Moclobemide ( Manerix ) advice please

[Minuno]

Hello I have recently been to my General Practitioner here in the Uk and have been prescribed this medication , that was nearly two weeks ago and I'm sorry to say I haven't opened the packet as yet, basically I realise I should take the tablets but am worried about them. If I may explain a little more. Originally around two months ago I was prescribed Lustral which dramatically altered the sexual areas of my life to quite a profound degree, obviously I was prescribed the Lustral to help with my depression and anxiety but I considered that they were making me worse and making other problems more exacerbated. I went and discussed this with my GP who said you shouldn't have been embarrassed to come and see me, and as soon as these symptoms started we could have re evaluated the medication, and picked something else to try.
Anyways that something else as the heading is Moclobermide?, I guess a lot of folk whom are reading this are asking to themselves what is that?. I too myself thought that but thought I'd give it a go, but haven't as yet.
My reasons for this are due to it being a Reversible MAOI , I have read that the medication isn't like the older MAOI types which have been found to be potentially lethal I. Around 100 cases due to bringing on hypertensive episodes when combined with the intake of a natural substance called tyramine?, I felt optimistic until I went to collect the tablets, then the pharmacist asked to speak to me about being careful with products like Cheese, bovril, marmite, beans and yeast products in general. I'm completely confused whether these are safe or not as the pharmacist really made me concerned, I've looked at the packing every day but haven't as yet opened them, anyone help or offer advice please.
As mentioned these tablets are supposed to be ok to take with things such as previously mentioned , apparently they don't bond with tyramine when it is ingested and have a short life of operation ( or what you call it ) but the pharmacist stressed that you still need to be careful when eating things etc, I do suffer with my blood pressure, due to anxiety and don't wish to send it up higher than it currently is.
Am I safe to take this medication?, is anyone else on it ?, and are you taking any special precautions with what you eat?.

Thanks I had to try 6 different chemists as none of them stocked it and 4 of them didn't even know what it was for without referring to the BNF for guidance.

[yenool]

I'm taking moclobemide currently and I can say it does not effect sexual function negatively like other antidepressants do. In fact the only side effects I have experienced on moclobemide are mild headaches when I first start taking it and a slightly weird metallic taste in my mouth.

It is a REVERSIBLE MAOI. This means it does NOT cause the same hypertensive reaction when taken with foods that contain tyramine. It is very safe and should not be confused with the potentially more dangerous older irreversible MAOIs.

My blood pressure has been a bit borderline for years and I have not seen any increase while taking this medication. I eat a normal diet; no special precautions.

I'm on 450mg and it did take about 3 months before I noticed any improvement in depression.



Thanks I had to try 6 different chemists as none of them stocked it and 4 of them didn't even know what it was for without referring to the BNF for guidance.

I go to Boots and they have to order it in for me every month which is a bit of a pain as I have to go back the next day to collect it. I always ask for the Meda "Manerix" brand version of Moclobemide too.

---------- Post added at 13:32 ---------- Previous post was at 13:02 ----------


Moclobemide only weakly potentiates the pressor response induced by tyramine or other indirectly acting sympathomimetics; therefore, there is no need to avoid dietary tyramine or over-the-counter decongestants with moclobemide as there is with older MAO inhibitors.

Source: http://www.ncbi.nlm.nih.gov/pubmed/8875133


Neither tyramine capsules (50 mg) nor cheese and wine meals (65 mg tyramine) produced a significant change in blood pressure and heart rate after single or repeated doses of moclobemide in volunteers. In contrast, after 1 weeks' treatment with tranylcypromine pressure response to cheese and wine meals was severe

Source: http://www.ncbi.nlm.nih.gov/pubmed/3081926


Moclobemide was given in a daily dose of 450 mg to be taken in three divided doses at the end of the meals. Tyramine was administered in the form of an artificially tyramine enriched cheese (camembert) together with a meal at noon. The total tyramine doses administered were 50 mg on day 5 and 100 mg on day 6 of each treatment period. Comparisons of blood pressure and heart rate changes after tyramine ingestion between moclobemide and placebo conditions did not indicate any relevant moclobemide-tyramine interaction. It is concluded that tyramine in quantities of up to 100 mg does not lead to clinically relevant blood pressure reactions in moclobemide-treated subjects, if moclobemide is taken at the end of the meal.

