Generic Name: moclobemide (moe-KLOE-be-mide)

Brand Names: Manerix®

Classification: Monoamine Oxidase Inhibitor (MAOI)

Issue Date: 1994

Moclobemide is a monoamine oxidase (MAO) inhibitor used to relieve certain types of mental depression. It works by blocking the action of a chemical substance known as monoamine oxidase (MAO) in the nervous system.

Although this medicine is very effective for certain patients, it may also cause some unwanted reactions if not taken in the right way. It is very important to avoid certain beverages and medicines while you are being treated with an MAO inhibitor. Your doctor may provide a list as a reminder of which products you should avoid.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For moclobemide, the following should be considered:

Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to moclobemide or monoamine oxidase inhibitors. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy
Studies of moclobemide use in pregnant women have not been done. In some animal studies, weight gain was decreased in pregnant females or their offspring after high doses of moclobemide. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding
Small quantities of moclobemide pass into the breast milk. Moclobemide is not recommended during breast-feeding, because it may cause unwanted effects in nursing babies.

Children
Studies on moclobemide have been done only in adult patients, and there is no specific information comparing use of moclobemide in children with use in other age groups.

Older adults
Older adults are especially sensitive to the effects of moclobemide. This may increase the chance of side effects during treatment. Dizziness or lightheadedness may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to these effects.

Other medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking moclobemide, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Amphetamines
• Appetite suppressants (diet pills)
• Dextromethorphan
• Medicine for asthma or other breathing problems
• Medicines for colds, sinus problems, or hay fever - including nose drops, sprays)
• Meperidine (Demerol®)
• fluvoxamine (Luvox®)
• fluoxetine (Prozac®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)
• amitriptyline (Elavil®)
• amoxapine (Asendin®)
• clomipramine (Anafranil®)
• desipramine (Norpramin®)
• doxepin (Sinequan®)
• imipramine (Tofranil®)
• nortriptyline (Aventyl®)
• protriptyline (Vivactil®)
• trimipramine (Surmontil®)

Using these medicines together may increase the chance of serious side effects.

Cimetidine (Tagamet®), may increase the effect of moclobemide; moclobemide doses may need to be lowered by approximately 50% in patients using cimetidine.

Use of Monoamine oxidase (MAO) inhibitors such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• procarbazine (Matulane®)
• selegiline (Eldepryl®)
• tranylcypromine(Parnate®)

Should be stopped within 2 weeks of taking monoamine oxidase (MAO) inhibitors. They may cause very serious side effects, such as sudden high body temperature, extremely high blood pressure, and severe convulsions; at least 14 days should be allowed between stopping treatment with one medicine and starting treatment with the other.

Ask your doctor about any changes you should make to your diet. Do not drink excessive amounts of alcohol while you are taking this medicine. Sometimes this medicine must be taken for several weeks before you begin to feel better. Your doctor should check your progress at regular visits, especially during the first few months of treatment, to make sure that this medicine is working properly and to check for unwanted effect.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Moclobemide should be taken after a meal. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.

Do not take any other medicine unless approved or prescribed by your doctor. This especially includes nonprescription (over-the-counter OTC) medicine, such as:

• nose drops or sprays
• cough, hay fever medicine
• appetite control
• "keep awake" products
• products that make you sleepy

Check with your doctor immediately if you experience any combination of the following symptoms:

• severe throbbing headache which starts at the back of the head and radiates forward
• stiff neck
• fast or racing heartbeat
• pounding or irregular heartbeat
• slow heartbeat

These may be symptoms of a serious side effect that should have a doctor's attention.

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are using before stopping completely.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.

This medicine may cause blurred vision or make some people drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are unable to see well or are not alert.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine or have used it within the past 2 weeks. Taking moclobemide together with medicines that are used during surgery or dental or emergency treatments may increase the risk of serious side effects.

After you stop using this medicine, you must continue to exercise caution for at least 1 to 2 weeks concerning drink and other medicine, since these things may continue to react with moclobemide.

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double dose.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• skin rash or hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Stop using Moclobemide and call your doctor at once if you have any of these serious side effects:

• Fast or racing heartbeat
• pounding or irregular heartbeat
• neck stiffness
• severe throbbing headache - starting at the back of the head and radiating forward
• slow heartbeat

Continue taking this medication and talk to your doctor if you have any of these less serious side effects:

• anxiety
• blurred vision or other changes in vision
• dizziness
• faintness or lightheadedness, especially when getting up
• fast or racing heartbeat
• high blood pressure
• irritability
• nervousness
• pounding or irregular heartbeat
• restlessness
• unusual tiredness or weakness

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

This drug should not be used with the following medications because very serious interactions may occur:

• apraclonidine
• brimonidine
• bethanidine
• bupropion
• buspirone
• carbamazepine
• dextromethorphan
• entacapone
• herbal products (e.g., ma huang)
• indoramin
• meperidine
• papaverine
• sibutramine
• fluoxetine
• citalopram
• methylphenidate
• ephedrine
• tolcapone
• amitriptyline
• doxepin
• sumatriptan
• zolmitriptan

If you are currently using any of these medications, tell your doctor or pharmacist before starting moclobemide. Before using this medication, tell your doctor of all the medicines you use (both prescription and nonprescription), especially of the following:

• levodopa
• insulin and oral diabetes drugs
• furazolidone
• linezolid
• phenelzine
• tranylcypromine
• sedatives
• sleeping pills
• blood pressure drugs

There may be other drugs not listed that can affect moclobemide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.