Author Topic: Moclobemide(manerix)  (Read 1640 times)

Emma_Mc

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Moclobemide(manerix)
« on: July 17, 2015, 11:31:21 PM »
Does anyone know anything about the drug Moclobemide? im currently on Duloxetine and i didnt know it lowered the threshold for seizures(the doc should have told me) i have Epilepsy and the Duloxtetine is making my seizures worse >:( I've heard the best drugs for people with Epilepsy are MAOIs as they dont lower the seizure threshold, I've already been on Trazadone which was great in terms on no side effects but not so great for helping the depression and anxiety so was just wondering how effective Moclobemide was and what the side effects where? gonna have to go back to the docs on tue and get off this Duloxetine so looking for a good alternative for him to put me on :chin: Muchos luv!

Amanda_George

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Re: Moclobemide(manerix)
« Reply #1 on: July 18, 2015, 12:07:48 PM »
I haven't got a clue I'm afraid, but hopefully SteveW will know  :)
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May your life be as pleasant as you are.

Emma_Mc

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Re: Moclobemide(manerix)
« Reply #2 on: July 18, 2015, 02:48:09 PM »
Yeah im hoping he'll get back to me Amanda x

SteveW

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Re: Moclobemide(manerix)
« Reply #3 on: July 18, 2015, 09:12:55 PM »
Bit of a coincidence here. I am epileptic too. I suffer from Temporal Lobe Epilepsy rather than Tonic Clonic Epilepsy but I don't think that is relevant here. I have talked to a number of psychiatrists about seizure threshold over the years and they have tended to agree with each other. The tricyclics are probably worst for lowering the seizure threshold. I read a study of one of them, Imipramine, where
0.6 % of people taking it developed seizures and they didn't have epilepsy to start with. Probably a group to avoid. Fluoxetine, sertraline, fluvoxamine, trazodone,and the monoamine oxidase inhibitors, of which Moclobemide is one, have a lower seizure risk. The rest are somewhere between. I have read that the SNRI's Duloxetine and Venlafaxine are often recommended as a compromise. Maybe this was your GP's thinking when he put you on Duloxetine.

Seizure threshold isn't the only epilepsy relevant thing. There are P-450 isoenzyme problems. These are liver chemicals. Phenytoin, Carbamazepine, and Phenobarbitone can affect the breakdown of some anti-depressants so you can find yourself on a lower dose than you might expect from what you are swallowing. In the reverse direction fluvoxamine, fluoxetine, sertraline, and paroxetine can inhibit the breakdown of anti-epileptics and you could find yourself with higher antiepileptic levels than you are used to. Whether that matters I suppose depends on whether you are tolerating your antiepileptics. If you are, having a little more in your system might not matter much.

Persuading your GP to prescribe Moclobemide could be difficult. It is really a drug for psychiatrists in secondary care. The older members of the group had very severe food restrictions, revolving around Tyramine. Moclobemide was supposed to free of these restrictions but now people are advised to cut down on Tyramine containing foods rather than exclude them completely. I think that is more problematic than avoiding them completely. People did die on the older MAOI's through eating the wrong thing.

That might make choice of an anti-depressant a bit difficult. You aren't exactly swamped with alternatives. I would personally go for fluvoxamine, fluoxetine, or sertraline. It might be worth considering referral to your Community Mental Health Team. Their psychiatrist should be on top of P-450 problems in a way your GP is unlikely to be.

