moclobemide

Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA) used as an antidepressant. It selectively inhibits MAO-A in the brain, increasing synaptic levels of serotonin, norepinephrine, and dopamine. Because the inhibition is reversible and short-lived, it carries a lower risk of hypertensive crisis and dietary tyramine interactions than irreversible MAO inhibitors.

It is approved for the treatment of major depressive episodes in many countries. It has also been used for other depressive states and, in some regions, studied for anxiety disorders. It is not generally used in bipolar depression. Dosing is oral, with gradual titration to a therapeutic range and typically given in divided doses; clinicians adjust based on response and tolerability.

Moclobemide is rapidly absorbed after oral dosing, with peak plasma concentrations in about 1–2 hours. It is extensively metabolized in the liver and excreted in urine and stool. The elimination half-life supports twice-daily dosing in many regimens.

Common adverse effects include dizziness, nausea, headache, dry mouth, and insomnia. It tends to cause fewer sexual side effects than some selective serotonin reuptake inhibitors. It can interact with other serotonergic drugs and with non-selective MAO inhibitors, and should be avoided with linezolid and certain other antidepressants; careful washout is advised when switching therapies. With moclobemide, dietary tyramine carries a smaller risk of hypertensive reaction than with classic MAOIs, but patients are advised to avoid markedly high-tyramine foods in some guidelines.

Moclobemide was developed in the 1980s as a reversible MAO-A inhibitor. It has been marketed under brand names such as Aurorix and Manerix in various countries. It is not approved in the United States.