Littlebrooklyn: Moclobemide

[LittlebrookLyn]

mod note added:  For US physicians, the use of MAOIs has long been restricted to phenelzine, tranylcypromine, and isocarboxazid, with most prescriptions being written for phenelzine. ... Outside the USA, physicians have long had access to the reversible MAOI moclobemide which also lacks dietary restrictions. (nih.gov.articles)

Moclobemide (sold as Amira, Aurorix, Clobemix , Depnil and Manerix) is a reversible inhibitor of monoamine oxidase A (RIMA) drug primarily used to treat depression and social anxiety. (wikipedia)

 

I've been taking 300mgs of Moclobemide for the last 25yrs, long time I know.

 

I was prescribed it for anxiety at a time when I was struggling badly with anxiety and agoraphobia that I've had for most of my adult life.  I also take 20mgs of Chlordiazepoxide, brand name Librium, which I don't think is prescribed for anxiety these days and is similar to Valium I think.

 

Last time I went to get my repeat prescription of my Moclobemide I was told there is a shortage of it and in fact 2 of the manufacturers have stopped production of it and I'm not sure when or if it's going to be available again.  For that reason I thought maybe it would be good to either taper off completely or even just a bit.  I did try tapering off back in 2005 and cut down half a pill every month.  Was okay for the first few months but then started to feel like I had a constant flu type of headache which my GP said was all in my imagination.  After 5mths I felt so bad I went back onto the full dose and after a month or so was back to normal again, so concluded that it was most likely due to tapering too quickly.

 

For the last week I have been taking my normal dose of Moclobemide, which is 150mg in the morning and 150mg in the evening one day,  then the next day I have been taking 150mg in the morning and 75mg in the evening.  Having just read about only reducing by 10% at a time I realise I'm possibly tapering too much, unless my maths is out.   I don't know that much about this med and my GP seems to know even less and I am waiting for a psych appointment but don't really have much confidence in their ability to help me as most people I know that come off meds seem to be weaned off very quickly.

 

I'm also waiting to hear if I need eye surgery, which is something that is adding to my anxiety.  I have a historic detached retina that last time I had checked out was told had progressed and may need surgery soon.  As I suffer with agoraphobia  I'm not even sure I've going to be able to get this surgery done and am even wondering if trying to taper at this point might be a bad idea, however I am also worried that if the supply of this med grinds to a halt here I would be in a worse situation.  Feel very much between a rock and a hard place and would welcome any advice.

 

Lyn

Edited January 2, 2020 by manymoretodays
name added to title, mod note on medication type

[Gridley]

Welcome to SA, Littlebrooklyn.  I sympathize with your concern about drug availability in the future.  I've had this happen to me more than once.  I too am on an old drug, Imipramine.  Is there any way you can stock up with a reserve inventory?  Might your psychiatrist be cooperative in writing you a prescription for a larger amount of capsules?  

 

Here's a link not specifically about Moclobemide but about MAO inhibitors in general.  

damnnardil: Anyone on MAO's? Nardil? - Introductions and ...

As you've learned, we recommend tapering by no more than 10% of your current dose every four weeks. In your case, you would drop 10% off both doses, with your first taper being 135mg twice daily.

 

Why taper by 10% of my dosage?

 

We strongly advise against alternate-day tapering, as this creates fluctuating amounts of the drug in your system, which buffets the nervous system.

 

You're right in your opinion that psychiatrists invariably taper their patients off psychiatric drugs too fast, setting the patient up for some lengthy and unpleasant withdrawal symptoms (which doctors don't believe exists).  The flu-like symptoms you experienced last time you taped were not "all in your head" but rather one of the most common withdrawal symptoms.  Tapering too fast will bring a repeat performance of withdrawal symptoms.

 

What is withdrawal syndrome.

 

Since you've cut the dose only for 3 or 4 days, I'd recommend going back up to your regular dose of 150mg twice daily.

I know that doesn't help you with the shortage problem, but it will let you avoid withdrawal.  I'd then hold there for at least a month or until after your eye surgery.  Then you could start your 10% taper.

 

For the 10% taper, you'll need small nonstandard doses.  Basically, there are three ways to obtain these--making your own liquid

(but I don't know how soluble the Moclobemide is), using a compounding pharmacy, or cutting tablets and weighing and putting the dose in a gelatin capsule.  Many members use the AWS Gemini-20 scale, available on Amazon.

The GEMINI-20 Scale

 

Using a digital scale to measure doses

 

How to make a liquid from tablets or capsules

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

[LittlebrookLyn]

Thank you so much for your reply to my post Gridley,  it certainly gave me a lot of food for thought!

 

I was also once on Imipramine back in the 80's but it gave me such bad palpitations I soon came off it.  I was also on the old MAOI Marplan twice, each time for about 3yrs and both times managed to come off with no help from my GP as back then there was no help available.  Don't think I had any withdrawals but was so long ago I can't remember how quickly I came off them.

 

I think you are probably right about me going back to my original dose while I get my eye surgery sorted.  I just hope my pharmacist can keep sourcing the Moclobemide as it's a continuing source of concern which I know you understand having had it happen to you too.  I don't have any digital scales but can easily get some and try cutting or shaving the tablets to get the right amount.

 

Lyn