MOCLOBEMIDE - AN UPDATE OF ITS PHARMACOLOGICAL PROPERTIES AND THERAPEUTIC USE

Unlike older monoamine oxidase inhibitors, which irreversibly and nons electively bind monoamine oxidase (MAO), moclobemide is a reversible a nd selective inhibitor of the MAO-A isozyme. Moclobemide only weakly p otentiates the presser response induced by tyramine or other indirectl y acting sympathomimetics; therefore, there is no need to avoid dietar y tyramine or over-the-counter decongestants with moclobemide as there is with older MAO inhibitors. Recent clinical trials and meta-analyse s have confirmed the efficacy of moclobemide in the treatment of depre ssive disorders. Moclobemide has been shown to have similar efficacy t o tricyclic antidepressants (TCAs), selective serotonin reuptake inhib itors (SSRIs) and nonselective, irreversible MAO inhibitors. Long term follow-up studies of 6 to 12 months' duration have demonstrated that the antidepressant efficacy of moclobemide is maintained Moclobemide, given alone or in combination with another antidepressant, has shown s ome efficacy in patients with refractory depression; however comparati ve trials are required to confirm these findings. Data are also availa ble to show clinical efficacy of moclobemide in the management of soci al phobia. Comparative studies have established that moclobemide is be tter tolerated at therapeutic dosages and has less toxicity in overdos e than TCAs and nonselective, irreversible MAO inhibitors. Moclobemide lacks the anticholinergic, sedative and cardiovascular effects associ ated with many of the older antidepressants. Compared with SSRIs, mocl obemide has a similar overall tolerability, although it tends to cause fewer gastrointestinal effects than the SSRIs and has not been report ed to interfere with sexual function. In summary, recent data which co nfirm and extend its comparative therapeutic efficacy and low potentia l for adverse effects have established moclobemide as an effective tre atment in depressive disorders. The drug is also effective in patients with a primary diagnosis of social phobia. Its lack of adverse antich olinergic, cardiovascular cognitive and psychomotor effects makes mocl obemide a particularly useful option in the elderly or patients with c ardiac disease.