Love

Steve
Sometimes the light is shining on me
Other times I can barely see
Lately it occurs to me
What a long, strange, trip it's been

Emma_Mc

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Re: Moclobemide(manerix)
« Reply #4 on: July 19, 2015, 09:30:56 AM »
WOW!! you really know your stuff Steve, you've been more informative than my useless docs and psychiatrists, i have Occipital Lobe Epilepsy and take Complex partial seizures, i take Grand Mal and Absence Seizures that are not controlled by drugs, im on Carbamazepine, Gabapentin and Levetiracetam(all at the highest dose) so theres no le-way with the dosage so i think its trying to find an AD thats not gonna increase my seizures and gonna work at the same time, Carbamazepine has been the bane of my life its interfered with every med i've ever taken but unfortunately its my main drug the other 2 are add-ons, it sucks being Epileptic dont it? lol would you mind if i sent you a PM Steve? thanx for all the advice your a wee gem! Muchos luv! x

SteveW

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Re: Moclobemide(manerix)
« Reply #5 on: July 19, 2015, 02:06:15 PM »
Epilepsy is indeed bad news, though you seem to have more varieties than the typical epileptic. I was lucky and eventually found a drug combination that got rid of my seizures completely. But while I was working my way through about 12 combinations I had a hell of a time. I managed to fall down the stairs 3 times and was back and forth to A and E like a yo yo.

Since you are on the maximum dose of 3 anti-epileptics, taking something that increased blood levels probably isn't a good idea. You would be OK with Levetiracetam and Gabapentin but Carbamazepine is a nightmare when it comes to interactions. I know I take it as well.

So that really leaves Trazodone and Moclobemide. When you took Trazodone did you push it to its maximum dose of 600 mg ? If you didn't it might be worth giving it a second go. Otherwise things do seem to point to Moclobemide. If you want to read about its effectiveness here is a link to an article that evaluates it.

     http://www.ncbi.nlm.nih.gov/pubmed/12595913
   
If you want to check out its side effects, here is another link.

     www.medicines.org.uk/emc/medicine/22291

You want section 4.8 Undesirable Effects

Feel free to send me a message. I am tied up today with musical matters, it's a long story, but I'll reply as soon as I can.

Love

Steve
Sometimes the light is shining on me
Other times I can barely see
Lately it occurs to me
What a long, strange, trip it's been

SteveW

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Re: Moclobemide(manerix)
« Reply #6 on: July 20, 2015, 04:38:59 PM »
Emma. Please Read

I did a bit of checking on moclobemide and carbamazepine in a specialist reference work, something was making me uneasy. This recommended that the two not be combined. This is down to carbamazepine's resemblance chemically to tricyclics which are also not recommended with moclobemide, though it isn't a tricyclic itself. I think it is a matter of raising the levels of carbamazepine rather than anything catastrophic. But I think this means you can't take Moclobemide.
Sometimes the light is shining on me
Other times I can barely see
Lately it occurs to me
What a long, strange, trip it's been

Emma_Mc

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Re: Moclobemide(manerix)
« Reply #7 on: July 20, 2015, 10:47:38 PM »
Damn, im running out of options FAST!!  :bash: Carbamazepine is a nightmare for interacting with other drugs i read somewhere that Reboxetine can lower seizures in Epileptics?? dont know if thats true though i might just be clutching at straws, do you know anything about it? If the Reboxetine isnt suitable the only other option i've got is Fluvoxamine or at a push the Venlafaxine one of they 3 has to be my life-saver coz thats me at the end of the road and i cant live this way! Thank you for letting me know about Moclobemide i really appreciate it Steve, Muchos luv! x

SteveW

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Re: Moclobemide(manerix)
« Reply #8 on: July 21, 2015, 06:20:18 AM »
Reboxetine does have a reputation for being neutral as far as induction of seizures is concerned. But it has an interaction with carbamazepine. According to the British National Formulary, Reboxetine may reduce blood levels of carbamazepine, which isn't good for your seizure control.

Fluvoxamine has a two way interaction with carbamazepine. Fluvoxamine will increase the level of Carbamazepine and Carbamazepine will increase the level of Fluvoxamine. What the final outcome would be I am not sure. But Fluvoxamine doesn't appear to cause seizures.

You might like to think about Citalopram. It does induce seizures but not at a high rate. 0.3% taking it develop seizures. I can't find any interaction with carbamazepine, but that doesn't mean there isn't one.
Sometimes the light is shining on me
Other times I can barely see
Lately it occurs to me
What a long, strange, trip it's been