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What is MARPLAN® (isocarboxazid)?
MARPLAN is a prescription medicine used to treat people with depression.

IMPORTANT SAFETY INFORMATION

Because of its potentially serious side effects, MARPLAN should not be considered as the first choice for the treatment of depression, but should be considered when other antidepressants have failed to control symptoms of depression. You should talk to your healthcare provider about the benefits and risks associated with treatment.

WARNING: SUICIDALITY

MARPLAN is not for use in children and adolescents. Antidepressant medicines such as MARPLAN may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. 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. You should pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings when taking MARPLAN, especially when starting treatment or when the dose is changed. Call your healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.

What is the most important information I should know about MARPLAN?

  • Symptoms may worsen with or without MARPLAN. Patients with major depressive disorder (MDD) may experience a worsening of depression and an increased risk of suicide or unusual behavior, both with and without treatment. 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 depression, and thoughts of suicide.
  • MARPLAN is not for use in treating bipolar depression. You should talk to your healthcare provider about the risks and benefits of starting treatment, as well as your treatment choices for depression and other serious mental illness.
  • Low blood pressure, faintness, and significant drowsiness may occur while taking MARPLAN. It is recommended to avoid potentially hazardous tasks, such as driving a car or operating machinery, until you know how MARPLAN affects you.
  • Taking MARPLAN with certain drugs and foods may result in dangerous increases in blood pressure. You should have your blood pressure checked on a regular basis while on MARPLAN and promptly tell your healthcare provider if you experience any of the following symptoms:
    • headache
    • rapid heartbeat
    • tightness in the throat or chest
    • dizziness
    • neck stiffness
    • nausea or vomiting
  • Avoid foods that contain tyramine while taking MARPLAN. When taking MARPLAN, you need to avoid certain foods that contain a chemical called tyramine because they may interact with MARPLAN and cause serious side effects. Caffeine should also not be consumed in large amounts. A list of foods to avoid while taking MARPLAN is provided below.

Foods you CANNOT eat:

In general, you should avoid foods that are aged to increase flavor.

Meat, Poultry, & Fish
Dry sausage
Pickled herring
Anchovies
Caviar
Liver
Meat extracts
Meat prepared with tenderizers
Beverages
Chianti wine
Sherry
Beer (including non-alcoholic beer)
Liqueurs
Dairy (milk products)
Cheese (particularly strong or aged varieties)
Sour cream
Yogurt
Fruits and Vegetables
Fava or broad bean pods (not beans)
Canned figs
Raisins
Bananas (particularly if overripe)
Avocados (particularly if overripe)
Other
Yeast extracts
Sauerkraut
Soy sauce
Chocolate

 

Who should not take MARPLAN?

Do not take MARPLAN if you:

  • are allergic to isocarboxazid
  • have or have had health conditions affecting the brain, heart, or blood vessels
  • have high blood pressure
  • have or have had recurrent headaches
  • have pheochromocytoma
  • have or have had liver disease
  • have kidney problems

What should I tell my healthcare provider before taking MARPLAN?

Some medications can interact with MARPLAN and cause serious unwanted effects. To avoid these effects, be sure to tell your doctor about ALL of the other medications you are taking, including herbal supplements.

Before you take MARPLAN, tell your healthcare provider if you have any of the following conditions:

  • epilepsy
  • liver disease
  • diabetes
  • hyperthyroidism
  • mental illness

The most common side effects of MARPLAN include

  • dry mouth
  • constipation
  • nausea
  • headache
  • sleep disturbance
  • dizziness

These are not all the possible side effects of MARPLAN. For more information, ask your healthcare provider or pharmacist. Tell your healthcare provider if you have any side effects that bothers you or that does not go away.

Please refer to the full Prescribing Information for a list of inactive ingredients found at www.marplan.com.

What should I avoid while taking MARPLAN?

  • Avoid foods that contain a chemical called tyramine. See the link to the dietary guide above for a list of foods you can and cannot eat while taking MARPLAN.
  • Avoid alcoholic beverages
  • Avoid caffeine in large amounts
  • Avoid taking 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 medicines may interact with MARPLAN to cause serious effects.

See the Contraindications section of the full Prescribing Information for a complete list of drugs to avoid.

The risk information provided here is not comprehensive. To learn more, talk about MARPLAN with your doctor or pharmacist. The FDA-approved product labeling can be found at www.marplan.com or 1-866-982-5438.

You may report side effects to the FDA at 1-800-FDA-1088, or at www.fda.gov/medwatch. You may also report side effects to VALIDUS at 1-866-982-5438 or [email protected].

MARPLAN is available by prescription only.

Please see the accompanying Medication Guide at www.marplan.com.

 

 

Quick Links

Important Safety Information for Patients10

Side Effects, Dietary Considerations, and Drug Interactions to Consider When Taking Marplan® (isocarboxazid) Tablets

Because Marplan® (isocarboxazid) Tablets work differently, you’ll be asked to take them in a different way than the other medications for depression.

  • You’ll be asked to stop taking your current medication for at least 2 weeks prior to initiating Marplan. During this period, your physician will monitor you closely. If you experience any symptoms, contact him or her immediately.
  • Please be mindful that Marplan 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 therapy, you need to avoid certain foods that might interact with its MAO inhibitor effects. Some foods may be high in a chemical called tyramine. 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.
  • You should not consume alcoholic beverages while taking Marplan.

Click here to download a handy Dietary Guide that lists these foods for you

Here is a brief list of “Do’s and Don’t’s” to help you take Marplan correctly. Following these instructions will reduce your likelihood of experiencing any untoward effects and increase your likelihood for success with Marplan therapy:

DO

  • Consult with your physician or other healthcare elsewhere professionals about the benefits and risks of using Marplan and how to take it appropriately.
  • Promptly tell your doctor if you experience any of the following symptoms while using Marplan:
    • headache
    • palpitations/tachycardia (rapid heart beat)
    • sense of constriction in the throat or chest
    • dizziness
    • neck stiffness
    • nausea or vomiting
  • Be vigilant for changes in behavior while using Marplan, especially when you are beginning Marplan therapy, or when the dose of Marplan 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 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 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.

DON’T

  • Don’t eat certain foods containing tyramine while taking Marplan. Tyramine may interact with Marplan 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.
  • 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 to cause serious 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 for limits in the amount of these beverages you can consume.

Always discuss the results of your Marplan therapy with your doctor. A few foods can cause dangerous interactions with Marplan – 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

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 that may be potentially fatal, may occur (hypertensive crisis). That’s why it is important that you minimize the tyramine you consume while you are taking Marplan.

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 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.

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). 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 website or from your doctor.

The Good News About the Many Foods You Can Enjoy

The most contemporary diet guidance indicates that you can take Marplan while enjoying many 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. So, go right ahead and enjoy a burger or a hot dog at the barbecue. Nearly all fruits and vegetables are OK too.

Marplan Foods

Avoiding Medication Interactions While Taking Marplan® (isocarboxazid) Tablets10

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 should be administered with caution to patients receiving Antabuse (disulfiram).
  • The use of Marplan 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 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 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; excessive amounts of caffeine; or central nervous system depressants such as narcotics, barbiturates, and alcohol. For a complete list of drugs to avoid please see “CONTRAINDICATIONS” in the important safety information and the full prescribing information.

Please click here to review the Marplan references.