Drugs Details

Drugs Info of Marplan
Drugs Details
  • Drugs Type  : Multum
  • Date : 20th Feb 2015 01:03 am
  • Brand Name : Marplan
  • Generic Name : isocarboxazid (Pronunciation: eye so kar BOX a zid)
Descriptions

Marplan (isocarboxazid), a monoamine oxidase inhibitor, is available for oral administration in 10-mg tablets. Each tablet also contains lactose, corn starch, povidone, D&C Red No. 27, FD&C Yellow No. 3, and magnesium stearate. Chemically, isocarboxazid is 5-methyl-3-isoxazolecarboxylic acid 2-benzylhydrazide. The structural formula is:

 

Marplan (isocarboxazid) Structural Formula Illustration

Isocarboxazid is a colorless, crystalline substance with very little taste.

What are the possible side effects of isocarboxazid (Marplan)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Stop using isocarboxazid and call your doctor at once if you have any of these serious...

Read All Potential Side Effects and See Pictures of Marplan »

What are the precautions when taking isocarboxazid (Marplan)?

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.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (e.g., stroke), heart problems (e.g., congestive heart failure, heart attack), high blood pressure, history of severe/frequent headaches, liver problems.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal/family history of...

Read All Potential Precautions of Marplan »


This monograph has been modified to include the generic and brand name in many instances.

Indications

Marplan (isocarboxazid) is indicated for the treatment of depression. Because of its potentially serious side effects, Marplan (isocarboxazid) is not an antidepressant of first choice in the treatment of newly diagnosed depressed patients.

The efficacy of Marplan (isocarboxazid) in the treatment of depression was established in 6-week controlled trials of depressed outpatients. These patients had symptoms that corresponded to the DSM-IV category of major depressive disorder; however, they often also had signs and symptoms of anxiety (anxious mood, panic, and/or phobic symptoms) (See CLINICAL PHARMACOLOGY).

A major depressive episode (DSM-IV) implies a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine symptoms: depressed mood, loss of interest in usual activities, significant change in weight and/or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation.

The antidepressant effectiveness of Marplan (isocarboxazid) in hospitalized depressed patients, or in endogenomorphically retarded and delusionally depressed patients, has not been adequately studied.

The effectiveness of Marplan (isocarboxazid) in long-term use, that is, for more than 6 weeks, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use Marplan (isocarboxazid) for extended periods should periodically evaluate the long-term usefulness of the drug for the individual patient.

Dosage Administration

For maximum therapeutic effect, the dosage of Marplan (isocarboxazid) must be individually adjusted on the basis of careful observation of the patient. Dosage should be started with one tablet (10 mg) of Marplan (isocarboxazid) twice daily. If tolerated, dosage may be increased by increments of one tablet (10 mg) every 2 to 4 days to achieve a dosage of four tablets daily (40 mg) by the end of the first week of treatment. Dosage can then be increased by increments of up to 20 mg/week, if needed and tolerated, to a maximum recommended dosage of 60 mg/day. Daily dosage should be divided into two to four dosages. After maximum clinical response is achieved, an attempt should be made to reduce the dosage slowly over a period of several weeks without jeopardizing the therapeutic response. Beneficial effect may not be seen in some patients for 3 to 6 weeks. If no response is obtained by then, continued administration is unlikely to help.

Because of the limited experience with systematically monitored patients receiving Marplan (isocarboxazid) at the higher end of the currently recommended dose range of up to 60 mg/day, caution is indicated in patients for whom a dose of 40 mg/day is exceeded (see ADVERSE REACTIONS).

How Supplied

Tablets, 10 mg isocarboxazid each, peach-colored, scored-bottles of 100 (NDC 30698-032-01).

Manufactured by Amneal Pharmaceuticals, Paterson, New Jersey 07504 for Validus Pharmaceuticals, Inc., Parsippany, New Jersey 07054. 1-866-9VALIDUS (1-866-982-5438) info@validuspharma.com. Printed in U.S.A.
Revised: June 2007. FDA rev date: 8/10/2007


This monograph has been modified to include the generic and brand name in many instances.

Side Effects

Adverse Findings Observed in Short-Term, Placebo-Controlled Trials

Systematically collected data are available from only 86 patients exposed to Marplan (isocarboxazid) , of whom only 52 received doses of ≥ 50 mg/day, including only 11 who were dosed at ≥ 60 mg/day. Because of the limited experience with systematically monitored patients receiving Marplan (isocarboxazid) at the higher end of the currently recommended dose range of up to 60 mg/day, caution is indicated in patients for whom a dose of 40 mg/day is exceeded (see WARNINGS).

The table that follows enumerates the incidence, rounded to the nearest percent, of treatment emergent adverse events that occurred among 86 depressed patients who received Marplan (isocarboxazid) at doses ranging from 20 to 80 mg/day in placebo-controlled trials of 6 weeks in duration. Events included are those occurring in 1% or more of patients treated with Marplan (isocarboxazid) and for which the incidence in patients treated with Marplan (isocarboxazid) was greater than the incidence in placebo-treated patients.

