Efficacy and adverse effects of moclobemide

Brodribb, T. R.; Downey, Max; Gilbar, Peter J; Fahy, Thomas; Menkes, David B.; Wood, Kaaren; Woods, David

doi:10.1016/s0140-6736(94)92715-4

Cited by 28 publications

(12 citation statements)

References 11 publications

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“…The literature contains numerous reports of cases of serotonin syndrome secondary to the combination of an MAOI and a tricyclic antidepressant, 15,11,12,15,17,20,27,28,[67][68][69][70][71][72][73][74] Moclobemide is a reversible MAOI which is relatively selective for MAO-A. It was hoped that this drug would be less likely to be implicated in the serotonin syndrome, but one case was reported in association with a moclobemide/imipramine combination, [73] and a second following administration of moclobemide in combination with clomipramine,l27] The combination of an MAOI and tricyclic antidepressant causing serotonin syndrome is the only one that has been reported to cause seizures.…”

Section: Monoamine Oxidase Inhibitor (Maoi) and Tricyclic Antidepressmentioning

confidence: 99%

The Serotonin Syndrome

Sporer

1995

Drug Safety

183

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The serotonin syndrome has increasingly been recognised in patients who have received combined serotonergic drugs. This syndrome is characterised by a constellation of symptoms (confusion, fever, shivering, diaphoresis, ataxia, hyperelflexia, myoclonus or diarrhoea) in the setting of the recent addition of a serotonergic agent. The most common drug combinations causing the serotonin syndrome are monoamine oxidase inhibitors (MAOIs) and serotonin selective reuptake inhibitors (SSRIs), MAOIs and tricyclic antidepressants, MAOIs and tryptophan, and MAOIs and pethidine (meperidine). This syndrome is caused by excess serotonin (5-hydroxytryptamine; 5-HT) availability in the CNS at the 5-HT1A-receptor. There may also be some interaction with dopamine and 5-HT2-receptors. This syndrome probably has a low incidence, even among patients taking these drug combinations, and there is likely to be some other as yet unidentified inciting factor causing some patients to develop a full serotonin syndrome. Because fatalities and severe complications have accompanied the serotonin syndrome, the previously described drug combinations should be used cautiously or not at all. The serotonin syndrome is usually mild and, if managed with drug withdrawal and supportive therapy, generally improves within hours. Patients who develop hyperthermia should be treated aggressively with external cooling and paralysis. Methysergide and cyproheptadine appear to be useful adjuncts in treating the serotonin syndrome.

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Section: Monoamine Oxidase Inhibitor (Maoi) and Tricyclic Antidepressmentioning

confidence: 99%

The Serotonin Syndrome

Sporer

1995

Drug Safety

183

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“…The authors concluded that moclobemide and serotonergic agents could likely cause a dangerous serotonin syndrome when ingested even in moderately low mixed overdoses. Other fatal cases with symptoms due to a serotonin syndrome have been reported including combinations of moclobemide with fluoxetine, sertraline with pimozide, imipramine or multiple drug intoxication [1,3,7,15,21,22,26,27]. The combination of moclobemide and pethidine was also demonstrated to induce fatality [11].…”

Section: Discussionmentioning

confidence: 98%

“…In contrast to classical MAO-A inhibitors it is considered a relatively safe drug with few side effects and a pure moclobemide overdose seems to be benign [13,14,16,17,23,29]. Fatal moclobemide overdoses have been documented concomitant with treatment with serotonergic agents producing a central serotonin syndrome [1,3,7,15,21,22,24,26,27]. This is a potentially lethal toxic hyperserotonergic state, most commonly resulting from an interaction between MAO inhibitors and agents increasing stimulation of 5-HT-receptors, such as serotonin reuptake inhibitors [28].…”

Section: Introductionmentioning

confidence: 99%

Suicide with moclobemide and perazine

Mußhoff¹,

Varchmin-Schultheiß²,

Madea³

1998

International Journal of Legal Medicine

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A 51-year-old woman who was diagnosed as suffering from depression was found dead in her flat. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs moclobemide (49.9 mg/l), perazine (1.27 mg/l) and some metabolites were identified in the blood. A combined drug intoxication resulting in synergistic effects to cardiovascular disorders was proposed as the cause of death.

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“…Nevertheless, the efficacity of such a method in the elimination of the drug and in the tissue lag required for recovery needs confirmation. With the more widespread use of moclobemide, there has been a concomitant rise in the frequency of the serotonin syndrome [10]. This medication must be employed with the utmost caution, a certain time interval should elapse before the introduction of a serotoninergic agent.…”

Section: Discussionmentioning

confidence: 99%

Serotonin syndrome due to an overdose of moclobemide and clomipramine

et al. 1997

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The serotonin syndrome is frequently characterized by minor neurologic manifestations that regress rapidly (such as confusion, tremor, ...). Many medications including tricyclic antidepressants, serotonin reuptake inhibitors, tryptophan and the association of monoamine oxidase inhibitors together with a serotoninergic agent have been implicated in this syndrome. In certain cases, and for poorly understood reasons, clinical manifestations can include circulatory collapse, malignant hyperthermia, convulsions and rhabdomyolysis. These forms are often fatal. Treatment, other than the withdrawal of the offending drug, is symptomatic. Dialysis may be of value in withdrawing the drug from the circulatory system. We report a patient with the serotonin syndrome of favorable outcome due to an overdose of moclobemide and clomipramine.

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Efficacy and adverse effects of moclobemide

Cited by 28 publications

References 11 publications

The Serotonin Syndrome

The Serotonin Syndrome

Suicide with moclobemide and perazine

Serotonin syndrome due to an overdose of moclobemide and clomipramine

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