnqvist J, Sihvo S, Syvälahti E, et al. Moclobemide and fluoxetine in the prevention of relapses following acute treatment of depression. Acta Psychiatr Scand 1995 Mar; 91: 189–94
Heinze G, Rössel L, Gabelic I, et al. Double-blind comparison of moclobemide and tranylcypromine in depression. Phar-macopsychiatry 1993 Nov; 26: 240–5
Gachoud J-P, Dick P, Köhler M. Comparison of the efficacy and tolerability of moclobemide and maprotiline in depressed patients treated by general practitioners. Clin Neuropharmacol 1994; 17 Suppl. 1: S29–37
Steinmeyer EM, Vorbach EU, Arnoldt KH. Efficacy and safety of moclobemide compared with maprotiline in treatment of major depressive disorder. A double-blind multicenter study with parallel groups. Pharmacopsychiatry 1993 Nov; 26: 246–53
Vaz-Serra A, Figueira ML, Firmino H, et al. Multicenter double-blind study of moclobemide and maprotiline. Clin Neuropharmacol 1994; 17 Suppl. 1: S38–49
Dabkowska M, Rybakowski JK. Moclobemide in treatment-resistant depression [abstract]. Eur Neuropsychopharmacol 1993 Sep; 3 Spec. Issue: 328–9
König F, Wolfersdorf M, Barg T, et al. Combined therapy using moclobemide and tricyclic and tetracyclic antidepressants for therapy-resistant depression [abstract]. Eur Psychiatry 1994; 9 Suppl. 1: 203
Soria CA, Remedi C, Flores M. Moclobemide and clomipramine in resistant depressions. Six months of combined use [abstract]. Eur Neuropsychopharmacol 1994 Sep; 4: 307–8
Stabl M, Kasas A, Blajev B, et al. A double-blind comparison of moclobemide and thioridazine versus moclobemide and placebo in the treatment of refractory, severe depression. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 41S–5S
Ebert D, Albert R, May A, et al. Combined SSRI-RIMA treatment in refractory depression: safety data and efficacy. Psychopharmacology 1995 Jun; 119(3): 342–4
Angst J, Stabl M. Efficacy of moclobemide in different patient groups: a meta-analysis of studies. Psychopharmacology 1992 Feb; 106 Suppl.: S109–113
Roth M, Mountjoy CQ, Amrein R, et al. Moclobemide in elderly patients with cognitive decline and depression. An international double-blind, placebo-controlled trial. Br J Psychiatry 1996; 168: 149–57
WPA Social Phobia Taskforce. In: Montgomery SA, editor. Pocket reference to social phobia. London: Science Press, 1995
Bisserbe J-C, Lepine JP. Moclobemide in social phobia: a pilot open study. GRP Group. Groupe de Recherche en Psy-chopharmacologie. Clin Neuropharmacol 1994; 17 Suppl 1: S88–94
Versiani M, Nardi AE, Mundim FD, et al. Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. Br J Psychiatry 1992 Sep; 161: 353–60
Nutt D, Montgomery SA. Moclobemide in the treatment of social phobia. Int Clin Psychopharmacol 1996; II Suppl. 3: 77–82
Versiani M, Nardi AE, Mundim FD, et al. The long-term treatment of social phobia with moclobemide. Int Clin Psychopharmacol 1996; II Suppl. 3: 83–8
Tiller J. Moclobemide for anxiety disorders: a focus on moclobemide in panic disorder [abstract]. Eur Neuropsychopharmacol 1996 Jun; 6 Suppl. 3: 150
Berlin I, Said S, Spreux-Varoquaux O, et al. The reversible monoamine oxidase-A inhibitor moclobemide facilitates smoking cessation and abstinence in heavy, dependent smokers [abstract no. 357]. Therapie 1995; 50 Suppl.