The prescriber should be aware that these figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those which prevailed in clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and non-drug factors to the adverse event incidence rate in the population studied.

The commonly observed adverse event that occurred in Marplan (isocarboxazid) patients with an incidence of 5% or greater and at least twice the incidence in placebo patients were nausea, dry mouth, and dizziness (see Table). In three clinical trials for which the data were pooled, 4 of 85 (5%) patients who received placebo, 10 of 86 (12%) who received < 50 mg of Marplan (isocarboxazid) per day, and 1 of 52 (2%) who received ≥ 50 mg of Marplan (isocarboxazid) per day prematurely discontinued treatment. The most common reasons for discontinuation were dizziness, orthostatic hypotension, syncope, and dry mouth.

Treatment-Emergent Adverse Events Incidence in Placebo-Controlled Clinical Trials with Marplan (isocarboxazid) Doses of 40 to 80 mg/day1

 

BODY SYSTEM/
ADVERSE EVENT
PLACEBO
(N=85)
MARPLAN < 50 mg
(N=86)
MARPLAN (isocarboxazid) ≥ 50 mg
(N=52)2
MISCELLANEOUS
Drowsy 0 4% 0%
Anxiety 1 2% 0%
Chills 0% 2% 0%
Forgetful 1% 2% 2%
Hyperactive 0% 2% 0%
Lethargy 0% 2% 2%
Sedation 1% 2% 0%
Syncope 0% 2% 0%
INTEGUMENTARY
Sweating 0% 2% 2%
MUSCULOSKELETAL
Heavy feeling 0% 2% 0%
CARDIOVASCULAR
Orthostatic hypotension 1% 4% 4%
Palpitations 1% 2% 0%
GASTROINTESTINAL
Dry mouth 4% 9% 6%
Constipation 6% 7% 4%
Nausea 2% 6% 4%
Diarrhea 1% 2% 0%
UROGENITAL
Impotence 0% 2% 0%
Urinary frequency 1% 2% 0%
Urinary hesitancy 0% 1% 4%
CENTRAL NERVOUS SYSTEM
Headache 13% 15% 6%
Insomnia 4% 4% 6%
Sleep disturbance 0% 5% 2%
Tremor 0% 4% 4%
Myoclonic jerks 0% 2% 0%
Paresthesia 1% 2% 0%
SPECIAL SENSES
Dizziness 14% 29% 15%
1Events reported by at least 1% of patients treated with Marplan (isocarboxazid) are presented, except for those that had an incidence on placebo greater than or equal to that on Marplan (isocarboxazid) .
2All patients also received Marplan (isocarboxazid) at doses < 50 mg.

Other Events Observed During the Postmarketing Evaluation of Marplan (isocarboxazid)

Isolated cases of akathisia, ataxia, black tongue, coma, dysuria, euphoria, hematologic changes, incontinence, neuritis, photosensitivity, sexual disturbances, spider telangiectases, and urinary retention have been reported. These side effects sometimes necessitate discontinuation of therapy. In rare instances, hallucinations have been reported with high dosages, but they have disappeared upon reduction of dosage or discontinuation of therapy. Toxic amblyopia was reported in one psychiatric patient who had received isocarboxazid for about a year; no causal relationship to isocarboxazid was established. Impaired water excretion compatible with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been reported.

DRUG ABUSE AND DEPENDENCE

Controlled Substance Class

Marplan (isocarboxazid) is not a controlled substance.

Physical and Psychological Dependence

Marplan (isocarboxazid) has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence. There have been reports of drug dependency in patients using doses of Marplan (isocarboxazid) significantly in excess of the therapeutic range. Some of these patients had a history of previous substance abuse. The following withdrawal symptoms have been reported: restlessness, anxiety, depression, confusion, hallucinations, headache, weakness, and diarrhea. Consequently, physicians should carefully evaluate Marplan (isocarboxazid) patients for history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse (eg, development of tolerance, incrementations of dose, drug-seeking behavior).

Read the Marplan (isocarboxazid) Side Effects Center for a complete guide to possible side effects

Interactions

See CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS sections for information on drug interactions.

Marplan (isocarboxazid) should be administered with caution to patients receiving Antabuse® (disulfiram, Wyeth-Ayerst Laboratories). In a single study, rats given high intraperitoneal doses of an MAO inhibitor plus disulfiram experienced severe toxicity, including convulsions and death.

Concomitant use of Marplan (isocarboxazid) and other psychotropic agents is generally not recommended because of possible potentiating effects. This is especially true in patients who may subject themselves to an overdosage of drugs. If combination therapy is needed, careful consideration should be given to the pharmacology of all agents to be used. The monoamine oxidase inhibitory effects of Marplan (isocarboxazid) may persist for a substantial period after discontinuation of the drug, and this should be borne in mind when another drug is prescribed following Marplan (isocarboxazid) . To avoid potentiation, the physician wishing to terminate treatment with Marplan (isocarboxazid) and begin therapy with another agent should allow for an interval of 10 days.

