MOBAN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MOBAN (MOBAN).
MOBAN (molindone) is an antipsychotic agent with mechanism of action not fully defined, but believed to involve dopamine D2 receptor blockade in the mesolimbic system, with minimal extrapyramidal effects due to weak D2 binding and possible serotonergic modulation.
| Metabolism | Primarily hepatic via microsomal enzymes, including CYP2D6 and CYP3A4, with glucuronidation and sulfation; active metabolites include 7-hydroxymolindone. |
| Excretion | Renal: 70-80% as metabolites and unchanged drug; biliary/fecal: ~20%. |
| Half-life | Terminal elimination half-life: 6-8 hours for parent drug; active metabolite (molindone) half-life ~12-15 hours; steady-state reached in 2-3 days. |
| Protein binding | ~76% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Approximately 1.5-2.0 L/kg; indicates extensive tissue distribution with penetration into CNS. |
| Bioavailability | Oral: ~90% absorbed but first-pass metabolism reduces systemic bioavailability to ~60-70%. |
| Onset of Action | Oral: 30-60 minutes for sedation; antipsychotic effect: days to weeks. |
| Duration of Action | Oral: 4-6 hours for acute effects; chronic therapy requires multiple daily doses due to short half-life. |
| Molecular Weight | 312.41 |
Oral: 50-100 mg/day in 3-4 divided doses, increase to 225 mg/day for severe conditions; maximum 400 mg/day. IM: 50-100 mg every 4-6 hours; maximum 400 mg/day.
| Dosage form | CONCENTRATE |
| Renal impairment | CrCl 10-50 mL/min: administer 50-75% of normal dose; CrCl <10 mL/min: administer 25-50% of normal dose. |
| Liver impairment | Child-Pugh Class A: no adjustment; Child-Pugh Class B: reduce dose by 25-50%; Child-Pugh Class C: avoid use or reduce dose by 75%. |
| Pediatric use | Weight-based: 0.5-1 mg/kg/day in 3 divided doses; maximum 2 mg/kg/day or 200 mg/day. |
| Geriatric use | Initiate at 25-50 mg/day in divided doses; titrate slowly; monitor for hypotension, sedation, and anticholinergic effects; use lowest effective dose. |
| 1st trimester | Limited human data; animal studies have not shown teratogenicity at clinically relevant doses. Use only if potential benefit outweighs risk. |
| 2nd trimester | May be used if necessary; monitor for maternal hypotension and sedation. |
| 3rd trimester | May cause extrapyramidal symptoms and/or withdrawal symptoms in neonates if used near term. Use only if benefit justifies risk. |
Clinical note
Comprehensive clinical and safety monograph for MOBAN (MOBAN).
| Placental transfer | Molindone crosses the placenta in humans; fetal serum concentrations are comparable to maternal levels. |
| Breastfeeding | Molindone (MOBAN) is excreted into breast milk in small amounts. The American Academy of Pediatrics considers it compatible with breastfeeding, but monitor infant for sedation and extrapyramidal symptoms. |
■ FDA Black Box Warning
Increased mortality in elderly patients with dementia-related psychosis. Antipsychotic drugs are not approved for the treatment of dementia-related psychosis.
| Serious Effects |
Hypersensitivity to molindone or any component of the formulationSevere CNS depressionComatose states
| Precautions | Neuroleptic Malignant Syndrome (NMS), Tardive Dyskinesia, QT prolongation, Hyperglycemia and diabetes mellitus, Orthostatic hypotension, Seizures, Dysphagia, Body temperature regulation impairment, Priapism |
| Food/Dietary | No significant food interactions. Take with or without food. Avoid grapefruit juice as it may alter metabolism. |
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| Lactation Rating |
| L3 (Moderately Safe) |
| Teratogenic Risk | Pregnancy Category C. First trimester: Limited human data; animal studies show risk, but potential benefit may warrant use. Second/third trimesters: Possible extrapyramidal symptoms and/or withdrawal in neonates exposed during third trimester. |
| Fetal Monitoring | Monitor maternal blood pressure, liver function, CBC; fetal monitoring for gestational age, weight, and neonatal adaption (e.g., EPS, withdrawal symptoms). |
| Fertility Effects | May cause hyperprolactinemia, which can impair fertility via menstrual irregularities or galactorrhea. Reversible upon discontinuation. |
| Clinical Pearls |
| MOBAN (molindone) is a first-generation antipsychotic with a unique piperidine structure. It has a lower propensity for weight gain and metabolic side effects compared to other antipsychotics. Monitor for extrapyramidal symptoms (EPS), especially akathisia and dystonia. It is associated with a risk of neuroleptic malignant syndrome (NMS). |
| Patient Advice | Take this medication exactly as prescribed; do not stop abruptly. · May cause drowsiness; avoid driving until you know how it affects you. · Report any unusual muscle movements, stiffness, or fever immediately. · Avoid alcohol and illicit drugs while taking this medication. · Store at room temperature away from moisture and heat. |