thoughtscape NP Psychiatry · Patient education
Moclobemide
Manerix / international reference
A reversible MAO inhibitor used outside the U.S. Checking interactions is an essential part of treatment.
Draft for review · Clinical content has not been revalidated for this website.
The protected MAO-A target is retained. Reversible action does not remove food precautions or serious drug interactions.
What it is used for
UK Manerix is approved for major depression and social phobia. Moclobemide is not FDA approved. This companion follows the reviewed UK product guidance.
Local uses and instructions differ. Your plan should identify the condition being treated; depression and social-phobia starting schedules are not identical.
How it works
It temporarily inhibits an enzyme called MAO-A, slowing the breakdown of serotonin, norepinephrine, and dopamine. This is thought to help mood symptoms.
It causes less sensitivity to tyramine in food than older irreversible MAOIs. That does not mean unlimited high-tyramine foods or safe drug combinations.
What to expect over time
STARTING
Follow your divided-dose schedule. For depression, UK guidance keeps the starting dose unchanged during the first week; do not increase it yourself.
OVER WEEKS
Depression benefit is assessed over at least 4–6 weeks. Sleep problems or restlessness can appear earlier; report them rather than adding a sleep aid.
SOCIAL ANXIETY
The UK social-phobia plan uses a different dose schedule and a longer trial. Review avoidance and daily function as well as anxiety.
Taking your medication
Take the prescribed divided doses at the end of meals with water. Ask for a written schedule. Liver disease or interacting medicines may require lower dosing.
Avoid large quantities of mature cheese, yeast extract, and fermented soy products. Ask for practical food guidance for your exact product and usual diet.
Do not drive until you know its effects. Carry a current medicine list and tell every clinician, dentist, and anesthesia team that you take an MAOI.
When to get help
Emergency: fever with agitation, confusion, stiff or twitching muscles, sweating, or an irregular heartbeat may be a serious interaction. Get help now.
Emergency: sudden severe headache, chest pain, fainting, seizure, suspected overdose, or inability to stay safe from self-harm. Get help immediately.
Stop and get urgent advice: hives, new swelling, or allergic rash. Breathing/swallowing trouble or face/throat swelling needs emergency help.
Early side effects
Trouble sleeping, headache, dizziness, nausea, or dry mouth can occur. Rise slowly. Tell your team about persistent agitation, restlessness, or poor sleep.
Other effects to discuss
Discuss bowel changes, numbness, vision changes, or unusual breast milk production. Check interactions before adding medicines for side effects.
What to keep track of
Keep checks of blood pressure, sleep, mood, and function. Confusion or severe weakness needs assessment; blood tests may be needed. Report worsening mood or suicidal thoughts at any age, especially before age 25 or after dose changes. High or irritable mood with little sleep needs urgent review. Ask someone you trust to notice changes.
Before you start
Review bipolar symptoms, agitation, or confusion, psychosis, thyroid disease, liver disease, heart-rhythm problems, fainting, and pregnancy or feeding plans. An adrenal tumor called pheochromocytoma rules out Manerix. It is not for children or adolescents under UK labeling. Check allergies and lactose-related restrictions, and confirm all prior-drug washout dates before starting.
Medicines & interactions
Antidepressants and MAOIs
Do not combine or cross-taper. SSRIs, SNRIs, clomipramine, bupropion, selegiline, and other antidepressants need specific stop/start instructions. A short half-life is not permission for a quick switch.
Pain and migraine medicines
Do not combine with tramadol, pethidine/meperidine, or triptans. Buprenorphine and other opioids need specialist review because serious interactions are possible. Do not start a combination yourself.
Cough, cold, and herbal products
Dextromethorphan cough remedies and St. John's wort must not be combined. Decongestants such as pseudoephedrine and stimulants also need review. Show your pharmacist the full medicine list.
Antibiotics and procedures
Linezolid must not be combined. Tell emergency, dental, and anesthesia teams about the MAOI before treatment, including planned medicines or dyes. Ask your team about alcohol and recreational substances.
Stomach medicines and new treatments
Cimetidine can greatly raise exposure and require a lower dose. Moclobemide can also affect medicines such as omeprazole. Check prescriptions, nonprescription drugs, and supplements before adding them.
Everyday tips
Connect each dose with the prescribed meal time.
Keep the medicine list on your phone and in your bag.
Pair treatment with therapy and a steady routine.
Ask before treating a cold, headache, or insomnia.
Your questions, answered
What if I miss a dose?
Take it when remembered unless the next dose is nearly due; then skip. Do not double. Ask your pharmacist if the timing is unclear or you have missed several doses.
Can I stop or switch medicines?
Arrange a taper and written stop/start dates. The waiting period depends on both medicines and local rules; fluoxetine can need 5–6 weeks before moclobemide. Do not overlap treatments on your own.
Do I need the classic MAOI diet?
UK Manerix guidance avoids large amounts of high-tyramine foods rather than using exactly the same restrictions as older irreversible MAOIs. Lower risk is not zero risk. Follow your local product advice.
Pregnancy or breastfeeding?
Do not use without an individual specialist plan. Pregnancy data are limited. Milk transfer appears low, but infant safety information is sparse; monitoring is especially important for newborn or preterm infants.
Storage & safety
Keep tablets secured from children and pets; follow the pack's storage and expiry instructions. Never share. Return unwanted medicine to a pharmacy. Overdose needs immediate emergency assessment; take the pack with you. In the U.S.: Poison Help 1-800-222-1222; emergencies 911; crisis support 988. Elsewhere use local services.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.