Read the Marplan Drug Interactions Center for a complete guide to possible interactions

Learn More »


This monograph has been modified to include the generic and brand name in many instances.

Warnings

See CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS sections for information on drug interactions.

Marplan (isocarboxazid) should be administered with caution to patients receiving Antabuse® (disulfiram, Wyeth-Ayerst Laboratories). In a single study, rats given high intraperitoneal doses of an MAO inhibitor plus disulfiram experienced severe toxicity, including convulsions and death.

Concomitant use of Marplan (isocarboxazid) and other psychotropic agents is generally not recommended because of possible potentiating effects. This is especially true in patients who may subject themselves to an overdosage of drugs. If combination therapy is needed, careful consideration should be given to the pharmacology of all agents to be used. The monoamine oxidase inhibitory effects of Marplan (isocarboxazid) may persist for a substantial period after discontinuation of the drug, and this should be borne in mind when another drug is prescribed following Marplan (isocarboxazid) . To avoid potentiation, the physician wishing to terminate treatment with Marplan (isocarboxazid) and begin therapy with another agent should allow for an interval of 10 days.

Read the Marplan Drug Interactions Center for a complete guide to possible interactions

Learn More »


This monograph has been modified to include the generic and brand name in many instances.

Precautions

Information for Patients

Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Marplan (isocarboxazid) and should counsel them in its appropriate use. A patient Medication Guide about “Antidepressant Medications, Depression and Other Serious Mental Illness, and Suicidal Thoughts and Actions” is available for Marplan (isocarboxazid) . The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.

Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking Marplan (isocarboxazid) .

Clinical Worsening and Suicide Risk

Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.

Pediatric Use

Safety and effectiveness in the pediatric population have not been established (see BOX WARNING and WARNINGS-Clinical Worsening and Suicide Risk). Anyone considering the use of Marplan (isocarboxazid) in a child or adolescent must balance the potential risks with the clinical need.

General

Hypotension

Hypotension has been observed during Marplan (isocarboxazid) therapy. Symptoms of postural hypotension are seen most commonly, but not exclusively, in patients with preexistent hypertension; blood pressure usually returns rapidly to pretreatment levels upon discontinuation of the drug. Dosage increases should be made more gradually in patients showing a tendency toward hypotension at the beginning of therapy. Postural hypotension may be relieved by having the patient lie down until blood pressure returns to normal.

When Marplan (isocarboxazid) is combined with phenothiazine derivatives or other compounds known to cause hypotension, the possibility of additive hypotensive effects should be considered.

Lower Seizure Threshold

Because Marplan (isocarboxazid) lowers the convulsive threshold in some animal experiments, suitable precautions should be taken if epileptic patients are treated. Marplan (isocarboxazid) appears to have varying effects in epileptic patients; while some have a decrease in frequency of seizures, other have more seizures.

Drugs that lower the seizure threshold, including MAO inhibitors, should not be used with Amipaque® (metrizamide, Sanofi Winthrop Pharmaceuticals). As with other MAO inhibitors, Marplan (isocarboxazid) should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.

Hepatotoxicity

There is a low incidence of altered liver function or jaundice in patients treated with Marplan (isocarboxazid) . In the past, it was difficult to differentiate most cases of drug-induced hepatocellular jaundice from viral hepatitis although this is no longer true. Periodic liver chemistry tests should be performed during Marplan (isocarboxazid) therapy; use of the drug should be discontinued at the first sign of hepatic dysfunction or jaundice.

Suicide

In depressed patients, the possibility of suicide should always be considered and adequate precautions taken. Exclusive reliance on drug therapy to prevent suicidal attempts is unwarranted, as there may be a delay in the onset of therapeutic effect or an increase in anxiety or agitation. Also, some patients fail to respond to drug therapy or may respond only temporarily. The strictest supervision, and preferably hospitalization, are required.

Use in Patients With Concomitant Illness

MAO inhibitors can suppress anginal pain that would otherwise serve as a warning of myocardial ischemia.

In patients with impaired renal function, Marplan (isocarboxazid) should be used cautiously to prevent accumulation.

Some MAO inhibitors have contributed to hypoglycemic episodes in diabetic patients receiving insulin or glycemic agents. Marplan (isocarboxazid) should therefore be used with caution in diabetics using these drugs.

Marplan (isocarboxazid) may aggravate coexisting symptoms in depression, such as anxiety and agitation.

Use Marplan (isocarboxazid) with caution in hyperthyroid patients because of their increased sensitivity to pressor amines.

Marplan (isocarboxazid) should be used cautiously in hyperactive or agitated patients, as well as in schizophrenic patients, because it may cause excessive stimulation. Activation of mania/hypomania has been reported in a small proportion of patients with major affective disorder who were treated with marketed antidepressants.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term studies to evaluate carcinogenic potential have not been conducted with this drug, and there is no information concerning mutagenesis or impairment of fertility.

Pregnancy Category C

The potential reproductive toxicity of isocarboxazid 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. Marplan (isocarboxazid) should be given to a pregnant woman only if clearly needed.

