MONOAMINE OXIDASE (MAO) INHIBITORS

Brand & Generic Names

ISOCARBOXAZID
Marplan
Nardil
Parnate
PHENELZINE
TRANYLCYPROMINE

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? No
• Drug class: MAO (monoamine oxidase) inhibitor, antidepressant

Uses

• Treatment for depression.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid. If you can't swallow whole, crumble tablet and take with liquid or food.

When to take:
At the same times each day.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Inhibits nerve transmissions in brain that may cause depression.

Time lapse before drug works:
4 to 6 weeks for maximum effect.

Don't take with:
Non-prescription diet pills, nose drops, medicine for asthma, cough, cold or allergy, or medicine containing caffeine or alcohol.
Foods containing tyramine*.
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Restlessness, agitation, excitement, fever, confusion, dizziness, heartbeat irregularities, hallucinations, sweating, breathing difficulties, insomnia, irritability, convulsions, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

• Fatigue, weakness.
• Dizziness when changing position, restlessness, tremors, dry mouth, constipation, difficult urination, blurred vision, "sweet tooth."

Infrequent:

• Fainting, enlarged pupils.
• Severe headache, chest pain.
• Hallucinations, insomnia, nightmares, diarrhea, rapid or pounding heartbeat, swollen feet or legs, joint pain.
• Diminished sex drive.

Rare:

Rash, nausea, vomiting, stiff neck, jaundice, fever, increased sweating, dark urine, slurred speech.

Warnings & Precautions

Don't take if:

• You are allergic to any MAO inhibitor.
• You have heart disease, congestive heart failure, heart-rhythm irregularities or high blood pressure.
• You have liver or kidney disease.

Before you start, consult your doctor:

• If you are alcoholic.
• If you have had a stroke.
• If you have diabetes, epilepsy, asthma, overactive thyroid, schizophrenia, Parkinson's disease, adrenal-gland tumor.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Over age 60:
Not recommended.

Pregnancy:
Risk to unborn child outweighs benefits. Don't use, especially during first 3 months.

Breast-feeding:
Safety not established. Consult doctor.

Infants & children:
Not recommended.

Prolonged use:

• May be toxic to liver.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check blood pressure, liver function.

Skin & sunlight:
May cause rash or intensify sunburn in areas exposed to sun or sunlamp.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes.

Discontinuing:

• Don't discontinue without doctor's advice until you complete prescribed dose, even though symptoms diminish or disappear.
• Follow precautions regarding foods, drinks and other medicines for 2 weeks after discontinuing.
• Adverse symptoms caused by this medicine may occur even after discontinuation. If you develop any of the symptoms listed under Overdose, notify your doctor immediately.

Others:

• May affect blood-sugar levels in patients with diabetes.
• Fever may indicate that MAO inhibitor dose requires adjustment.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Amphetamines*	Blood pressure rise to life-
	threatening level.
Anticholinergics*	Increased anticholinergic effect.
Anticonvulsants*	Changed seizure pattern.
Antidepressants,	Blood pressure rise to
tricyclic (TCA)*	life-threatening level. Possible
	fever, convulsions, delirium.
Antidiabetics,	Excessively low blood
oral and insulin*	sugar.
Antihypertensives*	Excessively low blood pressure.
Beta-adrenergic	Possible blood
blockers*	pressure rise if MAO inhibitor is
	discontinued after simultaneous use
	with acebutolol.
Bupropion	Increased risk of bupropion
	toxicity.
Buspirone	Very high blood pressure.
Caffeine	Irregular heartbeat or high blood
	pressure.
Carbamazepine	Fever, seizures. Avoid.
Central nervous system	Excessive depressant action.
(CNS) depressants*
Clozapine	Toxic effect on the central nervous
	system.
Cyclobenzaprine	Fever, seizures. Avoid.
Dextromethorphan	Very high blood pressure.
Diuretics*	Excessively low blood pressure.
Ephedrine	Increased blood pressure.
Ethinamate	Dangerous increased effects of
	ethinamate. Avoid combining.
Fluoxetine	Increased depressant effects of
	both drugs.
Furazolidine	Sudden, severe increase in
	blood pressure.
Guanadrel	High blood pressure.
Guanethidine	Blood pressure rise to life-
	threatening level.
Guanfacine	May increase depressant effects of
	either drug.
Hypoglycemics*,	Increased hypoglycemic effect.
Indapamide	Increased indapamide effect.
Insulin	Increased hypoglycemic effect.
Leucovorin	High alcohol content of leucovorin
	may cause adverse effects.
Levodopa	Sudden, severe blood pressure rise.
MAO inhibitors*	High fever, convulsions, death.
Maprotiline	Dangerous blood pressure rise.
Methyldopa	Sudden, severe blood pressure rise.
Methylphenidate	Increased blood pressure.
Methyprylon	Increased sedative effect, perhaps
	to dangerous level. Avoid.
Nabilone	Greater depression of central
	nervous system.
Narcotic analgesics*	Severe high blood pressure.
Paroxetine	Can cause a life-threatening reaction.
	Avoid.
Phenothiazines*	Possible increased phenothiazine
	toxicity.
Phenylpropanolamine	Increased blood pressure.
Pseudoephedrine	Increased blood pressure.
Sertraline	Increased depressive effects
	of both drugs.
Sympathomimetics*	Blood pressure rise to life-
	threatening level.
Trazodone	Increased risk of mental status
	changes.
Tryptophan	Increased blood pressure.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Increased sedation to dangerous
	level.
Caffeine drinks.	Irregular heartbeat or high blood
	pressure.
Drinks containing	Blood pressure rise to
tyramine*	life-threatening level.
Cocaine:	Overstimulation. Possibly fatal.
Foods containing	Blood pressure rise to
tyramine*	life-threatening level.
Marijuana:	Overstimulation. Avoid.
Tobacco:	No proven problems.