isocarboxazid

Contraindicated in:

Hypersensitivity;
Liver disease;
Severe renal impairment;
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:

May ↑ risk of suicide attempt/ideation, especially during early treatment or dose adjustment; risk may be greater in children or adolescents;
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: Safety and effectiveness not established in children;
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, SUICIDAL THOUGHTS/BEHAVIORS, 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 concurrent use of St. John's wort and SAMe.
Hypertensive crises may occur with large amounts of caffeine-containing herbs (cola nut, guarana, 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.

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

PO (Adults ): 10 mg twice daily; may ↑ 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).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, serotonin) in the body.

Therapeutic effects:

Improved mood in depressed patients.

Classifications ⬆ ⬇

Therapeutic Classification: antidepressants

Pharmacologic Classification: monamine oxidase inhibitors

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(antidepressant effect)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	3–6 wk	unknown

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 ≥2 wk after therapy has been discontinued; they may precipitate a hypertensive crisis. Instruct patient to notify health care provider immediately if symptoms of hypertensive crisis (severe headache, palpitations, chest or throat tightness, sweating, dizziness, neck stiffness, nausea, vomiting) develop.
Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care provider immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior occur.
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. Older adults are at ↑ risk for this side effect.
Instruct patient to consult with health care provider before taking any new prescription, OTC, or herbal product.
Advise patient to notify health care provider if dry mouth, urinary retention, or constipation occurs. Frequent rinses, good oral hygiene, and sugarless candy or gum may diminish dry mouth. An ↑ in fluid intake, fiber, and exercise may prevent constipation.
Advise patient to notify health care provider of medication regimen before surgery. If possible, therapy should be discontinued at least 2 wk before surgery.
Rep: Advise women of reproductive potential to notify health care provider 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 https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants.
Instruct patient to carry identification describing medication regimen at all times.

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Indications ⬇

Contraind./Precautions ⬆ ⬇