Nursing Mothers

Levels of excretion of isocarboxazid and/or its metabolites in human milk have not been determined, and effects on the nursing infant are unknown. Marplan (isocarboxazid) should be used in women who are nursing only if clearly needed.

Pediatric Use

Marplan (isocarboxazid) is not recommended for use in patients under 16 years of age, as safety and effectiveness in pediatric populations have not been demonstrated.


This monograph has been modified to include the generic and brand name in many instances.

OverDose

The lethal dose of Marplan (isocarboxazid) in humans is not known. There has been one report of a fatality in a patient who ingested 400 mg of Marplan (isocarboxazid) together with an unspecified amount of another drug. Symptoms: Major overdosage may be evidenced by tachycardia, hypotension, coma, convulsions, respiratory depression, sluggish reflexes, pyrexia, and diaphoresis; these signs may persist for 8 to 14 days. Treatment: General supportive measures should be used, along with immediate gastric lavage or emetics. If the latter are given, the danger of aspiration must be borne in mind. An adequate airway should be maintained, with supplemental oxygen if necessary. The mechanism by which amine-oxidase inhibitors produce hypotension is not fully understood, but there is evidence that these agents block the vascular bed response. Thus it is suggested that plasma may be of value in the management of this hypotension. Administration of pressor amines such as Levophed® (levarterenol bitartrate) may be of limited value (note that their effects may be potentiated by Marplan (isocarboxazid) ). Continue treatment for several days until homeostasis is restored. Liver function studies are recommended during the 4 to 6 weeks after recovery, as well as the time of overdosage.

In managing overdosage, consider the possibility of multiple drug involvement. The physician should consider contacting a poison control center on the treatment of any overdose.

ContrainDications

Marplan (isocarboxazid) should not be administered in combination with any of the following: MAO inhibitors or dibenzazepine derivatives; sympathomimetics (including amphetamines); some central nervous system depressants (including narcotics and alcohol); antihypertensive, diuretic, antihistaminic, sedative or anesthetic drugs, buproprion HCL, buspirone HCL, dextromethorphan, cheese or other foods with a high tyramine content; or excessive quantities of caffeine.

Marplan (isocarboxazid) should not be administered to any patient with a confirmed or suspected cerebrovascular defect or to any patient with cardiovascular disease, hypertension, or history of headache.

Contraindicated Patient Populations

Hypersensitivity

Marplan (isocarboxazid) should not be used in patients with known hypersensitivity to isocarboxazid.

Cerebrovascular Disorders

Marplan (isocarboxazid) should not be administered to any patient with a confirmed or suspected cerebrovascular defect or to any patient with cardiovascular disease or hypertension.

Pheochromocytoma

Marplan (isocarboxazid) should not be used in the presence of pheochromocytoma, as such tumors secrete pressor substances whose metabolism may be inhibited by Marplan (isocarboxazid) .

Liver Disease

Marplan (isocarboxazid) should not be used in patients with a history of liver disease, or in those with abnormal liver function tests.

Renal Impairment

Marplan (isocarboxazid) should not be used in patients with severe impairment of renal function.

Contraindicated MAOI-Other Drug Combinations

Other MAOI Inhibitors or With Dibenzazepine-Related Entities

Marplan (isocarboxazid) should not be administered together with, or in close proximity to, other MAO inhibitors or dibenzazepine-related entities. Hypertensive crises, severe convulsive seizures, coma, or circulatory collapse may occur in patients receiving such combinations. In patients being transferred to Marplan (isocarboxazid) from another MAO inhibitor or from a dibenzazepine-related entity, a medication-free interval of at least 1 week should be allowed, after which Marplan (isocarboxazid) therapy should be started using half the normal starting dosage for at least the first week of therapy. Similarly, at least 1 week should elapse between the discontinuation of Marplan (isocarboxazid) and initiation of another MAO inhibitor or dibenzazepine-related entity, or the readministration of Marplan (isocarboxazid) . The following list includes some other MAO inhibitors, dibenzazepine-related entities, and tricyclic antidepressants.

 

Generic Name Trademark (Manufacturer)
Other MAO Inhibitors
Furazolidone Furoxone® (Roberts Laboratories)
Pargyline HCL Eutonyl® (Abbott Laboratories)
Pargyline HCL and methyclothiazide Eutron® (Abbott Laboratories)
Phenelzine sulfate Nardil® (Parke-Davis)
Procarbazine Matulane® (Roche Laboratories)
Tranylcypromine sulfate Parnate® (SmithKline Beecham Pharmaceuticals)
Dibenzazepine-Related and Other Tricyclics
Amitriptyline HCL Elavil® (Zeneca)
  Endep® (Roche Products)
Perphenazine and amitriptyline HCL Etrafon® (Schering)
  Triavil® (Merck Sharp & Dohme)
Clomipramine hydrochloride Anafranil® (Novartis)
Desipramine HCL Norpramin® (Hoechst Marion Roussel)
  Pertofrane® (Rhone-Poulenc Rorer Pharmaceuticals)
Imipramine HCL Janimine® (Abbott Laboratories)
  Tofranil® (Novartis)
Nortriptyline HCL Aventyl® (Eli Lilly & Co.)
  Pamelor® (Novartis)
Protripyline HCL Vivactil® (Merck Sharp & Dohme)
Doxepin HCL Adapin® (Fisons)
  Sinequan® (Pfizer)
Carbamazepine Tegretol® (Novartis)
Cyclobenzaprine HCL Flexeril® (Merck Sharp & Dohme)
Amoxapine Asendin® (Lederle)
Maprotiline HCL Ludiomil® (Novartis)
Trimipramine maleate Surmontil® (Wyeth-Ayerst Laboratories)

