Isocarboxazid

DEA Class;  Rx

Common Brand Names; Marplan

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

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 disturbancea

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

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, during pregnancy

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