The latest research shows that foods have lower levels of tyramine than originally believed1-8.
Dietary Considerations
Patients can benefit from Marplan® (isocarboxazid) Tablets while consuming nearly all of the fresh foods and beverages they like—including a number of foods that were incorrectly believed to be "off-limits"1-8.
Modern research has shown that the tyramine levels of many foods are far lower than originally presumed1—and it is tyramine that can cause an unwanted pressor effect in the presence of MAO Inhibition. Such pressor effects can potentially lead to severe hypertension in MAO Inhibitors-treated patients who consume tyramine-containing food or beverages11-18.
Since MAO Inhibitors can increase the levels of tyramine in the gut, patients should adhere to the following dietary guidelines in order to take advantage of Marplan® (isocarboxazid) Tablets' antidepressant effects while minimizing the risk of adverse reactions.11-18
Newer Findings: Less Restrictive Dietary Guidelines
When Marplan® (isocarboxazid) Tablets was first introduced, nutritionists didn't have 21st century technology to perform measurements of tyramine in foods and beverages; and, to create the widest possible margin of safety, they recommended that patients taking MAO Inhibitors go on diets that were highly restrictive and very hard to adhere to. In addition, many popular foods were incorrectly classified as 'off-limits'11-18.
There are still some foods and beverages that patients on MAO Inhibitors should avoid or consume only in moderation. The newest analytic techniques reveal that many foods that were once restricted actually contain very little or no tyramine and thus can be consumed safely while patients are on Marplan® (isocarboxazid) Tablets therapy.11-18
The Key is FRESH Foods
When initiating Marplan® (isocarboxazid) Tablets therapy and instructing your patients about their diets, the key is to emphasize that they should eat fresh foods11-18.
Fresh dairy, fresh poultry, fresh fish, and fresh packaged or processed meats are all safe food choices for patients taking Marplan® (isocarboxazid) Tablets.11-18
Your patients can go right ahead and enjoy a burger or a hot dog at the barbeque. Nearly all fruits and vegetables are OK, too11-18.
However, you'll want to counsel patients to avoid any aged cheeses, fermented/dried/aged meats such as salami, most soy products, and any foods that haven't been stored properly or have gone beyond their expiration dates.11-18
It's Best to Avoid Alcohol19
When taking any antidepressant, it is unwise to drink alcoholic beverages, since they may aggravate the symptoms of depression9. However, should your patient choose to drink alcoholic beverages, we've listed alcoholic beverages to avoid in the 'Menu for a New Beginning' a downloadable patient education tool located in the Professional Resources section.
The best diet news is that—with your guidance—patients with Treatment-Resistant Major Depression* can now receive the benefits of Marplan® (isocarboxazid) Tablets' MAO Inhibitor efficacy while enjoying a varied, healthful diet that's easy to adhere to!
FOR MORE DETAILS PLEASE CLICK HERE TO VIEW FULL PRESCRIBING INFORMATION.
Avoiding Medication Interactions19
Since some medications can interact with Marplan® (isocarboxazid) Tablets and cause unwanted adverse effects, you'll want to encourage your patients to inform you of all medications they are taking, including OTC products and herbal supplements, before issuing a prescription for Marplan® (isocarboxazid) Tablets therapy.
Below is a list of medication combinations that should be avoided:
- Marplan® (isocarboxazid) Tablets should be used with caution in patients receiving Antabuse® (disulfram).
- The use of Marplan® (isocarboxazid) Tablets in combination with other psychotropic agents is not recommended, because one product can potentially magnify the effects of the other.
Marplan® (isocarboxazid) Tablets should not be used with:
- Other MAO Inhibitors, tri-cyclic medications (dibenzazepine and other); Wellbutrin® (buproprion); SSRI antidepressants; Buspar® (buspirone)
- Sympathomimetic drugs, including amphetamines and over-the-counter cold, hay fever or weight-reducing preparations containing vasoconstrictors (decongestants); tryptophan
- Demerol® (meperidine); the cough preventative, dextromethorphan; anesthetic agents, blood pressure drugs, including thiazide diuretics; excessive amounts of caffeine; central nervous system depressants such as narcotics, barbiturates, and alcohol
The MAO Inhibiting effects of Marplan® (isocarboxazid) Tablets can persist for a substantial period after it has been discontinued, so it is best to wait at least 10 days before prescribing any other psychotropic medication.
Rediscover efficacy in Treatment-Resistant* Major Depression
Rediscover
Please click on the menu column at the left to access product information, clinical data, and helpful patient support materials.
*Treatment failure with first-line antidepressants.
Please click here to review the Marplan® (isocarboxazid) Tablets references.
Please see Full Prescribing Information including BOXED WARNINGS regarding increased risk of suicidality in children and adolescents. MAO Inhibitors are contraindicated with certain drugs. Potential hypertensive crises may occur with foods that contain tyramine. As with all antidepressants, patients should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment.
Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Marplan® (isocarboxazid) Tablets or any other antidepressant in a child, adolescent or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Marplan® (isocarboxazid) Tablets is not approved for use in pediatric patients. (See Warnings: Clinical Worsening and Suicide Risk, Precautions: Information for Patients, and Precautions: Pediatric Use).
Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials.