Bupropion

The concurrent administration of a MAO inhibitor and buproprion hydrochloride (Wellbutrin®, and Zyban®, Glaxo Wellcome) is contraindicated. At least 14 days should elapse between discontinuation of an MAO inhibitor and initiation of treatment with buproprion hydrochloride.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Marplan (isocarboxazid) should not be administered in combination with any SSRI. There have been reports of serious, sometimes fatal, reactions (including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation and confusion progressing to delirium and coma) in patients receiving fluoxetine (Prozac®, Lilly) in combination with a monoamine oxidase inhibitor (MAOI), and in patients who have recently discontinued fluoxetine and are then started on a MAOI. Some cases presented with features resembling neuroleptic malignant syndrome. Fluoxetine and other SSRIs should therefore not be used in combination with Marplan (isocarboxazid) , or within 14 days of discontinuing therapy with Marplan (isocarboxazid) . As fluoxetine and its major metabolite have very long elimination half-lives, at least 5 weeks should be allowed after stopping fluoxetine before starting Marplan (isocarboxazid) . At least 2 weeks should be allowed after stopping sertraline (Zoloft®, Pfizer) or paroxetine (Paxil®, SmithKline Beecham Pharmaceuticals) before starting Marplan (isocarboxazid) . In addition, there should be an interval of least 10 days between discontinuation of Marplan (isocarboxazid) and initiation or fluoxetine or other SSRIs.

Buspirone

Marplan (isocarboxazid) should not be used in combination with buspirone HCL (Buspar®, Bristol Myers Squibb); several cases of elevated blood pressure have been reported in patients taking MAO inhibitors who were then given buspirone HCL. At least 10 days should elapse between the discontinuation of Marplan (isocarboxazid) and the institution of buspirone HCL. Serious reactions may also occur when MAO inhibitors are given with serotoninergic drugs (e.g., dexfenfluramine, fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, venlafaxine).

Sympathomimetics

Marplan (isocarboxazid) should not be administered in combination with sympathomimetics, including amphetamines, or with over-the-counter drugs such as cold, hay fever, or weight-reducing preparations that contain vasoconstrictors.

During Marplan (isocarboxazid) therapy, it appears that some patients are particularly vulnerable to the effects of sympathomimetics when the activity of metabolizing enzymes is inhibited. Use of sympathomimetics and compounds such as guanethidine, methyldopa, methylphenidate, reserpine, epinephrine, norepinephrine, phenylalanine, dopamine, levodopa, tyrosine, and tryptophan with Marplan (isocarboxazid) may precipitate hypertension, headache, and related symptoms. The combination of MAO inhibitors and tryptophan has been reported to cause behavioral and neurologic symptoms, including disorientation, confusion, amnesia, delirium, agitation, hypomanic signs, ataxia, myoclonus, hyperreflexia, shivering, ocular oscillations, and Babinski signs.

Meperidine

Meperidine should not be used concomitantly with MAO inhibitors or within 2 or 3 weeks following MAO therapy. Serious reactions have been precipitated with concomitant use, including coma, severe hypertension or hypotension, severe respiratory depression, convulsions, malignant hyperpyrexia, excitation, peripheral vascular collapse, and death. It is thought that these reactions may be mediated by accumulation of 5-HT (serotonin) consequent to MAO inhibition.

Dextromethorphan

Marplan (isocarboxazid) should not be used in combination with dextromethorphan. The combination of MAO inhibitors and dextromethorphan has been reported to cause brief episodes of psychosis or bizarre behavior.

Cheese or Other Foods With a High Tyramine Content

Hypertensive crises have sometimes occurred during Marplan (isocarboxazid) therapy after ingestion of foods with a high tyramine content. In general, patients should avoid protein foods in which aging or protein breakdown is used to increase flavor. In particular, patients should be instructed not to take foods such as cheese (particularly strong or aged varieties), sour cream, Chianti wine, sherry, beer (including non-alcoholic beer), liqueurs, pickled herring, anchovies, caviar, liver, canned figs, raisins, bananas or avocados (particularly if overripe), chocolate, soy sauce, sauerkraut, the pods of broad beans (fava beans), yeast extracts, yogurt, meat extracts, meat prepared with tenderizers, or dry sausage.

Anesthetic Agents

Patients taking Marplan (isocarboxazid) should not undergo elective surgery requiring general anesthesia. Also, they should not be given cocaine or local anesthesia containing sympathomimetic vasoconstrictors. The possible combined hypotensive effects of Marplan (isocarboxazid) and spinal anesthesia should be kept in mind. Marplan (isocarboxazid) should be discontinued at least 10 days before elective surgery.

