isocarboxazid) Use with MAO inhibitors (wait 1 week between discontinuation of MAO inhibitor and initiation of isocarboxazid) Concurrent use with CNS depressants may result in delirium, hyperpyrexia, seizures, coma, excitation, and hyper/hypotension Consumption of foods high in tyramine or supplements containing caffeine, tyrosine, tryptophan, phenylalanine, or phenylalanine (Hypertensive reactions may occur) Within 10 days of a surgery requiring general anesthesia Concurrent administration with furazolidone, pargyline, pargyline and methyclothiazide, phenelzine sulfate, procarbazine, tranylcypromine sulfate, dibenzazepine-related and other tricyclics, amitriptyline, perphenazine and amitriptyline, clomipramine hydrochloride, desipramine, imipramine, nortriptyline, protriptyline, doxepin, carbamazepine, cyclobenzaprine, amoxapine, maprotiline, trimipramine maleate Concomitant administration with meperidine or within 2-3 weeks following MAO therapy Cautions Use caution with doses >40 mg/day Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 years) Caution in patients with diabetes mellitus (monitor glucose closely), glaucoma, hepatic/renal impairment, thyroid dysfunction Therapy can cause serious side effects; not recommended as initial therapy; should be reserved for patients who have not responded satisfactorily to other antidepressants Hypotension may occur; seen most commonly in patients with preexistent hypertension; blood pressure usually returns rapidly to pretreatment levels upon discontinuation of drug; dosage increases should be made more gradually in patients showing a tendency toward hypotension at beginning of therapy; postural hypotension may be relieved by having the patient lie down until blood pressure returns to normal Therapy lowers convulsive threshold in some animal experiments, use caution if epileptic patients treated; therapy appears to have varying effects in epileptic patients; while some have a decrease in frequency of seizures, others have more seizures; discontinue at least 48 hours before myelography; should not resume therapy for at least 24 hours postprocedure There is low incidence of altered liver function or jaundice in patients receiving therapy; periodic liver chemistry tests should be performed during therapy; discontinue use at first sign of hepatic dysfunction or jaundice MAO inhibitors can suppress anginal pain that would otherwise serve as a warning of myocardial ischemia Use cautiously in hyperactive or agitated patients, as well as in schizophrenic patients; may cause excessive stimulation; activation of mania/hypomania reported in a small proportion of patients with major affective disorder who were treated with marketed antidepressants Hypertensive crisis Hypertensive crisis associated with MAO inhibitors use, which can be fatal; may result from co-administration of MAOIs and certain drugs and foods; monitor blood pressure should closely to detect any pressor response; discontinue therapy immediately if palpitations or frequent headaches occur; these symptoms may be prodromal of a hypertensive crisis If hypertensive crisis occurs, institute therapy to lower blood pressure Bipolar disorder A major depressive episode may be the initial presentation of bipolar disorder; treating such an episode with an antidepressant alone may increase likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder Prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression Drug is not approved for use in treating bipolar depression Pregnancy There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844405-6185 or visiting online at http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants The potential reproductive toxicity of the drug has not been adequately evaluated in animals; it is also not known whether isocarboxazid can cause embryo/fetal harm when administered to a pregnant woman or can affect reproductive capacity; drug should be given to a pregnant woman only if clearly needed Lactation Levels of excretion in human milk have not been determined, and effects on nursing infant are unknown; therapy should be used in women who are nursing only if clearly neededPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Nonselective monoamine oxidase inhibitor; may inhibit the enzyme monoamine oxidase, which is responsible for the breakdown of dopamine, serotonin, epinephrine, and norepinephrine, in turn causing an increase in endogenous concentrations of these neurotransmitters. Pharmacokinetics Effects may continue up to 2 wk after discontinuation BRAND FORM. UNIT PRICE PILL IMAGE Marplan oral- 10 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationisocarboxazid oral ISOCARBOXAZID - ORAL (eye-soe-kar-BOX-a-zid) COMMON BRAND NAME(S): Marplan WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: Isocarboxazid is an antidepressant (monoamine oxidase inhibitor). This medication treats depression by restoring the balance of certain natural substances (neurotransmitters) in the brain. Isocarboxazid can improve your mood and feelings of well-being. Usually, this medication is used in persons who have not responded to treatment with other drugs. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using isocarboxazid and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 2 to 4 times a day. The dosage is based on your medical condition and response to treatment.To reduce your risk of side effects, your doctor may start you at a low dose and then gradually increase your dose. Once your condition improves and you are better for a while, your doctor may work with you to reduce your regular dose. Follow your doctor's instructions carefully. Do not take more or less medication or take it more frequently than prescribed. Your condition will not improve any faster and your risk of side effects will increase.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day. It may take several weeks for the full benefits of this medication to be noticed. Do not stop taking this medication without consulting your doctor.If you suddenly stop using this medication, you may have withdrawal symptoms (such as restlessness, confusion, hallucinations, headache, weakness, and diarrhea). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used isocarboxazid for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.Inform your doctor if your condition lasts or gets worse. SIDE EFFECTS: See also Warning section.Dizziness, drowsiness, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, mental/mood changes (such as agitation, confusion), muscle stiffness, changes in sexual ability/interest, shaking (tremor), shivering, swollen ankles/legs, unusual weight gain, eye pain/swelling/redness, vision changes (such as double/blurred vision), signs of liver problems (such as nausea/vomiting that doesn't stop, stomach/abdominal pain, yellowing eyes/skin, dark urine), seizures.This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (See also Drug Interaction section.) Stop taking isocarboxazid and get medical help right away if any of these serious side effects occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, sudden sensitivity to light (photophobia).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before taking isocarboxazid, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (such as stroke), high blood pressure, history of severe/frequent headaches, liver problems, personal/family history of mental/mood disorders (such as schizophrenia, bipolar disorder), heart disease (such as heart failure, heart attack, coronary artery disease), kidney disease, certain nervous system diseases (Parkinson's syndrome, seizures), overactive thyroid (hyperthyroidism), personal/family history of glaucoma (angle-closure type).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).To minimize dizziness and the risk of fainting, get up slowly when rising from a sitting or lying position.Before having surgery or any procedures requiring use of contrast dye (such as myelography), tell your doctor or dentist you are on this medication. You may need to stop taking this drug beforehand. Follow your doctor's instructions carefully.If you have heart disease, this medication may mask chest pain. Avoid strenuous exercise while taking this medication.If you have diabetes, isocarboxazid may lower your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Older adults may be more sensitive to the side effects of this drug, especially the effects on blood pressure.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Since untreated mental/mood problems (such as depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your