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Marplan
Marplan is the brand name for isocarboxazid, a monoamine oxidase inhibitor (MAOI) used to treat depression that has not responded to other treatments. MAOIs like Marplan work by increasing the levels of certain chemicals in the brain (neurotransmitters) that affect mood, such as serotonin, norepinephrine, and dopamine. Marplan is typically used in patients with major depressive disorder (MDD) who have not found relief from other antidepressants.
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Frequently Asked Questions
How long does it take for Marplan to start working?
It may take 2 to 4 weeks before you begin to notice improvements in mood and symptoms of depression. Continue taking the medication as prescribed, and talk to your doctor if you do not see improvements after a few weeks.
Can I drink alcohol while taking Marplan?
It is best to avoid alcohol while taking Marplan, as it can increase the risk of side effects such as dizziness and drowsiness, and it may interact with tyramine, increasing the risk of a hypertensive crisis.
What should I do if I accidentally eat a food high in tyramine?
If you consume a food high in tyramine while taking Marplan and experience symptoms like a severe headache, rapid heartbeat, or nausea, seek emergency medical attention immediately, as this may indicate a hypertensive crisis.
What should I do if I miss a dose of Marplan?
If you miss a dose, take it as soon as you remember, unless it is close to your next scheduled dose. Do not double the dose to make up for the missed one.
Is Marplan safe for long-term use?
Marplan can be used long-term under close medical supervision. Regular monitoring by your healthcare provider is important, particularly for blood pressure and potential drug or food interactions.
Comprehensive Drug Guide
How Does Marplan Work?
Marplan works by inhibiting the activity of the enzyme monoamine oxidase (MAO), which is responsible for breaking down neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. By blocking this enzyme, Marplan increases the levels of these neurotransmitters, helping to improve mood and alleviate symptoms of depression. The increased availability of these chemicals is believed to help relieve depressive symptoms in patients with treatment-resistant depression.
Common Dosages
- 10 mg oral tablets
The typical starting dose is 10 mg twice daily, and it may be increased by 10 mg per week based on patient response and tolerance. The maximum recommended daily dose is 60 mg.
Typical Dosing
- For depression: The usual starting dose is 10 mg twice daily, which can be increased gradually by 10 mg per week, depending on the patient's response and tolerability. The maximum dose is 60 mg per day. It is typically taken in divided doses throughout the day.
Typical Dosing
FDA Approved Indications
- The treatment of depression in patients who have not responded to other antidepressants or therapies.
- It is typically reserved for patients with treatment-resistant depression due to its side effect profile and dietary restrictions.
Who Shouldn't Take Marplan?
- Pheochromocytoma (a tumor of the adrenal gland)
- Severe liver disease
- Cardiovascular disease such as uncontrolled hypertension or heart disease
- Use of other MAOIs or recent use of other antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), due to the risk of serotonin syndrome.
- Use of foods high in tyramine (like aged cheeses and cured meats) due to the risk of hypertensive crises.
Advice From The Pharmacist
- Dietary restrictions: Avoid foods high in tyramine while taking Marplan, as consuming these can lead to dangerously high blood pressure (hypertensive crisis). Foods to avoid include aged cheeses, cured meats, fermented foods, and certain alcoholic beverages like beer and red wine.
- Marplan can interact with many medications. Always inform your doctor of any other medications or supplements you are taking, especially other antidepressants or over-the-counter medications like decongestants.
- Monitor blood pressure regularly, as Marplan can increase the risk of hypertension, particularly when combined with certain foods or medications.
- If you miss a dose, take it as soon as you remember unless it’s close to your next dose. Do not double up doses.
- Avoid alcohol and other central nervous system depressants while taking Marplan, as these can increase the risk of side effects like dizziness and drowsiness.
Side Effects of Marplan
Common Side Effects
- Dizziness or lightheadedness
- Drowsiness
- Dry mouth
- Weight gain
- Insomnia
- Constipation
Uncommon/Severe Side Effects
- Hypertensive crisis (severe high blood pressure), especially when combined with foods high in tyramine
- Serotonin syndrome, particularly when combined with other serotonergic agents
- Severe orthostatic hypotension (a sudden drop in blood pressure when standing)
Risks and Warnings of Marplan
- Hypertensive Crisis: One of the major risks of taking Marplan is the development of a hypertensive crisis if certain foods high in tyramine are consumed. Symptoms of a hypertensive crisis include a severe headache, nausea, vomiting, neck stiffness, and rapid heart rate. Immediate medical attention is required in such cases.
- Serotonin Syndrome: This potentially life-threatening condition can occur if Marplan is taken with other medications that increase serotonin levels, such as SSRIs, SNRIs, or certain pain medications like tramadol. Symptoms include agitation, confusion, rapid heart rate, high blood pressure, and muscle rigidity.
- Orthostatic Hypotension: Marplan can cause a drop in blood pressure when moving from a sitting to a standing position, which can lead to dizziness or fainting. Rise slowly from sitting or lying down to minimize this risk.
Interactions with Marplan
Common Drug Interactions
- SSRIs, SNRIs, TCAs: Combining Marplan with other antidepressants, especially those that affect serotonin, can lead to serotonin syndrome and should be avoided.
- Tyramine-rich foods: Foods like aged cheeses, cured meats, and fermented products can lead to a dangerous spike in blood pressure (hypertensive crisis) when consumed while on Marplan.
- Over-the-counter medications: Some cold medicines, particularly decongestants and certain pain relievers, can interact with Marplan and increase the risk of high blood pressure.
- Alcohol: Alcohol may exacerbate side effects such as dizziness, drowsiness, and confusion when taken with Marplan.
Alternatives to Marplan
- SSRIs (e.g., fluoxetine, sertraline): A common class of antidepressants used for depression and anxiety disorders, typically tried before MAOIs like Marplan.
- SNRIs (e.g., venlafaxine, duloxetine): Another class of antidepressants that target serotonin and norepinephrine, used for depression and anxiety.
- Tricyclic antidepressants (e.g., amitriptyline, nortriptyline): Older antidepressants used for mood disorders, which may be prescribed before MAOIs.
- Other MAOIs (e.g., phenelzine, tranylcypromine): Additional options for patients requiring MAOI treatment for depression.