CNS Depressants

Marplan (isocarboxazid) should not be used in combination with some central nervous system depressants, such as narcotics, barbiturates, or alcohol.

Antihypertensives

Marplan (isocarboxazid) should not be used in combination with antihypertensive agents, including thiazide diuretics. A marked potentiating effect on these drugs has been reported, resulting in hypotension.

Caffeine

Excessive use of caffeine in any form should be avoided in patients receiving Marplan (isocarboxazid) .


This monograph has been modified to include the generic and brand name in many instances.

Clinical Pharamacology

Pharmacodynamics

Isocarboxazid is a non-selective hydrazine monoamine oxidase (MAO) inhibitor. In vivo and in vitro studies demonstrated inhibition of MAO in the brain, heart, and liver. The mechanism by which MAO inhibitors act as antidepressants is not fully understood, but it is thought to involve the elevation of brain levels of biogenic amines. However, MAO is a complex enzyme system, widely distributed throughout the body, and drugs that inhibit MAO in the laboratory are associated with a number of clinical effects. Thus, it is unknown whether MAO inhibition per se, other pharmacologic actions, or an interaction of both is responsible for the antidepressant effects observed.

Pharmacokinetics

Marplan (isocarboxazid) pharmacokinetic information is not available.

Clinical Efficacy Data

The effectiveness of Marplan (isocarboxazid) was demonstrated in two 6-week placebo-controlled studies conducted in adult outpatients with depressive symptoms that corresponded to the DSM-IV category of major depressive disorder. The patients often also had signs and symptoms of anxiety (anxious mood, panic, and/or phobic symptoms). Patients were initiated with a dose of 10 mg bid, with increases every 2 to 4 days, as tolerated, until a therapeutic effect was achieved, up to a maximum dose of 80 mg/day. Doses were administered on a divided schedule ranging from 2 to 4 times a day. The mean dose overall for both studies was approximately 40 mg/day, with very few patients receiving doses greater than 60 mg/day. In both studies at the end of 6 weeks, patients receiving Marplan (isocarboxazid) had significantly greater reduction in signs and symptoms of depression evaluated by the Hamilton Depression Scale, for both the Total Score and the Depressed Mood Score, than patients who received placebo.


This monograph has been modified to include the generic and brand name in many instances.

Patient Information

Medication Guide
Antidepressant Medicines, Depression and other Serious Mental Illnesses,
and Suicidal Thoughts or Actions

Read the Medication Guide that comes with you or your family member's antidepressant medicine. This Medication Guide is only about the risk of suicidal thoughts and actions with antidepressant medicines. Talk to your, or your family member's, healthcare provider about:

  • all risks and benefits of treatment with antidepressant medicines
  • all treatment choices for depression or other serious mental illness

What is the most important information I should know about antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions?

  1. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.
  2. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness also called manic-depressive illness) or suicidal thoughts or actions.
  3. How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?
    • Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
    • Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
    • Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.

Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling very agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worse irritability
  • acting aggressive, being angry, or violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in behavior or mood

What else do I need to know about antidepressant medicines?

  • Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.
  • Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.
  • Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.
  • Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.
  • Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child's healthcare provider for more information.

This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.


This monograph has been modified to include the generic and brand name in many instances.

Consumer Overview Uses

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

 

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. Therefore, 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 immediately 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 available from your pharmacist before you start using isocarboxazid and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

Take this medication by mouth, usually 2 to 4 times a day as directed by your doctor. This medication may be taken with or without food. Dosage is based on your medical condition and response to therapy and usually will not be more than 60 milligrams per day.

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.

This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as restlessness, confusion, hallucinations, headache, weakness, and diarrhea) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.

Inform your doctor if your condition persists or worsens.

Consumer Overview Side Effect

SIDE EFFECTS: See also Warning section.

Dizziness, drowsiness, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she 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 immediately if any of these unlikely but serious side effects occur: fainting, mental/mood changes (e.g., agitation, confusion), muscle stiffness/twitching, changes in sexual ability/interest, shaking (tremor), shivering, swollen ankles/legs, unusual weight gain, vision changes (e.g., double/blurred vision).

Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: severe stomach/abdominal pain, persistent nausea/vomiting, seizures, dark urine, yellowing eyes/skin.

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 seek immediate medical attention 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).

A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: 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.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

 

Read the Marplan (isocarboxazid) Side Effects Center for a complete guide to possible side effects

Learn More »

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.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (e.g., stroke), heart problems (e.g., congestive heart failure, heart attack), high blood pressure, history of severe/frequent headaches, liver problems.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal/family history of mental/mood disorders (e.g., schizophrenia, bipolar disorder), family history of high blood pressure, heart disease (e.g., coronary artery disease, history of chest pain), kidney disease, certain nervous system diseases (Parkinson's syndrome, seizures), overactive thyroid (hyperthyroidism).

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.

