Dietary Considerations and Drug Interactions
The most important reaction associated with MAO inhibitors is the occurrence of hypertensive crises, which have sometimes been fatal, resulting from the co-administration of MAOIs and certain drugs and foods (see CONTRAINDICATIONS). These crises are characterized by some or all of the following symptoms: occipital headache that may radiate frontally, palpitation, neck stiffness or soreness, nausea or vomiting, sweating (sometimes with fever and sometimes with cold, clammy skin), and photophobia. Either tachycardia or bradycardia may be present, and associated constricting chest pain and dilated pupils may occur. Intracranial bleeding, sometimes fatal, has been reported in association with the increase in blood pressure.
Blood pressure should be followed closely in patients taking Marplan® (isocarboxazid) Tablets to detect any pressor response. Therapy should be discontinued immediately if palpitations or frequent headaches occur during Marplan therapy as these symptoms may be prodromal of a hypertensive crisis.
Warnings to the Patient
Patients should be instructed to report promptly the occurrence of headache or other unusual symptoms, ie, palpitation and/or tachycardia, a sense of constriction in the throat or chest, sweating, dizziness, neck stiffness, nausea, or vomiting. Patients should be warned against eating the foods listed under CONTRAINDICATIONS while on Marplan therapy and should also be told not to drink alcoholic beverages. The patient should also be warned about the possibility of hypotension and faintness, as well as drowsiness sufficient to impair performance of potentially hazardous tasks, such as driving a car or operating machinery. Patients should also be cautioned not to take concomitant medications, whether prescription or over-the-counter drugs such as cold, hay fever, or weight-reducing preparations, without the advice of a physician. They should be advised not to consume excessive amounts of caffeine in any form. Likewise, they should inform their physicians and their dentist about the use of Marplan.
Patients can benefit from Marplan 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.”1,7,8
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 inhibitor-treated patients who consume tyramine-containing food or beverages.1,7,8
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’s antidepressant effects while minimizing the risk of adverse reactions.1,7,8
The latest research shows that foods have lower levels of tyramine than originally believed.1,7,8
Newer Findings: Less Restrictive Dietary Guidelines
Years ago, when Marplan 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 your patients 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 your patients are taking Marplan.
The Key is FRESH Foods
Fresh dairy, fresh poultry, fresh fish, and fresh packaged or processed meats are all safe food choices for patients taking Marplan.1,7,8
Your patients can go right ahead and enjoy a burger or a hot dog at the barbeque. Nearly all fruits and vegetables are OK, too.1,7,8
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.1,7,8
The best diet news is that—with your guidance—patients taking Marplan can now receive the benefits of MAO inhibitor efficacy while enjoying a varied, healthful diet.
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Avoiding Medication Interactions10
Since some medications can interact with Marplan 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 therapy.
Below is a list of medication combinations that should be avoided:
- Marplan should be used with caution in patients receiving Antabuse® (disulfram)
- The use of Marplan in combination with other psychotropic agents is not recommended, because one product can potentially magnify the effects of the other
Marplan 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 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.
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