Some snippets from
MIMS
For the purposes of this argument, think of MDMA as an uber-SSRI, except instead of preventing serotonin from being broken down and removed from the equation, MDMA is causing your flimsy neurones to be exposed to every drop of serotonin that you have...... Same effective result - (much) higher levels of the stuff in your CNS.
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Interactions
Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin syndrome and washout periods. Due to the possibility of development of serotonin syndrome, moclobemide should not be administered concomitantly with selective serotonin reuptake inhibitors or tricyclic antidepressants. This possibility increases with increasing dose and fatalities have occurred where one or more of these drugs have been ingested in overdose (see Overdosage).
There are limited data (i.e. small clinical pharmacology studies and postmarketing reports) to support the safety of changing from low to moderate doses of serotonin reuptake inhibitors to moclobemide 300 mg/day by ceasing the SSRI on one day and starting moclobemide on the next. In one study, 18 healthy subjects were changed from moclobemide 300 mg on day one to fluoxetine 40 mg/day for the next seven days then fluoxetine 20 mg/day for a further seven days. On day 16, in addition to fluoxetine 20 mg/day, subjects were randomised to receive moclobemide in ascending doses from 100 to 600 mg or placebo, for the next eight days. On day 24, all patients received moclobemide 300 mg. There were no differences in the adverse reactions reported between the two groups, although the power of the study to detect clinically significant interactions is limited, given the number of subjects and the dose of moclobemide used. Caution is, however, recommended and the dose of moclobemide should be held at 300 mg/day for the first week. Particular attention should also be given to the patient's medical history and concomitant therapy with other psychotropic drugs known to interact with or facilitate serotonin (5-HT) functions.
Tyramine. In animal experiments it has been shown that the pressor effects of tyramine are less with moclobemide than with other inhibitors of monoamine oxidase. Results from studies in humans showed that when tyramine is administered intravenously or orally under pharmacological conditions by using a provocative model, moclobemide leads to a slight and short lasting potentiation of the tyramine pressor effect. The potentiation of the pressor effect was even lower or did not occur when tyramine was mixed with a meal. A high protein or fat content meal further reduced the potentiation. In human studies, it was demonstrated that up to 100 mg of tyramine, corresponding to 1,000 to 2,000 g of mild or 200 g of strong cheese or to 70 g of Marmite yeast extract, can safely be ingested during chronic treatment with moclobemide 200 mg three times per day postprandially. Thus an interaction with tyramine rich foods is of no clinical importance during moclobemide treatment under normal conditions and moclobemide taken at the end of a meal. Neither age nor depression influences the interaction.
Serotonin agonists. Some serotonin agonists are metabolised predominantly by monoamine oxidase A and may need to be avoided or have their dosage reduced if administered concomitantly with moclobemide.
Sympathomimetic amines. Possible undesired interactions between moclobemide and directly acting sympathomimetic amines were investigated in healthy subjects. Phenylephrine reactivity was investigated by infusion of increasing phenylephrine doses before and after moclobemide (100 mg single; 200 mg single; 100 mg three times per day for one week; 200 mg three times per day for three weeks) administration. After the three lowest doses, phenylephrine reactivity remained unchanged. After chronic administration of the highest dose there was a slight increase by 1.8 of the sensitivity factor in only four out of the six subjects, in the other two it was unchanged. Thus only after repeated administration of the high therapeutic doses of moclobemide 200 mg three times per day could a slight interaction be observed. Phenylephrine was given intravenously, but in general it would be used as a nasal decongestant. Recommended use in these indications would be unlikely to result in concentrations of phenylephrine which cause relevant blood pressure increases.
Alcohol. Concomitant moclobemide administration did not further reduce performance in subjects with a blood content of alcohol distinctly reducing performance. In elderly subjects, there was also no additional influence at therapeutic doses.
Overdosage
The highest reported overdose is 20.55 g. The usual signs of overdose with moclobemide alone are nausea, vomiting, drowsiness, disorientation, slurred speech, amnesia, reduced reflexes, agitation, hypertension and convulsions.
As with other antidepressants, combination overdoses of moclobemide and other antidepressants, alcohol and other drugs can be life threatening. Fatalities have been reported in combination overdoses. Patients should be hospitalised and closely monitored so that appropriate treatment can be given. Serotonin syndrome symptoms (hypertension, spasm, altered consciousness) have been reported with mixed overdoses with clomipramine or selective serotonin reuptake inhibitors.
Management of the overdose should include monitoring of vital signs and consideration of other agents ingested in multiple overdoses. Other measures may include activated charcoal.
