Using Manerix (Moclobemide) when on Methadone...interactions?

[THE_REAL_OBLIVION]

Alright, the only antidepressant that ever did anything for me was Moclobemide, a reversible MAOI that you have to take twice a day because it has a short half-life. It is only available in Canada, Australia and the UK as far as I know, some people use it to do a "pharmahuasca" but that's not the point of this post. Normally I just use drugs.com when in doubt about different medication interactions but drugs.com is a US centered site, I am unable to find a similar site that has basically the same database that pharmacists have in their computers when validating scripts for patients. So I cannot choose Moclobemide from the list of medication.

I'm feeling quite nervous/depressed about some life events that I cannot control pretty much and I would be ready to start moclobemide treatment as soon as possible. I have a feeling the methadone which makes me very lazy/unable to care is at fault here, but I am already in the process of getting rid of the liquid shackles : i am dropping by 3mg every 3 weeks, which I did twice so far and am doing easily as long as I have clonidine (one of the first to show and worst feeling of opiate withdrawal in my book is those irritating as all hell cold sweats and body temperature/transpiration.

I am aware Moclobemide does raise BP a little but that side effect goes away with time, in my experience, I have been on it for 8 months in the past and it worked wonderfully to help me not commit the irreparable...I really wish there was more talk about moclobemide and less talk about the newest of the new antidepressants that companies invite just because their patents to previous meds ended.

Anyways...if somebody has personal experience with taking moclobemide and methadone at once OR if somebody can point me to a paper somewhere online (or more)...I have googled but I guess my google-fu fails this time because the information is quite scarce. As I find this strange, moclobemide is used very often in Australia.

Thanks in advance. (no I will not pop a 150mg tab while waiting for answers).

 

[Epsilon Alpha]

Well I know mu opioid receptor activation tends to inhibit 5HT signalling (in the gut at least) however as methadone is a weird fully synthetic ligand it might cause some of the 5HT release as seen in Dermerol.

Go on pubmed and run a few searches on methadone 5HT/ SERT/ serotonin syndrome and see what pops up would be my first attempt at looking at it. Also methadone dates back to WW2 so you might have to look back pretty far to find interactions with MAOI's

 

[THE_REAL_OBLIVION]

http://chealth.canoe.ca/drug_info_details.asp?channel_id=0&brand_name_id=453&page_no=2

Here's the Manerix pdr-equivalent info sheet from health canada if it can help anyone. I see methadone is in the list, but I keep thinking it could increase the strength of methadone, the wiki for manerix indicates that :


Other MAO-Inhibitors, tramadol and MDMA: Development of serotonin syndrome, which may be fatal, is possible. MAOIs, in general, interfere with the metabolism of SSRIs.
Opiates: Moclobemide potentiates the analgesic action of opiates.
Antidepressants without serotonergic action: Moclobemide treatment is possible after a latent period of 48 hours. The moclobemide dose should not exceed 300 mg daily during the first week.
Benzodiazepines: Moclobemide doubles the half-life of diazepam and the active metabolite nordiazepam. The diazepam dose should be reduced accordingly.

Sigh, the whole paragraph about interactions has citations at the end of it's every sentence except this part I have juste quoted. I knew Manerix made my valium hit much harder and also clonazepam, but more obvious with valium. I was still very very not addicted physically to opiates when I was on Manerix, in fact it had helped me be able to focus on things other than the pain problem that led me to opiate use, legal or not (combined TMJ disorder and trigeminal neuralgia on my left jawbone area, that place was the victim of really hard trauma at some time, actually useless info here but that thing happened right when I turned 18 years old at a hardcore punk show where some dipshit was windmilling in a circle pit and somehow i caught one of his swinging knuckles which were much stronger than they would have been if he hadnt been running around getting some energy from all the velocity he was carrying....i still remember that moment and it's where all those pain problems arised...from a goddamn idiot who cannot watch for the safety of others as he moshes around in a circle pit...lol, geez.


