PsychoTropical Research - Dr Ken Gillman, Serotonin Syndrome, Mirtazapine, Dual Action Drugs. Seretonin Syndrome - Risk with moclobemide.

PsychoTropicalResearch, serotonin and serotonin syndrome research.

Seretonin Syndrome - Risk with moclobemide

Seretonin Syndrome - Risk with moclobemide

Date Created: 06/02/1999    Last Modified: 21/10/2002    Last Checked: 21/10/2002

"The angel of death has been abroad throughout the land; you may almost hear the beating of his wings."
John Bright: Speech, House of Commons; 1855

Many deaths have been caused by MAOI / SRI combinations. Serotonin reuptake inhibitors (SRIs) include; clomipramine, imipramine, venlafaxine, milnacipran, duloxetine, sibutramine and all of the selective serotonin reuptake inhibitors (SSRIs) as well as some narcotic analgesics and probably St John's wort (see SSGuide and my published papers for a complete list).

The same risk (perhaps to a lesser degree) is present with moclobemide / SRI combinations because moclobemide is a type of monoamine oxidase inhibitor (dubbed a 'RIMA'-- reversible inhibitor of monoamine oxidase-A).

Some publications suggest that combining moclobemide and SSRIs is safe; ‘Roche’ (makers of moclobemide) employees / associates have recently published papers (1997/8) supporting that stance.

A non-partisan view of the evidence indicates this is a seriously mistaken view; there have now been approximately 20 deaths reported in the literature from serotonin syndrome involving moclobemide. There must have been many more unreported deaths. I have been informed of a few via www.psychotropical.com.

Moclobemide / SRI combinations are dangerous and they have caused a number of fatalities from serotonin syndrome.

Severe serotonin syndrome and deaths are especially likely when even a small over-dose of moclobemide (as little as 2000 mg) is combined with any serotonin reuptake inhibitor.

Various other combinations of serotonergic drugs are safe (eg MAOI with Lithium or with L-Tryptophan). They may rarely cause marked side effects but are unlikely to give rise to serious morbidity.

Serotonin syndrome is a seriously under-rated problem; it is one of the few, and surest, ways of precipitating morbidity of a terminal nature.

Gillman, P.K., Serotonin Syndrome: History and Risk. Fundamental and Clinical Pharmacology, 1998. 12(5): p. 482-491. [Review]

Gillman, P.K., Serotonin syndrome: clomipramine too soon after moclobemide. International Clinical Psychopharmacology, 1997. 12: p. 339-342. [Review]