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 (e.g., 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 levels. Check your blood sugar regularly, and share the results with your doctor. Tell your doctor immediately if you have symptoms of low blood sugar such as cold sweat, shaking, rapid heart rate, fainting, and hunger. Your anti-diabetic medication or diet may need to be adjusted.

Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the effects on blood pressure.

This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Consumer Overview Missed Dose

DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious (possibly fatal) interactions may occur: other antidepressants (including maprotiline, mirtazapine, nefazodone, SNRIs such as duloxetine/venlafaxine, SSRIs such as citalopram/fluoxetine/paroxetine, TCAs such as amitriptyline/nortriptyline), appetite suppressants (e.g., diethylpropion), drugs for attention deficit disorder (e.g., atomoxetine, methylphenidate), certain antihistamines (azatadine, carbetapentane, chlorpheniramine), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, dextromethorphan, certain drugs for high blood pressure (e.g., guanethidine, methyldopa), other MAO inhibitors (linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine), certain narcotic medications (such as fentanyl, meperidine, methadone, tapentadol), certain drugs for Parkinson's (e.g., entacapone, levodopa, tolcapone), street drugs (e.g., MDMA/"ecstasy", LSD, mescaline), stimulants (e.g., amphetamines, cocaine, dopamine, epinephrine, phenylalanine), tetrabenazine, "triptan" migraine drugs (e.g., sumatriptan, rizatriptan), tramadol, tyrosine, tryptophan.

If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting isocarboxazid. Do not take these medications within the 2 weeks before, during or after treatment with isocarboxazid. If you have been taking fluoxetine, wait at least 5 weeks after stopping fluoxetine before starting isocarboxazid. Discuss with your doctor how much time to wait between starting or stopping any of these drugs and taking isocarboxazid.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: drugs for high blood pressure (e.g., beta blockers such as atenolol, clonidine, rauwolfia alkaloids such as reserpine, "water pills"/diuretics such as hydrochlorothiazide).

Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with isocarboxazid such as isoniazid (INH), phenothiazines (e.g., thioridazine), theophylline, or tricyclic antidepressants (e.g., imipramine) among others. Consult your doctor or pharmacist for details.

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., phenytoin), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, lithium, risperidone, trazodone).

Check the labels on all your medicines (e.g., allergy, cough-and-cold products, diet pills) because they may contain dextromethorphan, decongestants, stimulants, or drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.

It is very important that you follow special dietary restrictions in order to limit the amount of tyramine in your diet. Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate. Caffeine can increase the side effects of this medication. Foods and beverages high in tyramine should be avoided while you are taking this medication and for at least 2 weeks after you stop using this medication.

Foods high in tyramine include: aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, brick, bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, colby, edam), aged/dried/fermented/salted/smoked/pickled/processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring), banana peel, beef/chicken liver (stored, not fresh), bouillon cubes, commercial gravies, concentrated yeast extracts, fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread, kim chee (Korean fermented cabbage), orange pulp, overripe or spoiled fruits, packaged soups, red wine, sauerkraut, sherry, snow pea pods, sourdough bread, soy sauce, soybeans, soybean paste/miso, tofu, tap beer and ale, vermouth.

Moderate-to-low tyramine content foods include: alcohol-free beer, avocados, bananas, bottled beer and ale, chocolate and products made with chocolate, coffee, cola, cultured dairy products (e.g. buttermilk, yogurt, sour cream), distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.

Tell your doctor or pharmacist immediately if you notice symptoms of high blood pressure such as fast/slow heartbeat, vomiting, sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, or slurred speech.

Contact your healthcare professionals (e.g., doctor, pharmacist, dietician) for more information, including recommendations for your diet.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

 

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

 

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (e.g., blood pressure, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

 

MISSED DOSE: If you miss a dose, take as soon as you remember unless the next scheduled dose is within 2 hours. In that case, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

 

STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

 

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

 

Information last revised September 2013. Copyright(c) 2013 First Databank, Inc.

Patient Detailed Side Effect

Brand Names: Marplan

Generic Name: isocarboxazid (Pronunciation: eye so kar BOX a zid)

  • What is isocarboxazid (Marplan)?
  • What are the possible side effects of isocarboxazid (Marplan)?
  • What is the most important information I should know about isocarboxazid (Marplan)?
  • What should I discuss with my doctor before taking isocarboxazid (Marplan)?
  • How should I take isocarboxazid (Marplan)?
  • What happens if I miss a dose (Marplan)?
  • What happens if I overdose (Marplan)?
  • What should I avoid while taking isocarboxazid (Marplan)?
  • What other drugs will affect isocarboxazid (Marplan)?
  • Where can I get more information?

What is isocarboxazid (Marplan)?

Isocarboxazid is a monoamine oxidase inhibitor (MAOI) that works by increasing the levels of certain chemicals in the brain.

Isocarboxazid is used to treat symptoms of depression that may include anxiety, panic, or phobias. This medication is usually given after other antidepressants have been tried without successful treatment of symptoms.

Isocarboxazid may also be used for purposes other than those listed in this medication guide.

