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Misc Moclobemide (MAOI) and Interactions. Can anyone advise?

bnonymous

Greenlighter
Joined
Nov 19, 2018
Messages
5
Hi guys. I'm taking Moclobemide for anxiety and depression. It's helped me pretty well on the anxiety front at least.

Anyway, my doctors seem to know nothing about it as I asked them to put me on it, they didn't even know what it was and I get conflicting info from the doctors I saw about it.

I know serotonin syndrome can kill me so I can take MDMA but I'm wondering what else I MUST avoid? Coke? All opiates?

Can I drink lean? In the UK I need to buy codeine and promethazine separately but I think I read anti histimines are a no-no with Moclobemide? Does codeine produce serotonin so I can't take that either?

I have some tramadol pills but I read thats a definite no.

It's annoying taking Moclobemide because it keeps me stable but I worry a lot about what drugs I can and can't do.

Super struggling to get any answers so if anyone can help thanks a lot.
 
That's a tough question. While moclobemide is a reversible MAO-A and to a lesser extend MAO-B inhibitor (this means that you don't have to follow a strict diet) there are still quite a few interactions.
As a rule of thumb I'd say don't take any stimulants as you might risk serotonin toxicity (risk is lower than with irreversible MAOIs, but it can still happen) or a hypertensive crisis
For promethazine: looking at wikipedia moclobemide inhibits CYP2C19, CYP2D6 and CYP1A2. Promethazine is metabolized via CYP2D6, so combining the two will result in slower metabolism of promethazine, which can lead to greater side effects.
For tramadol: a big no no as tramadol has SNRI activity, so the combo can lead to serotonin toxicity and a hypertensive crisis
For codeine: codeine is metabolized via CYP2D6 into morphine, so taking moclobemide might decrease the effects of codeine
Another interaction is with cimetidine, as it'll increase blood plasma levels of moclobemide
Another no no would be DXM, as the combo can lead to serotonin toxicity and a hypertensive crisis
Another opioid you shouldn't combine with moclobemide would be pethidine/meperidine
 
Yeah, not many doctors are familiar with moclobemide in the UK yet bnonymous. I also had to ask to be put on it, and convince them that it had essentially no dietary interactions.

We have to advise you to be cautious really, and I would listen to what ^^ kk says above.

In my own personal experience, mixing moclobemide with simultants like caffeine, methamphetamine, amphetamine, cocaine and sibutramine basically put me to sleep (which defeated the point of me mixing them).

I didn't try it with anything else.
 
I would avoid cocaine. It is a serotonin and dopamine reuptake inhibitor, it could kill you. All amphetamine based stimulants will be dangerous, not just mdma.

I dont know about opiates. I dont want to tell you yes without reviewing the medical and scientific literature first. Also be aware that illicit opiates can contain all kinds of drugs that can cause problems, just because research shows opiates are safe, does not mean all the random drugs in illicit opiates are safe... this includes pills from the street which are usually fake presses.

Try searching MAOI and opioids in Google scholar and see what that turns up.
 
That's a tough question. While moclobemide is a reversible MAO-A and to a lesser extend MAO-B inhibitor (this means that you don't have to follow a strict diet) there are still quite a few interactions.
As a rule of thumb I'd say don't take any stimulants as you might risk serotonin toxicity (risk is lower than with irreversible MAOIs, but it can still happen) or a hypertensive crisis
For promethazine: looking at wikipedia moclobemide inhibits CYP2C19, CYP2D6 and CYP1A2. Promethazine is metabolized via CYP2D6, so combining the two will result in slower metabolism of promethazine, which can lead to greater side effects.
For tramadol: a big no no as tramadol has SNRI activity, so the combo can lead to serotonin toxicity and a hypertensive crisis
For codeine: codeine is metabolized via CYP2D6 into morphine, so taking moclobemide might decrease the effects of codeine
Another interaction is with cimetidine, as it'll increase blood plasma levels of moclobemide
Another no no would be DXM, as the combo can lead to serotonin toxicity and a hypertensive crisis
Another opioid you shouldn't combine with moclobemide would be pethidine/meperidine

Thanks so much for taking the time to write this, it's really helpful and I appreciate it. So, both codeine and prom are metabolized by CYP2D6 but I could get more side effects from the prom and less effects from the codeine? If so, how does that work?

Ultimately, is bottom line is this a safe combo? I'd be using 150mg of codeine and 75mg promethazine.

Yeah, not many doctors are familiar with moclobemide in the UK yet bnonymous. I also had to ask to be put on it, and convince them that it had essentially no dietary interactions.

We have to advise you to be cautious really, and I would listen to what ^^ kk says above.

In my own personal experience, mixing moclobemide with simultants like caffeine, methamphetamine, amphetamine, cocaine and sibutramine basically put me to sleep (which defeated the point of me mixing them).

