USING MOCLOBEMIDE 

Indonesian Experiences

Dr. Yul Iskandar

Medical and Research Director, Dharma Graha Hospital

Moclobemide is short-acting (maximum 24 hours), reversible inhibitor of monoamine oxidase (MAO). It is a benzamide derivative that inhibits the deamination of serotonine, norepinephrine and dopamine. This drug has been using in Indonesia since 1993.

 In this paper we discuss the pharmacokinetic profile, such us bioavailability (= F), an apparent volume of distribution, binding of the drug to plasma proteins, peak plasma concentrations, and steady-state concentration, blood clearance and the elimination half-life, safety assessment and chronic toxicological studies.

 This paper also presented our result from open multicentre clinical studies carried out with moclobemide in 206 patients in the treatment of depression in Indonesian patients. The evaluations are: Vital signs, MADRS, HADS, Clinical Global Impression, Clinical Global Improvement, and adverse events.

The Results was: Montgomery Asberg Depression Rating Scale (MADRS) score, Visit 1 (36), Visit 2 (25), Visit 3 (16), Visit 4 (9).; Hospital Anxiety Depression Scale (HAD) Scale Visit1 (44), Visit 2 (34), Visit 3 (26), Visit 4 (20).;. Clinical Global Impression (CGIMPRESS) Visit 1 (5), Visit 2 (4), Visit 3 (3), Visit 4 (2) .; Clinical Global Improvement (CGIMPROVE) on visit 4,Very much improvement (1) 55%, Much improvement (2) 36%, Minimally improvement (3) 7% and No Change or worse 2%. ; Efficacy and Tolerance. Excellent (E) & Good (G) 91% and Fair (F) & Poor (P) =9%

From Total patients: 206 patients, the adverse events are: Dizziness 1 (0,5 %), Dry mouth 1 (0,5%), Fatigue 7 (3,5%), Gastric Complaint 5 (2,5%), Headache 21 (10,5%), Insomnia 4 (2,0%), Nausea 9 (4,5%), Paraesthesia 1 (0,5%), Palpitation 4 (2,0%), Restlessness 1 (0,5%), Vomiting 1 (0.5%). Adverse events were reported in 40 (20%) patients. The symptom usually mild, and disappeared with continuing medication. . No patients stop the trial because of side effects.

In this paper we also reported using Moclobemide for social phobia to five patients. We presented case illustration which is typically the patient with social phobia who respond to moclobemide. Three patients with the dose of 300 mg a day, one patient with 3 times 150mg a day, and one patient with 3 times 75 mg a day. Unfortunately one patient (with doses 300 mg) must be drop off the medication due to her complains that her hairs fall.(This patient had been using SSRI before we have been given Moclobemide). The other four patients improved from mild to markedly improved.

Dharma Graha Hospital

Jl. Kahfi I/125

Jakarta Selatan