Takáts A, Tárczy N, Simó M, et al. Moclobemide/aurorix treatment in Parkinson’s disease with depression. New Trends Clin Neuropharmacol 1994; 8: 260
Sieradzan K, Channon S, Ramponi C, et al. The therapeutic potential of moclobemide, a reversible selective monoamine oxidase A inhibitor in Parkinson’s disease. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 51S–9S
Trott GE, Friese HJ, Menzel M. Use of moclobemide in children with attention deficit hyperactivity disorder. Psychopharmacology 1992 Feb; 106 Suppl.: 134–6
Lingjaerde O, Reichborn-Kjennerud T, Haggag A, et al. Treatment of winter depression in Norway. II. A comparison of the selective monoamine oxidase A inhibitor moclobemide and placebo. Acta Psychiatr Scand 1993 Nov; 88: 372–80
Wilson A, Hickie I, Wright M, et al. Moclobemide in chronic fatigue syndrome: a double-blind, placebo-controlled trial [abstract]. Neuropsychopharmacology 1994 May; 10 Suppl. 2: 24
Moll E, Neumann N, Schmid-Burgk W, et al. Safety and efficacy during long-term treatment with moclobemide. Clin Neuropharmacol 1994; 17 Suppl. 1: S74–87
Hilton S, Jaber B, Ruch R. Moclobemide and cardiac safety [abstract]. Eur Psychiatry 1994; 9 Suppl. 1: 194s
Coupland NJ, Wilson SJ, Potokar JP, et al. A comparison of the effects of phenelzine treatment with moclobemide treatment on cardiovascular reflexes. Int Clin Psychopharmacol 1995; 10: 229–38
Joubert AF, Gagiano CA, Joubert G. Antidepressants and weight: a comparative study of four antidepressants and their effect on the weight of depressed patients [abstract]. Behav Pharmacol 1995 May; 6 Suppl. 1: 30–1
Chen DT, Ruch R. Safety of moclobemide in clinical use. Clin Neuropharmacol 1993; 16 Suppl. 2: 63–8
Fischer P. Serotonin syndrome in the elderly after antidepressive monotherapy [letter]. J Clin Psychopharmacol 1995; 15: 440–2
’Kane GM, Gottlieb T. Severe adverse reaction to moclobemide [letter]. Lancet 1996 May 11; 347: 1329–30
Hilton S, Jaber B, Ruch R. Moclobemide safety: monitoring a newly developed product in the 1990s. J Clin Psychopharmacol 1995 Aug; 15 Suppl. 2: 76S–83S
Hender L. Moclobemide in overdose. Aust J Hosp Pharm 1996; 26(2): 272–3
Liebenburg R, Berk M, Winkler G. Serotonergic syndrome after concomitant use of moclobemide and fluoxetine [letter]. Hum Psychopharm 1996; 11: 146–7
Mayersohn M, Guentert TW. Clinical pharmacokinetics of the monoamine oxidase-A inhibitor moclobemide. Clin Pharmacokinet 1995; 29(5): 292–332
Myrenfors PG, Eriksson T, Sandstedt CS. Moclobemide overdose. J Intern Med 1993 Feb; 233: 113–5
Iwersen S, Schmoldt A. Three suicide attempts with moclobemide. Clin Toxicol 1996; 34(2): 223–5
Neuvonen PJ, Pohjola-Sintonen S, Tacke U. Five fatal cases of serotonin syndrome after moclobemide-citalopram or moclobemide-clomipramine overdoses. Lancet 1993 Dec 4; 342: 1419
Power BM, Pinder M, Hackett LP, et al. Fatal serotonin syndrome following a combined overdose of moclobemide, clomipramine and fluoxetine. Anaesth Intensive Care 1995 Aug; 23: 499–502
Hernandez AF, Montero MN, Pla A, et al. Fatal moclobemide overdose or death caused by serotonin syndrome? J Forensic Sci 1995 Jan; 40: 128–30
Kuisma MJ. Fatal serotonin syndrome with trismus. Ann Emerg Med 1995 Jul; 26: 108
Lejoyeux M, Adès J, Rouillon F. Serotonin syndrome: incidence, symptoms and treatment. CNS Drugs 1994 Aug; 2(2): 132–43
Sporer KA. The serotonin syndrome: implicated drugs, patho-physiology and management. Drug Saf 1995; 13(2): 94–104
Wallnöfer A, Guentert TW, Eckernäs SA, et al. Moclobemide and fluvoxamine co-administration: a prospective study in healthy volunteers to investigate the potential development of the serotonin syndrome. Hum Psychopharm 1995 Jan-Feb; 10: 25–31