Also, I've had 50mg of trazodone yesterday, and I find it is the thing that improves my sleep quality the most while going down in my dosage of methadone, sure if i'd take more valium i'd get about the same effect but not really..I felt extremely better right after using it, it felt like one of my first restful sleep in years....I know that thing is tricyclic antidepressant or close to that anyway. I will be waiting a little before I drop any manerix...i know you gotta wait for a while for your brains to flush out all the changes in your self-biology after using a tca to another form of antidepressant..especially MAOI's...but this one isn't like the others....so complicated..

 

[THE_REAL_OBLIVION]

Alright, I have this to add, since the moclobemide wiki entry has changed so much since the last time I looked at it....it's interesting you mentioned Demerol here Epsilon, because

"Combination treatment with pethidine[45] (Interaction may be fatal)"

"Moclobemide also interacts with pethidine/meperidine,[75] and dextropropoxyphene"

I'm suddenly being very disappointed. I think propoxyphene is in the family of methadone isn't it ? I wouldn't want to risk qt elongation by combining the 2 (seems like what could cause the risk with darvon at least..you seem to imply demerol could be different from methadone/propoxyphene)
This subject is getting more interesting as I plunge into it but it seems even less probable I will be combining these, I'll have to wait for when my methadone dose is low enough to switch to bupe (doctors and people here have been telling me i need to be on maximum 30mg of methadone for the switch to be possible, currently at 57mg, will drop by 3 more mg march 6..) Sigh...i guess I could try the other antidepressant which I didn't hate so much and worked fast like moclobemide : wellbutrin. I couldn't take it as long as moclobemide back then but I also wasn't on methadone then, this one is a real game changer.

 

[ebola?]

Weird. I wonder what the relevant mechanism responsible for methadone's effects on serotonin is.

ebola

 

[sekio]

Demerol is actually a triple reuptake inhibitor (SNDRI) and was implicated in the serotonin syndrome death of Libby Zion, who was given it while full of a MAOI. I don't think methadone is actually a reuptake inhibitor at all...

Antidepressants of the older MAO inhibitor type such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may cause coma, slow or shallow breathing, low blood pressure, excitability, seizures, or shock if methadone is given within 2 weeks of the last MAO inhibitor dose.

I would avoid concurrent methadone+MAOI, entirely. You would essentially have to titrate back up from 0mg methadone, very very slowly, once you "stabilised"...

 

[THE_REAL_OBLIVION]

Demerol is actually a triple reuptake inhibitor (SNDRI) and was implicated in the serotonin syndrome death of Libby Zion, who was given it while full of a MAOI. I don't think methadone is actually a reuptake inhibitor at all...



I would avoid concurrent methadone+MAOI, entirely. You would essentially have to titrate back up from 0mg methadone, very very slowly, once you "stabilised"...

It is not this simple, had you bothered reading the moclobemide related links I have posted you would have seen that moclobemide is VERY different from those old school MAOI's, it's a reversible maoi with practically no effect on MAO-B (10%) maybe.

That's why I find it fascinating, because it's not like moclobemide is that rarely used and surely a patient with methadone has shown up with using that or wanting to go back to it. The mechanism of action of moclobemide is very novel for a med from the 70's, it doesn't need one to watch their diet, only restrictions are huge amount of cheese nobody would eat heh. I think the jury is not out yet on combining these. I will ask a professional (my methadone docs) at my next appointment, i'd be surprised if they knew at all but sometimes the coolest chick there is there (the best docs are the guys but they are great because they go by their own guidelines) has this little computer where she is able to look at all interactions with methadone.When I got there inpatient for 6 days at first she was the first one i've seen and she even took the time to look at if my antibiotics I was taking at the time for bronchitis were safe with methadone, turned out it was :D


p.s In unrelated terms, how weird is it to be with a methadone doctor who is younger than you are and they seem to be very interested in you so they can add to their knowledge only but still, I find that more admirable than most other kind of doctors out there and that woman doc is 26-27 maybe and i'm slightly older than that...feels weird,I mean when I went there there was a girl I knew since grade 8 who was a nurse right in the drug abuse clinics...goddamnit. Anyway that is not on topic at all for here and I will stop with my unrelated stories, the wake n baking..

 

[Epsilon Alpha]

I'm actually very interested in the effects of the synthetic opioids on 5HT right now. One would expect opioids to generally reduce release unless its reducing inhibition on 5HT neurons. Perhaps methadone is a SERT ligand?