Isocarboxazid Tablets

What is this medication?

ISOCARBOXAZID (eye soe kar BOX azid) treats depression. It works by increasing levels of dopamine, norepinephrine, and serotonin in your brain, substances that help regulate mood. It belongs to a group of medications called MAOIs.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Marplan

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Glaucoma
• Headache or migraine
• Heart disease
• High blood pressure
• History of irregular heartbeat
• History of stroke
• If you often drink alcohol
• Kidney disease
• Liver disease
• Mental illness
• Pheochromocytoma
• Recent head trauma
• Seizures
• Suicidal thoughts, plans, or attempt; a previous suicide attempt by you or a family member
• An unusual or allergic reaction to isocarboxazid, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

Take this medication by mouth with water. Take it as directed on the prescription label at the same time every day. Keep taking it unless your care team tells you to stop.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. Special care may be needed

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

• Atomoxetine
• Buspirone
• Caffeine
• Carbamazepine
• Certain medications for blood pressure like guanabenz, guanadrel, guanethidine, or reserpine
• Cocaine
• Cyclobenzaprine
• Dextromethorphan
• Diet pills or stimulants, like amphetamines or ephedra
• Diphenoxylate
• Ephedrine
• General or local anesthetics
• Ginseng
• Green tea
• Guarana
• Linezolid
• MAOIs like phenelzine, rasagiline, safinamide, selegiline, tranylcypromine
• Medications for migraine headaches
• Medications for movement abnormalities as in Parkinson's disease like entacapone, levodopa, selegiline, tolcapone
• Meperidine
• Methylene blue
• Other medications for mental depression, anxiety, or mood or mental problems
• Prescription pain medications
• Procarbazine
• SAM-e
• St. John's Wort
• Tramadol
• Tryptophan
• Tyramine (found in cheese, red wine, beer, chocolate and other foods)
• Viloxazine
• Yohimbine

This medication may also interact with the following:

• Barbiturates, like phenobarbital
• Diuretics
• Isoniazid
• Medications for allergies, colds, flu symptoms, sinus congestion, and breathing difficulties
• Medications for diabetes
• Phenothiazines like chlorpromazine, prochlorperazine, thioridazine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Tell your care team if your symptoms do not get better or if they get worse. Visit your care team for regular checks on your progress. Because it may take several weeks to see the full effects of this medication, it is important to continue your treatment as prescribed by your care team.

This medication can interact with certain foods that contain tyramine. The combination may cause severe headaches, a rise in blood pressure, or irregular heart beat. Foods that contain significant amounts of tyramine include aged cheeses, meats and fish (especially aged, smoked, pickled, or processed such as bologna, pepperoni, salami, summer sausage), beer and ale, alcohol-free beer, wine (especially red), sherry, hard liquor, liqueurs, avocados, bananas, figs, raisins, soy sauce, miso soup, yeast/protein extracts, bean curd, fava or broad bean pods, or any over-ripe fruit. Ask your care team, pharmacist, or nutritionist for a complete listing of tyramine-containing foods. Also, avoid drinks containing caffeine, such as tea, coffee, chocolate, or cola. After stopping this medication, ask your care team how long you should continue avoiding these foods and drinks.

Patients and their families should watch out for new or worsening thoughts of suicide or depression. Also watch out for sudden changes in feelings such as feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, overly excited and hyperactive, or not being able to sleep. If this happens, especially at the beginning of treatment or after a change in dose, call your care team.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medication. Avoid alcoholic drinks.

This medication may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your eye doctor if the problem does not go away or is severe.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your care team if the problem does not go away or is severe.

Do not treat yourself for coughs, colds, or allergies without asking your care team for advice. Do not take any medications for weight loss without your care team's approval. Some ingredients in these products may increase possible side effects.

This medication may affect blood sugar levels. If you have diabetes, check with your care team before you change your diet or the dose of your diabetic medication.

Tell your care team that you are taking this medication if you are scheduled to have any surgery, procedure or medical testing. You should usually stop taking this medication at least 10 days before elective surgery.

This medication may cause a decrease in vitamin B6. You should make sure that you get enough vitamin B6 while you are taking this medication. Discuss the foods you eat and the vitamins you take with your care team.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome
• Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
• Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
• Seizures
• Severe increase in blood pressure—sudden, severe headache, nausea, vomiting, stiff neck, fast or irregular heartbeat
• Thoughts of suicide or self-harm, worsening mood, feelings of depression

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Constipation
• Dizziness
• Dry mouth
• Headache
• Nausea
• Tremors

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Keep the container tightly closed. Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, take the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.