Posted by Larry Hoover on June 18, 2003, at 9:52:43
In reply to My moclobemide pooped out - what to do next?, posted by david maclean on June 18, 2003, at 7:03:55
> Hi guys. I have quite a few questions to ask here about moclobemide pooping out. Please bear with me and if you can answer my queries then I would be really very grateful to you!
>
> I have been taking the Reversible MAOI moclobemide for four to five months. Initially I got to 750 mg a day and I had really very good results with that dose!
>
> But after a month or so that dose "pooped out" and after that I did not get any real benefit from it.It pooped out on me, at about the same point in time.
> At my request my psychiatrist upped the dose to 900 mg but she was reluctant. Sadly, the 900 mg does not give me any improvement.
>
> What dose can I safely go to with moclobemide? I get no side effects (apart from a rather strange thinning of my semen) so side effects are not going to limit me for now.
>
> I seem to recall hearing that 900 to 1200 mg of moclobemide is a more therapeutic dose than the 600 mg recommended here in the UK by the manufacturers. But 900 mg seems high to my shrink.Here's a study testing the 1200 mg dose. There was a higher risk of blood pressure increase with tyramine challenge at the 1200 level.
Psychopharmacology
Abstract Volume 140 Issue 2 (1998) pp 164-172Original investigation: Clinical pharmacology of moclobemide during chronic administration of high doses to healthy subjects
J. Dingemanse (1)(2), N. Wood (1), T. Guentert (1), S. Řie (3), M. Ouwerkerk (4), R. Amrein (5)
(1) Department of Clinical Pharmacology, F. Hoffmann-La Roche, Basel, Switzerland
(2) Jacor Research, Buchenstrasse 2, CH-4103 Bottmingen, Switzerland
(3) School of Pharmacy, University of California, San Francisco, California USA
(4) Clin-Pharma Research, Birsfelden, Switzerland
(5) Department of Clinical Research, F. Hoffmann-La Roche, Basel, Switzerland
Received: 27 October 1997/Final version: 31 March 1998Abstract The objectives of this study were to assess the tolerability, safety, pharmacodynamics and pharmacokinetics of high-dose moclobemide in healthy subjects. Two sequential groups of six male and six female subjects (eight on active treatment, four on placebo) received for 8 days moclobemide 450 mg b.i.d. and 600 mg b.i.d., respectively. Intravenous tyramine pressor tests were conducted at baseline, at the beginning of treatment and at steady state. Oral tyramine pressor tests with 50, 100 and 150 mg tyramine were conducted under steady-state conditions. Pharmacokinetic parameters of moclobemide and two of its metabolites in plasma and urine were determined after the first and last dose of moclobemide. The incidence and intensity of adverse events was dose-dependent. The most frequently reported adverse events were insomnia, headache, dizziness and dry mouth. The IV tyramine pressor sensitivity during both moclobemide dosing regimens was enhanced 3 to 4-fold. Intake of tyramine 50 mg did not result in systolic blood pressure increases greater than 30 mmHg. With regard to blood pressure increases, tyramine 100 mg is still compatible with moclobemide 450 mg b.i.d. but not with 600 mg b.i.d. The clearance of moclobemide decreased by about 60% on multiple dosing, but no differences were found between both dosing regimens. The urinary excretion of the N-oxide metabolite doubled during multiple dosing. In conclusion, the maximum tolerated dose of moclobemide in healthy subjects is 600 mg b.i.d. provided the tyramine content in a meal is not higher than 50 mg.
> One thought strikes me. The benefits I got from moclobemide seemed to me to be very similar to what I imagine a stimulant might do to me. I once read that some of the metabolites which an MAOI decomposes to in the body were amphetamine-like substances. If this is correct then maybe what I really need is a an amphetamine-like stimulant in place of an MAOI. (I suffer from chronic depression - I am dysthmic with a lot of apathy and seem to have what some call "atypical" depression.)That is one specific MAOI (selegiline?). I don't recall which one for sure. In that case, you get the MAOI effect, and the stimulant effect, i.e. a double dopamine whammy.
> Can a stimulant be used with moclobemide? Should I consider asking my shrink to replace my moclobemide with a stimulant? Any recommendations for which stimulant to request?
>
> Thanks for any answers.You can try taking dopamine precursors to increase dopamine availability, or even just a high dose of b-vitamins (in case moclobemide depletes b-vitamins). There is an inherent risk of adverse events, so discuss that with your p-doc.
Lar
poster:Larry Hoover
thread:234733
URL: http://www.dr-bob.org/babble/20030614/msgs/234758.html