Rimarex
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Moclobemide
It is a revesible monamine oxidase inhibitor (MAOI)
It is supposed to act by reversible inhibitor of monoamine oxidase type A and is termed as RIMA. Moclobemide ideal in the elderly or patients with cardiovascular disease.
Indications: Treatment of major depression. Social phobias.
Contradictions: Acute confusional states. Pheochromocytoma hypersensitivity. Schizophrenia.
Safety Profile: Avoid in agitated or excited patients, thyrotoxicosis, severe hepatic impairment.
Adverse Effects: Sleep disturbances, dizziness, nausea, headache, restlessness, agitation, confusional states. Rarely raised liver enzymes. Possible hyponatraemia, hepatic failure, cholelithiasis, insomnia, tremor, dry mouth, constipation anxiety.
Drug Interactions: Analgesics: CNS excitation or depression, codeine, pethidine and possibly phenytoin, morphine and other opioid analgesics. Effects of Ibuprofen and possibly other NSAIDs enhanced.
Other Antidepressants: Moclobemide should not be started until atleast a week after a tricyclic or related, anti depression or an SSRI or related anti depressants has been stopped (2 weeks in the case of paroxetine and sertraline and atleast 5 weeks in the case of fluoxetine) or at least a week after an MAOI has been stopped.
Dopaminergics: Hypertensive Crisis with levodopa. 5 HT agonist : Risk of CNS toxicity (reduce dose of zolmitriptan) Sympathomimetics : Avoid likes ephedrine, pseudoephedrine & phenylpropanolamine.
Ulcer healing drugs : Cimetidine inhibits metabolism (increase plasma moclobemide concentration) Tyramine rich foods : moclobemide is likely to cause less potentiation of the professor effect of tyramine than the traditional MAOI’s, but patients should be advised to avoid consuming large amounts of tyramine rich foods (like mature cheese yeast extract and fermented soyabean products)
Dosage: Adult: Initially 300mg daily usually in divided doses after food the dose needs to be adjusted according to response. The usual dosage range in 150 to 600 mg daily.