Spigset O, Mjörn-Dal T. Serotonin syndrome caused by a moclobemide-clomipramine interaction. BMJ 1993 Jan 23; 306: 248
Brodribb TR, Downey M, Gilbar PJ. Efficacy and adverse effects of moclobemide [letter]. Lancet 1994 Feb 19; 343: 475
Amrein R, Guntert TW, Dingemanse J, et al. Interactions of moclobemide with concomitantly administered medication: evidence from pharmacological and clinical studies. Psycho-pharmacology 1992 Feb; 106 Suppl.: 24–31
Dingemanse J, Kneer J, Fotteler B, et al. Switch in treatment from tricyclic antidepressants to moclobemide: a new generation monoamine oxidase inhibitor. J Clin Psychopharmacol 1995 Feb; 15: 41–8
Gram LF, Brsen K. Moclobemide treatment causes a substantial rise in the sparteine metabolic ratio. Danish University Antidepressant Group. Br J Clin Pharmacol 1993 Jun; 35: 649–52
Rudorfer MV, Manji HK, Potter WZ. Comparative tolerability profiles of the newer versus older antidepressants. Drug Saf 1994 Jan; 10: 18–46
Gillman PK. Possible serotonin syndrome with moclobemide and pethidine [letter]. Med J Aust 1995 May 15; 162: 554
Härtter S, Ziegler G, Bauer J, et al. Pharmacokinetic interactions between moclobemide and dextromethorphan. Naunyn Schmiedebergs Arch Pharmacol 1995; 351 Suppl.: R3
Dingemanse J. An update of recent moclobemide interaction data. Int Clin Psychopharmacol 1993 Jan; 7: 167–80
Korn A, Eichler HG, Gasic S. Moclobemide, a new specific MAO-inhibitor does not interact with direct adrenergic agonists. Pharmacol Toxicol 1987; 60 Suppl. 1: 31
Zimmer R, Gieschke R, Fischbach R, et al. Interaction studies with moclobemide. Acta Psychiatr Scand 1990; 82 Suppl. 360: 84–6
Frazer A. Antidepressant drugs. Depression 1994; 2(1): 1–19
Isacsson G, Holgren P, Wasserman D, et al. Use of antidepressants among people committing suicide in Sweden. BMJ 1994 Feb 19; 308: 506–9
Vuori E, Lönnqvist J, Klaukka T. Antidepressants and suicide [letter]. BMJ 1994 Jun 11; 308: 1573
Isacsson G, Holmgren P, Wasserman D, et al. Author’s reply [letter]. BMJ 1994 Apr 2; 308: 916
Isometsa E, Henriksson M, Heikkinen M, et al. Suicide and the use of antidepressants [letter]. BMJ 1994 Apr 2; 308: 915
Owen A. Nearly a third of deaths related to poisoning [letter]. BMJ 1994 Apr 2; 308: 915
O’Hare T. Patients at risk given newer drugs [letter]. BMJ 1994 Apr 2; 308: 915
Molco A, Stanley M. Antidepressants and suicide risk: issues of chemical and behavioral toxicity. J Clin Psychopharmacol 1992; 12(2) Suppl.: 13S–8S
Tancer ME, Uhde TW. Social phobia: a review of pharmacological treatment. CNS Drugs 1995 Apr; 3(4): 267–278
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Various sections of the manuscript reviewed by: G. Chouinard, Clinical Psychopharmacology Unit, Allan Memorial Institute, Montreal, Quebec, Canada; L. Evans, Anxiety Disorder Clinic, New Farm, Queensland, Australia; P. Kragh-Sørensen, Department of Psychiatry, Odense University, Odense, Denmark; G. Laux, Psychiatric Hospital, Wasserburg, Germany; K. Maquire, Department of Psychiatry, Austin Hospital, Heidelberg, Victoria, Australia; N.P.V. Nair, Douglas Hospital Research Centre, Verdun, Quebec, Canada; R.G. Priest, Department of Psychiatry, Paterson Centre for Mental Health, London, England; C. Reynaert, University Department of Psychiatry, Cliniques Universitaires de Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium; T. Silverstone, Department of Psychological Medicine, Dunedin, New Zealand
An erratum to this article is available at http://dx.doi.org/10.1007/BF03259133.
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Fulton, B., Benfield, P. Moclobemide. Drugs 52, 450–474 (1996). https://doi.org/10.2165/00003495-199652030-00013
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DOI: https://doi.org/10.2165/00003495-199652030-00013