Important Product Safety Information for Patients1
Side Effects, Dietary Considerations and Drug Interactions to Consider When Taking Marplan® (isocarboxazid) Tablets
Because Marplan® (isocarboxazid) Tablets works differently, you'll be asked to take it in a different way than the other medications for depression:
- You'll be asked to stop taking your current medication for at least two weeks prior to initiating Marplan® (isocarboxazid) Tablets. During this period your physician will monitor you closely. If you experience any symptoms, contact him or her immediately.
- Please be mindful that Marplan® (isocarboxazid) Tablets may interact with some other prescription medicines, some OTC cough/cold, weight-control, and hay fever/allergy preparations, and some herbal supplements, and may cause adverse events. Be sure to tell your doctor about all the medications and supplements you are taking.
- When taking Marplan® (isocarboxazid) Tablets therapy, you need to avoid certain foods that might interact with its MAO Inhibitor effects. Although you'll need to avoid any foods that have a high tyramine level, you can enjoy a considerable variety of fresh foods and pasteurized foods.
Safety Information for Patients1
Here is a brief list of "Do's and Don't's" to help you take Marplan® (isocarboxazid) Tablets correctly. Following these instructions will reduce your likelihood of experiencing any untoward effects and increase your likelihood for success with on Marplan® (isocarboxazid) Tablets therapy:
- Consult with your physician or other health care professionals about the benefits and risks of using Marplan® (isocarboxazid) Tablets, and how to take it appropriately.
- Promptly tell your doctor if you experience any of the following symptoms while using Marplan® (isocarboxazid) Tablets:
- palpitations/tachycardia (rapid heart beat)
- sense of constriction in the throat or chest
- neck stiffness
- nausea or vomiting
- Be vigilant for changes in behavior while using Marplan® (isocarboxazid) Tablets, especially when you are beginning Marplan® (isocarboxazid) Tablets therapy, or when the dose of Marplan® (isocarboxazid) Tablets is being changed. These changes in behavior may indicate a worsening of your depression and an increased risk of suicide. On a day-to-day basis, patients, and their families and caregivers should be alert to the emergence of an increase in symptoms such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsive behavior, akathisia (inner restlessness), mania, hypomania (a mind in persistent overdrive), worsening of the depression, and thoughts of suicide.
- Report any of these symptoms to the doctor, especially if they were not part of your initial symptoms, and if they are severe, or abrupt in onset.
- Be aware that Marplan® (isocarboxazid) Tablets may cause drowsiness, hypotension and faintness. If these symptoms occur, you should not perform potentially dangerous tasks, such as driving or operating machinery.
- Inform other healthcare professionals who are providing you with care (other doctors, the dentist, and other health professionals) that you are taking Marplan® (isocarboxazid) Tablets.
- Don't eat certain tyramine-containing foods while taking Marplan® (isocarboxazid) Tablets. Tyramine may interact with Marplan® (isocarboxazid) Tablets to cause serious untoward effects. Click here to view and download a helpful Dietary Guide that lists foods to avoid.
- Don't drink alcoholic beverages, especially those containing high amounts of tyramine (such as white wine and tap beer). The Dietary Guide (hot link) on this website lists alcoholic beverages to avoid. As with all antidepressants, it is unwise to drink any alcohol since it may aggravate symptoms of depression.
- Don't take additional prescription medicines or over-the-counter drugs without first consulting with your doctor or pharmacist. Some OTC cough/cold, weight-control, and hay fever/allergy preparations may interact with Marplan® (isocarboxazid) Tablets to cause serious untoward effects.
- Don't consume excessive amounts of caffeine. Caffeine is found in such products as coffee, tea, chocolate, cola drinks, and OTC 'stay-awake' drugs. See the Dietary Guide (hot link) for limits in the amount of these beverages.
Always discuss the results of your Marplan® (isocarboxazid) Tablets therapy with your doctor. A few foods can cause dangerous interactions with Marplan® (isocarboxazid) Tablets - but most of the foods that you like may be just fine to eat. Here's information about:
- Why food interactions can happen
- The new information about the many foods you can enjoy
- The few foods and beverages to avoid
The Cause of Food Interactions8
On previous web pages we looked at how Marplan® (isocarboxazid) Tablets treats depression by elevating the levels of certain brain chemicals called neurotransmitters. Marplan® (isocarboxazid) Tablets is thought to balance a person's mood by elevating the levels of three of those neurotransmitters. It does this by blocking an enzyme called Mono-Amine Oxidase (MAO) in the brain and in the gut.
In the gut, MAO Inhibitors can cause an increase in levels of a chemical called tyramine. Tyramine is also present in some foods and beverages, particularly when those foods and beverages are aged or fermented.
If there is too much tyramine in the body, a dangerous rise in blood pressure may occur. That's why it is important that you minimize the tyramine you consume while you are taking Marplan® (isocarboxazid) Tablets.
Years ago, when Marplan® (isocarboxazid) Tablets was first introduced, nutritionists didn't have advanced ways to measure tyramine in foods and beverages. So, to be as safe as possible, a diet restricting foods containing tyramine was developed, but that old diet was difficult to stay with because so many foods were incorrectly thought to be 'off limits'.
Fortunately—based on newer scientific studies—the recommendations have changed. While there still are some foods and drinks you should avoid—or consume only in moderation, we now know that most foods that were once restricted are, in fact, very low in tyramine—and considered safe to consume when you are taking Marplan® (isocarboxazid) Tablets.
The Good News about the Many Foods You Can Enjoy
The most contemporary diet guidance indicates that you can Marplan® (isocarboxazid) Tablets while enjoying nearly all of the foods and beverages that you currently like. Look below at the Menu for a New Beginning and you'll see that freshness is the key - fresh dairy, fresh poultry, fresh fish, and fresh packaged or processed meats are safe food choices when you are taking Marplan® (isocarboxazid) Tablets. So go right ahead and enjoy a burger or a hot dog at the barbecue. Nearly all fruits and vegetables are OK too.
However, you'll want to avoid any aged cheeses, fermented/dry/aged meats such as salami, most soy products, or any foods that haven't been stored properly or have passed their expiration dates.
Don't drink alcoholic beverages, especially those containing high amounts of tyramine (including white wine and tap beer). The Dietary Guide and the Menu for a New Beginning on this Website list alcoholic beverages to avoid. As with all antidepressants, it is unwise to drink any alcohol since it may aggravate the symptoms of depression.
More information can be obtained from other on-line resources listed on this web site or from your doctor.
Avoiding Medication Interactions While Taking Marplan® (isocarboxazid) Tablets3
Some medications can interact with Marplan® (isocarboxazid) Tablets and cause unwanted effects. To avoid these effects, be sure to tell your doctor about ALL of the other medications you are taking, including herbal supplements.
Here is a list of medication combinations that should be avoided:
- Marplan® (isocarboxazid) Tablets should be administered with caution to patients receiving Antabuse® (disulfiram)
- The use of Marplan® (isocarboxazid) Tablets in combination with other psychotropic agents is not recommended without your doctor's knowledge, because one product can potentially magnify the effects of the other.
- 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 taking any other psychotropic medication.
- Marplan® (isocarboxazid) Tablets should not be used with other MAO Inhibitors, tri-cyclic medications (dibenzazepine-related 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; or excessive amounts of caffeine; or central nervous system depressants such as narcotics, barbiturates, and alcohol.
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.