Why come off slowly
Stopping moclobemide is usually harder than starting it. The relationship between the dose you take and its effect on the brain isn't a straight line — at lower doses, even a small reduction in milligrams can be a large change in effect. This is why prescribers increasingly recommend hyperbolic tapering: smaller and smaller reductions as the dose gets lower, rather than fixed steps.
In practice that means the standard strengths — designed for the treatment range, not for coming off — often can't give you the small doses the end of a taper needs. That's where a method like the one below, so you can measure a precise fraction, comes in.
The liquid method, step by step
- Cut a tablet to the portion you need with a pill cutter.
- Crush the piece between two spoons over a small plate.
- Stir it into a measured volume of water to make a known concentration — it will look cloudy, which is expected.
- Stir again immediately before drawing your dose; the active ingredient settles quickly.
- Measure your prescribed dose with an oral syringe and take it.
- Make a fresh liquid each day and discard any unused liquid in the rubbish.
Your step-by-step taper schedule
This is the Moclobemide schedule from the RELEASE Toolkit, reproduced with permission. It's a starting point to discuss with your prescriber — you can pause, slow down or speed up depending on how you feel. Aim to reduce roughly every 2–4 weeks.
| Step | Daily dose | Liquid (2mg/ml), twice daily | Capsules, twice daily |
|---|---|---|---|
| 1 | 150mg | 1 × 150mg tablet | — |
| 2 | 105mg | ½ × 150mg tablet & 15ml liquid | ½ × 150mg tab & 1 × 30mg capsule |
| 3 | 75mg | ½ × 150mg tablet | — |
| 4 | 60mg | 30ml liquid | 2 × 30mg capsules |
| 5 | 50mg | 25ml liquid | 1 × 30mg & 2 × 10mg capsules |
| 6 | 40mg | 20ml liquid | 1 × 30mg & 1 × 10mg capsules |
| 7 | 30mg | 15ml liquid | 1 × 30mg capsule |
| 8 | 25mg | 12.5ml liquid | 1 × 25mg capsule |
| 9 | 20mg | 10ml liquid | 2 × 10mg capsules |
| 10 | 17mg | 8.5ml liquid | 1 × 10mg & 1 × 7mg capsules |
| 11 | 14mg | 7ml liquid | 2 × 7mg capsules |
| 12 | 10mg | 5ml liquid | 1 × 10mg capsule |
| 13 | 7mg | 3.5ml liquid | 1 × 7mg capsule |
| 14 | 4.5mg | 2.25ml liquid | 3 × 1.5mg capsules |
| 15 | 3mg | 1.5ml liquid | 2 × 1.5mg capsules |
| 16 | 1.5mg | 0.75ml liquid | 1 × 1.5mg capsule |
| 17 | Stop | You've completed the taper 🎉 | |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Twice-daily tablet / liquid / solution |
|---|---|---|
| 1 | 300mg | 1 × 300mg tablet |
| 2 | 240mg | 24ml liquid (switch to 10mg/ml liquid) |
| 3 | 200mg | 20ml liquid |
| 4 | 175mg | 17.5ml liquid |
| 5 | 150mg | 1 × 150mg tablet |
| 6 | 140mg | 14ml liquid |
| 7 | 125mg | 12.5ml liquid |
| 8 | 112mg | 11.2ml liquid |
| 9 | 100mg | 10ml liquid |
| 10 | 90mg | 9ml liquid |
| 11 | 80mg | 8ml liquid |
| 12 | 75mg | ½ × 150mg tablet |
| 13 | 65mg | 6.5ml liquid |
| 14 | 60mg | 6ml liquid |
| 15 | 55mg | 5.5ml liquid |
| 16 | 50mg | 5ml liquid |
| 17 | 45mg | 4.5ml liquid |
| 18 | 40mg | 4ml liquid |
| 19 | 35mg | 3.5ml liquid |
| 20 | 32mg | 3.2ml liquid |
| 21 | 29mg | 2.9ml liquid |
| 22 | 27mg | 2.7ml liquid |
| 23 | 24mg | 2.4ml liquid |
| 24 | 22mg | 2.2ml liquid |
| 25 | 20mg | 2ml liquid |
| 26 | 18mg | 1.8ml liquid |
| 27 | 16mg | 1.6ml liquid |
| 28 | 14mg | 1.4ml liquid |
| 29 | 12mg | 1.2ml liquid |
| 30 | 10mg | 1ml liquid |
| 31 | 9.5mg | 9.5ml dilute solution (switch to 1mg/ml dilute solution) |
| 32 | 8mg | 8ml dilute solution |
| 33 | 7mg | 7ml dilute solution |
| 34 | 5.5mg | 5.5ml dilute solution |
| 35 | 4.6mg | 4.6ml dilute solution |
| 36 | 3.6mg | 3.6ml dilute solution |
| 37 | 2.6mg | 2.6ml dilute solution |
| 38 | 1.7mg | 1.7ml dilute solution |
| 39 | 0.85mg | 0.85ml dilute solution |
| 40 | Stop | You've completed the taper 🎉 |
Highlighted steps are the most important — do not skip them.
- Do not skip the final small-dose steps — they're the most important for preventing withdrawal.
- Don't skip days, alternate days, or suddenly stop.
- If withdrawal symptoms appear, you can return to your previous dose; when ready, reduce more slowly.
Schedule © The University of Queensland (RELEASE Toolkit), reproduced with permission. Dosing guidance: Dr Mark Horowitz.
Measuring smaller doses accurately
Use the right tool for your method — an oral syringe for liquids (your pharmacist can supply 1 mL, 5 mL and 10 mL sizes), or a milligram scale for weighing. Choose the smallest measuring tool that fits your dose: it's far more accurate for tiny amounts.
- Measure slowly and double-check before you take your dose.
- Read at eye level, against the syringe plunger's flat edge.
- Keep the concentration or method the same each day so doses stay consistent.
What withdrawal can feel like
Withdrawal effects vary a lot between people. They often come in waves — harder days followed by windows of feeling more like yourself. Common, usually-manageable effects include dizziness, "brain zaps", nausea, vivid dreams, irritability and low mood. They tend to ease if you hold at your current dose for a while before reducing again.
Questions for your appointment
- How quickly is it safe for me to reduce, and by how much each step?
- How long should I hold at each dose before the next reduction?
- What should I do on a bad day — hold, slow down, or pause?
- Which symptoms mean I should contact you sooner?
- Would a compounded oral liquid be more accurate for my lowest doses?