reversible inhibitors of monoamine oxidase A

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Moclobemide is a reversible inhibitor of monoamine oxidase A that is indicated only for major depression.

  • less pressor effects of tyramine than do MAOIs - but patients should avoid eating large amounts of tyramine rich foods.
  • treatment with sympathomimetics should be avoided whilst using meclobemide. Less risk of interactions than MAOIs.
  • should not be prescribed with another antidepressant. Also should not be started until patient has a washout period from other antidepressant therapy (five times half life of other antidepressant).
  • has a short half-life so that no treatment-free period is required after a patient has stopped taking it.
  • side effects include agitation, confusion, sleep disturbance, dizziness, headache, nausea.

Summary guidance regarding switching to or from an MAOI states (1):

  • care is required when switching between antidepressants.
  • when switching between monoamine-oxidase inhibitor (MAOI) or moclobemide (a reversible inhibitor of monoamine-oxidase type A- RIMA) and other antidepressants, the first antidepressant agent should be withdrawn gradually and discontinued before starting the second antidepressant
  • for switches that involve a MAOI, a washout period is always advised
  • patients should be assessed on an individual basis to determine how quickly the switch can be made by assessing history of discontinuation reactions, concurrent medication and severity of depression
  • the potential for medication errors should be considered

Reference:

  • NHS Specialist Pharmacy Service (April 2019). How do you switch between monoamine oxidase inhibitors and SSRI, tricyclic or related antidepressants?

Last edited 09/2019

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