Reversible inhibitors of monoamine oxidase A

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inhibitor of monoamine-oxidase type A- RIMA) and other antidepressants, the first antidepressant agent should be withdrawn gradually and discontinued before starting the second antidepressant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?