What are the possible side effects of isocarboxazid (Marplan)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Stop using isocarboxazid and call your doctor at once if you have any of these serious side effects:

  • sudden and severe headache, rapid heartbeat, stiffness in your neck, nausea, vomiting, cold sweat, sweating, vision problems, sensitivity to light;
  • chest pain, fast or slow heart rate;
  • swelling, rapid weight gain;
  • jaundice (yellowing of the skin or eyes); or
  • feeling light-headed, fainting.

Less serious side effects may include:

  • dizziness, headache;
  • tremors or shaking;
  • constipation, nausea; or
  • dry mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the Marplan (isocarboxazid) Side Effects Center for a complete guide to possible side effects

Learn More »

What is the most important information I should know about isocarboxazid (Marplan)?

There are many other medicines that can cause serious or life-threatening medical problems if you take them together with isocarboxazid. Do not take isocarboxazid before telling your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

While you are taking isocarboxazid, you must not drink alcohol or eat foods that are high in tyramine, listed in the "What should I avoid while taking isocarboxazid?" section of this leaflet. Eating tyramine while you are taking isocarboxazid can raise your blood pressure to dangerous levels, causing symptoms that include sudden and severe headache, rapid heartbeat, stiffness in your neck, nausea, vomiting, cold sweat, vision problems, and sensitivity to light. Stop taking isocarboxazid and call your doctor at once if you have any of these symptoms.

Isocarboxazid can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Side Effects Centers
  • Marplan

Patient Detailed How Take

What should I discuss with my doctor before taking isocarboxazid (Marplan)?

Do not use this medication if you have used another MAOI such as phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take isocarboxazid before another MAOI has cleared from your body.

Do not take this medication if you are allergic to isocarboxazid, or if you have:

  • pheochromocytoma (tumor of the adrenal gland);
  • a history of stroke or blood clots;
  • liver disease;
  • kidney disease;
  • heart disease;
  • high blood pressure; or
  • a history of severe or frequent headaches.

There are many other medicines that can cause serious or life-threatening medical problems if you take them together with isocarboxazid. The following drugs should not be used while you are taking isocarboxazid:

  • diet pills, caffeine, stimulants, ADHD medication, asthma medication, over-the-counter cough and cold or allergy medicines;
  • blood pressure medication;
  • diuretics (water pills);
  • bupropion (Wellbutrin, Zyban);
  • buspirone (BuSpar);
  • carbamazepine (Carbatrol, Tegretol);
  • furazolidone (Furoxone);
  • meperidine (Demerol, Mepergan);
  • pargyline (Eutonyl);
  • procarbazine (Matulane);
  • alcohol or medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety).
  • antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adepin, Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil); or
  • antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

If you have any of these other conditions, you may need an isocarboxazid dose adjustment or special tests:

  • high blood pressure;
  • diabetes;
  • a thyroid disorder;
  • schizophrenia;
  • epilepsy or other seizure disorder;
  • if you have taken another antidepressant within the past 5 weeks; or
  • if you are also taking tryptophan (L-tryptophan), guanethidine (Ismelin), levodopa (Larodopa, Parcopa, Sinemet), or methyldopa (Aldomet).

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. It is not known whether isocarboxazid will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether isocarboxazid passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give isocarboxazid to anyone younger than 16 years old without the advice of a doctor.

How should I take isocarboxazid (Marplan)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results.

Your blood pressure will need to be tested often. Visit your doctor regularly.

Take this medication for the entire length of time prescribed by your doctor. It may take up to 6 weeks or longer before you notice improvement in your symptoms.

Store at room temperature away from moisture and heat.

Side Effects Centers
  • Marplan

Patient Detailed Avoid Taking

What happens if I miss a dose (Marplan)?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose (Marplan)?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include shallow breathing, fast heart rate, sweating, fever, slow reflexes, feeling light-headed, fainting, or seizure (convulsions).

What should I avoid while taking isocarboxazid (Marplan)?

While you are taking isocarboxazid you must not eat foods that are high in tyramine, including:

  • cheese (especially strong or aged cheeses);
  • sour cream and yogurt;
  • beer (including non-alcoholic beer), sherry, Chianti wine, liquers;
  • dry sausage (such as hard salami, pepperoni), anchovies, caviar, liver, pickled herring;
  • canned figs, raisins, bananas;
  • avocados;
  • chocolate or caffeine;
  • soy sauce;
  • sauerkraut;
  • fava beans;
  • yeast extracts;
  • meat extracts;
  • meat prepared with tenderizer; or
  • over-the-counter supplements or cough and cold medicines that contain dextromethorphan or tyramine.

You should become very familiar with the list of foods and medicines you must avoid while you are taking isocarboxazid. Eating tyramine while you are taking isocarboxazid can raise your blood pressure to dangerous levels which could cause life-threatening side effects.

Isocarboxazid may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

What other drugs will affect isocarboxazid (Marplan)?

There are many other medicines that can cause serious or life-threatening medical problems if you take them together with isocarboxazid. Do not take isocarboxazid before telling your doctor about all other prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about isocarboxzazid.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2013 Cerner Multum, Inc. Version: 2.02. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

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