Moclobemide
| Evidence Level: L2 | Predicted Indications: 2 |
Table of Contents
Moclobemide: From Anxiety Disorder to Agoraphobia
One-Sentence Summary
Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA), originally used for anxiety disorder, neurotic disorder and dysthymic disorder. The TxGNN model predicts it may be effective for agoraphobia, mainly as it presents alongside panic disorder. Currently no registered clinical trials are listed, but 10 publications support this direction, including 2 randomised controlled trials in panic disorder.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Anxiety disorder, neurotic disorder, dysthymic disorder (the ARTG entry has no indication text) |
| Predicted New Indication | Agoraphobia |
| TxGNN Prediction Score | 0.9943 |
| Evidence Level | L2 |
| Australia Market Status | Listed on the PBS Schedule (1 of 1 items) – TGA (ARTG) registration status is not included in this data |
| Number of PBS Items | 1 (valid: 1) |
| Recommended Decision | Proceed with Guardrails |
Why is This Prediction Reasonable?
Moclobemide inhibits monoamine oxidase A reversibly, which raises synaptic serotonin, noradrenaline and dopamine. Detailed mechanism of action data was not available in the data compiled for this report, so this description reflects the established pharmacology of the drug class. Pharmacology data confirms that moclobemide acts on both MAO-A and MAO-B.
Agoraphobia usually occurs together with panic disorder, and antidepressants that enhance monoamine signalling are established treatments for both. Moclobemide is already used for anxiety disorders, so this prediction is a plausible extension within the same disease family.
An important caveat: the supporting evidence is mostly in panic disorder with agoraphobia, not agoraphobia on its own. The prediction applies best to agoraphobia as a comorbid or related presentation.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 10448444 | 1999 | RCT | Br J Psychiatry | Placebo-controlled comparison of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia |
| 10361962 | 1999 | RCT | Eur Arch Psychiatry Clin Neurosci | Double-blind comparison of moclobemide 450 mg/day with clomipramine 150 mg/day in panic disorder, with and without agoraphobia (135 patients randomised) |
| 28867934 | 2017 | Review | Dialogues Clin Neurosci | Guideline-based treatment recommendations for anxiety disorders, including panic disorder/agoraphobia |
| 32002937 | 2020 | Review | Adv Exp Med Biol | Psychopharmacological treatment of anxiety disorders based on guidelines and meta-analyses |
| 8313401 | 1993 | Review | Clin Neuropharmacol | Reversible MAO-A inhibitors (brofaromine, moclobemide) in panic disorder; better tolerated and without dietary restrictions |
| 7717094 | 1995 | Review | Acta Psychiatr Scand Suppl | Overview of RIMAs, including antidepressant efficacy of moclobemide |
| 12006898 | 2002 | Review | J Clin Psychopharmacol | Analysis of therapeutic response in panic disorder using moclobemide data |
| 16850261 | 2006 | Clinical study | Metab Brain Dis | Effects of citalopram and moclobemide on resting brain perfusion in social anxiety disorder |
| 7954487 | 1994 | Open-label pilot | Clin Neuropharmacol | 35 outpatients with social phobia improved on moclobemide 300-600 mg/day over 12 weeks |
| 7892341 | 1995 | Case report | Psychiatr Prax | Treatment-refractory panic disorder remitted with imipramine, moclobemide and behaviour therapy |
Study types were judged from titles and abstracts and should be verified against the full texts.
Australia Market Information
| ARTG Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| ARTG 14442D | Aurorix 300 mg | Tablet 300 mg (oral) | Not stated in the data compiled for this report |
Safety Considerations
- Drug Interactions: Pharmacology data confirms moclobemide targets MAO-A and MAO-B. The literature indicates relevant interactions with serotonergic agents (such as SSRIs), sympathomimetics and triptans, since MAO-A inhibitors alter triptan metabolism.
For full warnings and contraindications, please refer to the TGA-approved Product Information (PI).
Conclusion and Next Steps
Decision: Proceed with Guardrails
Rationale: Two randomised trials in panic disorder with or without agoraphobia, plus guideline-level reviews, support the use of moclobemide. However, the evidence is not specific to agoraphobia alone, and no registered trials were identified.
To proceed, the following is needed:
- Full-text review to confirm trial designs and outcomes, particularly for agoraphobia-specific results
- Detailed mechanism of action data
- Review of the TGA Product Information for warnings, contraindications and approved indications
- An interaction-management plan covering serotonergic drugs, sympathomimetics and triptans
- Checks for registered Australian trials (including ANZCTR) in panic disorder or agoraphobia
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.