Source: http://www.ncbi.nlm.nih.gov/pubmed/3283292

[Minuno]

Thank you for the advice, am I safe to drink Guiness with these tablets please with regard to MAOI it says Tap beer (Draft beer) is a no no?

Thanks

[Minuno]

I have tried to find out how much tyramine so to be found in alcohol , as mentioned and am having problems, I know you say that you can eat a normal diet etc but it does say on the instruction leaflet

" Do not eat large quantities of foods containing tyramine when taking Manerix "

This is what I find confusing, you say with respect that you can eat a normal diet but the manufacturer is saying that you have to watch what you eat, and to boot they don't really go into what exactly is a normal amount or an excessive amount for example , I regularly in the past have eaten a small 4 cheese Pizza , Had Bovril on bread and butter ( yeast extract ) and like the odd pint of Guinness ( say 4 pints twice per week ) , now I daren't have a drink or have things like Bisto Gravy Granules and the like.

If the manufacturer won't say what is an excessive amount or warn against such what choice is there?.

I have been taking the tablets now for a week and haven't noticed a single difference in how I am or for that matter a single side affect, but my diet and stuff I love to eat has altered dramatically

Thanks for any further advice.

---------- Post added at 19:15 ---------- Previous post was at 19:00 ----------

Considering tyramine is supposed to be a potential cause of Migraine headaches there isn't much dietary advice as to how much tyramine is to be found in products, I've been to the shops and read the small boxes ( usually don't bother ) and there isn't squat as to how much there is to be found in foods and beers. I emailed the manufacturer of Bisto and they themselves ain't sure and will get back to me!!.

I'd really like to know what is classed as an excessive amount of tyramine, I've never eaten Stillton so I'm not at risk there, but am determined to give these tablets a good shot, although currently with them having no effect at all and no side effects I feel as if I am taking a placebo!!!.

[yenool]

I'm not medically qualified. I can only tell you my personal experience and share with you the information I found when I was researching this topic for myself. You have to draw your own conclusions.

I am eating/drinking a normal diet on the moclobemide with no issues, this is including large portions of foods that should be high in tyramine like pizza and chunks of camembert cheese. I came to the conclusion from all the information I have read (such as in the links I posted above) that tyramine is virtually a non issue with this medication.


"Moclobemide’s propensity to interact with tyramine is slight and short lasting, as pharmacological studies in animals and man have shown (see Warnings and Precautions).
The potentiation of the pressor effect was even lower or did not occur when moclobemide was administered after a meal. An interaction with tyramine rich foods is of no clinical importance during moclobemide therapy under normal conditions and if moclobemide is taken at the end of a meal." source: http://www.medsafe.govt.nz/profs/datasheet/a/ApoMoclobemidetab.pdf


I understand "large amounts" to mean way more than you would find in a regular diet. Given that all the evidence available shows this reaction is mild/insignificant I think it isn't worth worrying about.

One of those studies above showed that 100mg tyramine produced no hypertensive reaction. This website http://psychotropical.com/index.php/maoi-diet-abbreviated states that few cheeses contain more than 25mg of tyramine per 100g. So you would have to eat 400g of cheese to get anywhere near 100mg of tyramine. Who eats 400g of cheese, that is like a whole big packet from the supermarket!

The same website also states
"A teaspoon of ‘Marmite’’ would have at most 5/1000 x 300 mg of tyramine, i.e. only a couple of milligrams."
and

"Modern hygienic production methods have made excessive tyramine concentrations rare (in both wine and beer). A little caution is warranted with 'boutique' and open fermented beers, rare examples can be high."

---------- Post added at 20:15 ---------- Previous post was at 20:10 ----------

Keep in mind your doctor would not have prescribed this to you if they felt it was dangerous or unsuitable for your situation.

I found it didn't have much effect until I was on 300mg and 450mg is better still. It really look a long time (12 weeks I guess) before I started noticing subtle changes. I'm pleased I stuck with it because it has improved my depression. It is not a cure but things are better and the side effects are mild.