classic MAOIs and the tricyclics in terms of tolerance and safety profile. Moclobemide has little effect on psychomotor functions. Other side effects include nausea, insomnia, tremor and lightheadedness; orthostatic hypotension (dizziness upon standing) is uncommon even among the elderly. Behavioural toxicity or other impairments relating to everyday living does not occur with moclobemide, except that in doses of 400 mg or higher peripheral reaction time may be impaired. Peripheral oedema has been associated with moclobemide. Some of the side effects are transient and disappear within 2 weeks of treatment. Serious fatigue, headache, restlessness, nervousness and sleep disturbances have been described as side effects from moclobemide therapy. A paradoxical worsening of depression has been reported in some individuals in several studies, and reports of suicide or suicidal ideation have been reported as a rare adverse effect of moclobemide. Overall, antidepressants decrease the risk of suicide. Moclobemide is believed to have only small proconvulsant effects; however, rarely seizures may occur. Hypertension has been reported to occur very rarely with moclobemide therapy. Moclobemide is relatively well tolerated. The following are the potential adverse effects and their respective incidences: Common (>1% incidence) adverse effects Nausea Dry mouth Constipation Diarrhoea Insomnia Dizziness Anxiety Restlessness Uncommon/Rare (<1%) adverse effects Difficulties falling asleep Nightmares and vivid dreams Hallucinations Memory disturbances Confusion Disorientation Delusions Increased depression Excitation/irritability Hypomania Mania Aggressive behaviour Apathy Tension Suicidal ideation Suicidal behaviour Migraine Extrapyramidal effects Tinnitus Paraesthesia Dysarthria Heartburn Gastritis Tympany Indigestion Hypertension Bradycardia Extrasystoles Angina/chest pain Phlebetic symptoms Flushing Exanthema/rash Allergic skin reaction Itching Gingivitis Stomatitis Dry skin Conjunctivitis Pruritus Urticaria Disturbances of micturition (dysuria, polyuria, tenesmus) Metrorrhagia Prolonged menstruation General malaise Skeletal/muscular pain Altered taste sensations Hot flushes/cold sensation Photopsia Dyspnoea Visual disturbances Increased hepatic enzymes without associated clinical sequelae. Contraindications Avoid use in: Confusional states Bipolar disorder (although it seems less likely than imipramine to cause a manic switch) Phaeochromocytoma and caution is recommended in: Agitated/excited patients Thyrotoxicosis Interactions Drug Moclobemide has fewer interactions than irreversible MAOIs. Cimetidine however, causes a significant rise in moclobemide levels and therefore if the combination is used, lower doses of moclobemide have been recommended. There is little increase in the effects of alcohol when combined with moclobemide and, in fact, moclobemide causes a reduction in alcohol-related impairments. Moclobemide also interacts with pethidine/meperidine, and dextropropoxyphene. Ephedrine in combination with moclobemide increases the risk of cardiovascular adverse effects. Moclobemide is also likely to interact with warfarin.