I didn't try it with anything else.

Thanks for your help and advice. Interesting you had the same experience as me. Did you get on well with the Moc? I've been using it to help with GAD which even benzos didn't really help with and it's been good so I'm hesitant to stop taking it but like I said, bit of a bitch having to consider interactions...

I would avoid cocaine. It is a serotonin and dopamine reuptake inhibitor, it could kill you. All amphetamine based stimulants will be dangerous, not just mdma.

I dont know about opiates. I dont want to tell you yes without reviewing the medical and scientific literature first. Also be aware that illicit opiates can contain all kinds of drugs that can cause problems, just because research shows opiates are safe, does not mean all the random drugs in illicit opiates are safe... this includes pills from the street which are usually fake presses.

Try searching MAOI and opioids in Google scholar and see what that turns up.

Thanks for the tip and advice. Tried searching on Google scholar but I found it hard to find a clear cut answer unfortunately.
 
Can't edit on my phone so another post, the link I posted lists some opioids as weak serotonin reuptake inhibitors, i.e. tramadol, penthidine, methadone etc. but opioids like codeine, hydrocodone, dihydrocodeine, oxycodon should be alright to take
 
Can't edit on my phone so another post, the link I posted lists some opioids as weak serotonin reuptake inhibitors, i.e. tramadol, penthidine, methadone etc. but opioids like codeine, hydrocodone, dihydrocodeine, oxycodon should be alright to take

Thanks a lot man, really appreciate your help. Ok so it looks like a lot of opiates are ok apart from the ones on the list, as you stated.

Wonder if anyone else can also back that article up as I saw on the label of this codeine it says to not take with MAOIs...
 
Thanks a lot man, really appreciate your help. Ok so it looks like a lot of opiates are ok apart from the ones on the list, as you stated.

Wonder if anyone else can also back that article up as I saw on the label of this codeine it says to not take with MAOIs...

why would you want to? pholcodine has no recreational value. it is not the same chemical as codeine


Pholcodine is a drug which is an opioid cough suppressant (antitussive). It helps suppress unproductive coughs and also has a mild sedative effect, but has little or no analgesic effects. It is also known as morpholinylethylmorphine and homocodeine.
 
why would you want to? pholcodine has no recreational value. it is not the same chemical as codeine


Pholcodine is a drug which is an opioid cough suppressant (antitussive). It helps suppress unproductive coughs and also has a mild sedative effect, but has little or no analgesic effects. It is also known as morpholinylethylmorphine and homocodeine.


My bad. Was meant to link this (codeine phosphate): http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1516943899660.pdf

Also says don?t take with MAOIs.

So it?s just always conflicting advice because the article you sent said ok but then this says it?s not.

Annoying.
 
It just says to consult your doctor or pharmacist (imo a good idea, I study drug research and pharmacists know quite a lot about medication and dangerous interactions, so maybe ask a pharmacist about it)
I found this https://www.sps.nhs.uk/articles/wha...ioids-and-monoamine-oxidase-inhibitors-maois/
Morphine, codeine, oxycodone and buprenorphine are alternative opioids for patients receiving MAOIs, though starting at a low dose and titrating cautiously against clinical response is advised. Blood pressure and the signs and symptoms of CNS and respiratory depression should be monitored closely.
Imo it should be alright to combine codeine and moclobemide (but I'm not a doctor nor pharmacist) the only interaction I see is that the metabolism of codeine via CYP2D6 might be inhibited resulting in lesser effects due to lesser morphine production. Just start low and see how you feel
 
It just says to consult your doctor or pharmacist (imo a good idea, I study drug research and pharmacists know quite a lot about medication and dangerous interactions, so maybe ask a pharmacist about it)
I found this https://www.sps.nhs.uk/articles/wha...ioids-and-monoamine-oxidase-inhibitors-maois/

Imo it should be alright to combine codeine and moclobemide (but I'm not a doctor nor pharmacist) the only interaction I see is that the metabolism of codeine via CYP2D6 might be inhibited resulting in lesser effects due to lesser morphine production. Just start low and see how you feel

Thank you man... Just to be even safer - the half life of Moclobemide I see is 2 hours. I take 2x300mg a day (normally morning and evening). Would it be even safer if I took 600mg in the morning and then something else 4 hours later, as in would the drug be way more out my system or totally by then?

Thanks again.
 
Although the half-life is short, it's pharmacodynamic effect lasts much longer, so no, not really. I'd not mess with your existing prescription routine tbh.

Regarding symptoms of respiratory depression, MOC tends to elevate levels of NE (ie stimulation), countering that risk. But caution is of course warranted, and titrate slowly and carefully. None of us can give you medical advice or a guarantee, just information that we've read ourselves or personal anecdotes.
 
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