Posted by ed_uk on December 15, 2004, at 7:48:33
Hi everyone,
Has anyone ever been treated with a combination of selegiline and moclobemide? Did the combination resemble the effect of Nardil or Parnate in any way?
Although the manufacturers state that selegiline should never be combined with moclobemide, it is possible that this combination may be useful so long as the usual MAOI food restrictions are observed. The combination might potentially be useful in countries where older MAOIs are not available.
............A study in 24 subjects to assess the safety and tolerability of giving 100–400 mg moclobemide and 10 mg selegiline daily, sequentially or combined, found that the adverse effects were no greater under steady-state conditions than with either drug alone, but the sensitivity to tyramine was considerably increased. The mean tyramine sensitivity factors for moclobemide alone, selegiline alone, and moclobemide plus selegiline were 2–3, 1.4, and 8–9 respectively. One subject showed a value of 18 when given both drugs. The reason is that when taken together the moclobemide inhibits MAO-A while selegiline inhibits MAO-B so that little or no MAO activity remains available to metabolize the tyramine.
In practical terms this means that patients taking moclobemide with selegiline should be given the same dietary restrictions about tyramine-rich foods and drinks (cheese, some wines and beers, etc.) which relate to the non-selective MAOIs such as phenelzine (Nardil) and tranylcypromine (Parnate), although the risks are less. The tyramine sensitivity of these latter MAOIs is about 25 or more.
Ed.
poster:ed_uk
thread:429796
URL: http://www.dr-bob.org/babble/20041211/msgs/429796.html