isocarboxazid (Rx)

Brand and Other Names:Marplan
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 10 mg

Depression

10 mg PO q6-12hr, increase by 10 mg/day q2-4d to 40 mg/day PO divided q6-12hr by end of first week

After first week, may increase by up to 20 mg/week to maximum 60 mg/day; decrease dose to maintenance dose once maximum effect achieved

Safety and efficacy not established

Depression

10 mg PO q6-12hr, increase by 10 mg/day q2-4d to 40 mg/day PO divided q6-12hr by end of first week

After first week, may increase by up to 20 mg/week to maximum 60 mg/day; decrease dose to maintenance dose once maximum effect achieved

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Interactions

Interaction Checker

and isocarboxazid

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Common

            • Orthostatic hypotension
            • Dizziness
            • Drowsiness
            • Fatigue
            • Headache
            • Hyperreflexia
            • Sleep disturbance
            • Weakness
            • Tremor
            • Constipation
            • Dry mouth

            Less Common

            • Confusion
            • Decreased memory
            • Paresthesia
            • Anorexia
            • Nausea
            • Vomiting
            • Impotence
            • Urinary frequency or retention
            • Nystagmus

            Uncommon

            • Edema
            • Anxiety
            • Hypomania
            • Irritation
            • Hypermetabolic syndrome (hyperpyrexia, tachycardia, tachypnea, incr CPK, acidosis)
            • SIADH
            • Arthralgia

            Rare

            • Risk of hypertensive crisis (usually due to drug interaction)
            • Ataxia
            • Seizure
            • Jaundice
            • Visual disturbance
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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            In children and young adults, risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Pheochromocytoma, CHF, CVD, severe renal impairment

            Confirmed or suspected cerebrovascular defect or any patient with cardiovascular disease, hypertension, or history of headache

            Schizophrenia

            History of liver disease or abnormal liver function tests

            Concurrent administration with MAO inhibitors or dibenzazepine derivatives; sympathomimetics (including amphetamines); some central nervous system depressants (including narcotics and alcohol); antihypertensive, diuretic, antihistaminic, sedative or anesthetic drugs, bupropion (within 14 days of isocarboxazid discontinuation), buspirone (<10 days of isocarboxazid discontinuation), dextromethorphan, cheese or other foods with a high tyramine content; or excessive quantities of caffeine

            Use with SSRIs (<14 days of discontinuing isocarboxazid; wait 5 weeks between discontinuation of fluoxetine and initiation of 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
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            Pregnancy & Lactation

            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 needed

            Pregnancy 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.

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            Pharmacology

            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

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.