isocarboxazid

ROUTE	ONSET	PEAK	DURATION
PO	unknown	3–6 wk	unknown

Contraindicated in:

Hypersensitivity;
Liver disease;
Severe renal disease;
Cerebrovascular disease;
Cardiovascular disease;
Uncontrolled hypertension;
Pheochromocytoma;
Severe or frequent headaches;
Patients undergoing elective surgery requiring general anesthesia (should be discontinued ≥10 days before surgery);
Excessive consumption of caffeine;
Concurrent use of meperidine, SSRIs, SSNRIs, tricyclic antidepressants, tetracyclic antidepressants, nefazodone, trazodone, procarbazine, selegiline, linezolid, carbamazepine, cyclobenzaprine, bupropion, buspirone, sympathomimetics, other MAO inhibitors, dextromethorphan, narcotics, alcohol, general anesthetics, diuretics, tryptophan, or antihistamines;
Concurrent use of foods containing high concentrations of tyramine (see Food Sources for Specific Nutrients).

Use Cautiously in:

Patients who may be suicidal or have a history of drug dependency;
Hyperthyroidism;
Schizophrenia;
Bipolar disorder;
Seizure disorders;
Diabetes (↑ risk of hypoglycemia);
OB: Use during pregnancy only if potential maternal benefit outweighs risk to fetus;
Lactation: Use during breastfeeding only if potential maternal benefit outweighs risk to infant;
Pedi: May ↑ risk of suicide attempt/ideation especially during first 1–2 mo of treatment or with dose adjustments (approved for use in children ≥16 yr);
Pedi: Children <16 yr (safety and effectiveness not established);
Geri: ↑risk of adverse reactions in older adults..

Adv. Reactions/Side Effects ⬆ ⬇

CV: HYPERTENSIVE CRISIS, orthostatic hypotension

Derm: photosensitivity

EENT: blurred vision

GI: nausea, black tongue, constipation, diarrhea, dry mouth

GU: dysuria, sexual dysfunction, urinary incontinence, urinary retention

Neuro: dizziness, headache, akathisia, anxiety, ataxia, drowsiness, euphoria, insomnia, restlessness, SEIZURES, weakness

Interactions ⬆ ⬇

Drug-drug:

Serious, potentially fatal adverse reactions may occur with concurrent use of other antidepressants (SSRIs, SSNRIs, bupropion, tricyclics, tetracyclics, nefazodone, trazodone), carbamazepine, cyclobenzaprine, procarbazine, or selegiline; avoid using within 2 wk of each other (wait 5 wk from end of fluoxetine therapy).
Hypertensive crisis may occur with amphetamines, levodopa, dopamine, epinephrine, norepinephrine, methylphenidate, or vasoconstrictors; concurrent use contraindicated.
Hypertension or hypotension, coma, seizures, respiratory depression, and death may occur with meperidine ; avoid using within 2–3 wk of MAO inhibitor therapy.
Concurrent use with dextromethorphan may produce psychosis or bizarre behavior.
Hypertension may occur with concurrent use of buspirone; avoid using within 10 days of each other.
Additive hypotension may occur with antihypertensives, spinal anesthesia, opioids, or barbiturates.
Additive hypoglycemia may occur with insulins or oral hypoglycemic agents.
Risk of seizures may be ↑ with tramadol.

Drug-Natural Products:

Serious, potentially fatal adverse effects (serotonin syndrome) may occur with concomitant use of St. John's wort and SAMe.
Hypertensive crises may occur with large amounts of caffeine-containing herbs (cola nut, guarana, or malt).
Insomnia, headache, tremor, hypomania may occur with ginseng.
Hypertensive crises, disorientation, and memory impairment may occur with tryptophan or supplements containing tyrosine or phenylalanine.

Drug-Food:

Hypertensive crisis may occur with ingestion of foods containing high concentrations of tyramine (see Food Sources for Specific Nutrients).
Consumption of foods or beverages with high caffeine content ↑ the risk of hypertension and arrhythmias.

Route/Dosage ⬆ ⬇

PO (Adults ): 10 mg twice daily; may be ↑ every 2–4 days by 10 mg, up to 40 mg/day by the end of the first wk, then may ↑ by up to 20 mg every wk, up to 60 mg/day in 2–4 divided doses. After optimal response is obtained, dose should be slowly ↓ to lowest effective amount (40 mg/day or less).

Availability ⬆ ⬇

Assessment ⬆ ⬇

Assess mental status, mood changes, and anxiety level frequently. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient.
Monitor BP and pulse rate before and frequently during therapy. Report significant changes promptly.
Monitor intake and output ratios and daily weight. Assess patient for urinary retention.

Lab Test Considerations:

Assess hepatic function periodically during prolonged or high-dose therapy.
- Monitor serum glucose closely in diabetic patients; hypoglycemia may occur.

Toxicity and Overdose:

Concurrent ingestion of tyramine-rich foods and many medications may result in a life-threatening hypertensive crisis. Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, photosensitivity, neck stiffness, sweating, and enlarged pupils.
- Symptoms of overdose include anxiety, irritability, tachycardia, hypertension or hypotension, respiratory distress, dizziness, drowsiness, hallucinations, confusion, seizures, sluggish reflexes, fever, and diaphoresis. Treatment includes induction of vomiting or gastric lavage and supportive therapy as symptoms arise.

Implementation ⬆ ⬇

Do not administer this medication in the evening because the psychomotor stimulating effects may cause insomnia or other sleep disturbances.
PO: Tablets may be crushed and mixed with food or fluids for patients with difficulty swallowing.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Take missed doses if remembered within 2 hr; otherwise, omit and return to regular dosage schedule. Do not discontinue abruptly as withdrawal symptoms (nausea, vomiting, malaise, nightmares, agitation, psychosis, seizures) may occur.
Caution patient to avoid alcohol, CNS depressants, OTC drugs, and foods or beverages containing tyramine (see Food Sources for Specific Nutrients) or excessive caffeine during and for at least 2 wk after therapy has been discontinued; they may precipitate a hypertensive crisis. Instruct patient to notify health care professional immediately if symptoms of hypertensive crisis (e.g. severe headache, palpitations, chest or throat tightness, sweating, dizziness, neck stiffness, nausea, or vomiting) develop.
Instruct parents or guardians of children to contact health care professional immediately if child exhibits any suicidal thoughts or behaviors (e.g. worsening depression, new or worsening anxiety, agitation, panic attacks, insomnia, new or worsening irritability, violent behavior, impulsive actions, excessive talking, unusual changes in mood or behavior).
May cause dizziness or drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
Caution patient to change positions slowly to minimize orthostatic hypotension. Geriatric patients are at increased risk for this side effect.
Instruct patient to consult with health care professional before taking any new prescription, OTC, or herbal product.
Advise patient to notify health care professional if dry mouth, urinary retention, or constipation occurs. Frequent rinses, good oral hygiene, and sugarless candy or gum may diminish dry mouth. An increase in fluid intake, fiber, and exercise may prevent constipation.
Advise patient to notify health care professional of medication regimen before surgery. If possible, therapy should be discontinued at least 2 wk before surgery.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Encourage patients who become pregnant while taking isocarboxazid to enroll in National Pregnancy Registry for Antidepressants at 1-844405-6185 or visiting online at http://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants.
Instruct patient to carry identification describing medication regimen at all times.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