Indications for MARPLAN:
Initially 10mg twice daily. May increase by 10mg every 2–4 days up to 40mg daily. If tolerated, may increase by 20mg/week to max 60mg/day divided into 2–4 doses.
<16yrs: not recommended.
See Interactions. Pheochromocytoma. Cardiovascular, cerebrovascular, or liver disease. Hypertension. Chronic headache. To avoid potentially severe or fatal interactions, allow sufficient drug-free interval (see full labeling) between isocarboxazid and sympathomimetics (eg, amphetamines, pseudoephedrine), tricyclic antidepressants (eg, amitriptyline, clomipramine), SSRIs or other neurotransmitter reuptake inhibitors (eg, fluoxetine), maprotiline, CNS depressants (eg, alcohol, barbiturates, narcotics), antihistamines, antihypertensives (eg, guanethidine), anesthetics, bupropion, buspirone, carbamazepine, cyclobenzaprine, dibenzazepines, diuretics, dextromethorphan, dopamine, other MAOIs (eg, phenelzine, selegiline, furazolidone, tranylcypromine), levodopa, methyldopa, methylphenidate, phenylalanine, tryptophan-, dopamine-, tyrosine-, or tyramine-containing foods, excess caffeine or chocolate. Meperidine within 3 weeks of isocarboxazid.
Suicidality and antidepressant drugs.
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor all patients for clinical worsening or unusual behavioral changes. Screen for risk of bipolar disorder prior to initiation. Mania/hypomania. Psychosis. Epilepsy. Hyperthyroidism. Surgery. Schizophrenia. Discontinue if palpitations or headache occurs, 48hrs before to 24hrs after myelography, or at 1st sign of jaundice or hepatic dysfunction. Avoid abrupt cessation. Hypotension. Monitor BP and observe patient frequently. May mask anginal pain or aggravate anxiety or agitation. Renal impairment. Elderly. Debilitated. Pregnancy. Nursing mothers.
See Contraindications. Hypertensive crises with sympathomimetics, levodopa, and high-tyramine foods (eg, cheese, salami, chocolate, wine, beer, pickled herring, chicken livers, yeast extract, yogurt, broad beans). Caution with antidiabetic agents, antiparkinson agents, disulfiram. Potentiates CNS depressants, antihypertensives. Psychosis with dextromethorphan. Circulatory collapse, coma, death with meperidine. Do not start within 5wks of fluoxetine, 10 days of buspirone, or 2wks of sertraline, paroxetine, bupropion or citalopram, or 1wk of venlafaxine discontinuance.
Orthostatic hypotension, hypertensive crises, dizziness, headache, dry mouth, GI disturbances, blurred vision, akathisia, ataxia, black tongue, coma, dysuria, euphoria, hematologic changes, incontinence, photosensitivity, seizures, changes in blood sugar.
To enroll pregnant patients exposed to Marplan in the National Pregnancy Registry for Antidepressants, call (844) 405-6185.