20 May 2009

Isocarboxazid (Generic Note: The brand name MarplanR was formerly used for isocarboxazid preparations.) - United Kingdom

Updated: 20 May 2009

Isocarboxazid

For the treatment of the symptoms of depressive illness.

Isocarboxazid Description, Presentation and Dosage

Isocarboxazid Description

Isocarboxazid Drug Class Description

Monoamine-oxidase inhibitors (MAOIs, antidepressants).

Isocarboxazid Drug Description

Each tablet contains 10mg Isocarboxazid

Isocarboxazid Generic Name

Generic Note: The brand name MarplanR was formerly used for isocarboxazid preparations.

Isocarboxazid Presentation

Isocarboxazid Presentation

Tablets

Isocarboxazid Manufacturer

Cambridge Laboratories

Free Medical Education Resources

Isocarboxazid Dosage

Isocarboxazid Adult Dosage

A daily dose of 30mg, in single or divided doses, should be given until improvement is obtained. The maximal effect is only observed after a period varying from 1 - 4 weeks. If no improvement has been seen by 4 weeks, doses up to 60mg may be tried, according to the patient's tolerance, for no longer than 4 - 6 weeks, provided the patient is closely monitored because of the increased risk of adverse reactions occurring.

Once the optimal effect is achieved, the dose should be reduced to the lowest possible amount sufficient to maintain the improvement. Clinical experience has shown this to be usually 10 - 20mg daily but up to 40mg daily may be required in some cases.

Isocarboxazid Child Dosage

Isocarboxazid Tablets are not indicated for paediatric use

Isocarboxazid Elderly Dosage

The elderly are more likely to experience adverse reactions such as agitation, confusion and postural hypotension. Half the normal maintenance dose may be sufficient to produce a satisfactory clinical response.

Isocarboxazid Precautions, Reactions and Contraindications

Isocarboxazid Special Precautions

Isocarboxazid Special Precautions

Depression is associated with an increased risk of suicidal thoughts, self harm and suicide (suicide-related events). This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs. It is general clinical experience that the risk of suicide may increase in the early stages of recovery.

Patients with a history of suicide-related events, or those exhibiting a significant degree of suicidal ideation prior to commencement of treatment are known to be at greater risk of suicidal thoughts or suicide attempts, and should receive careful monitoring during treatment. A meta-analysis of placebo-controlled clinical trials of antidepressant drugs in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old.

Close supervision of patients and in particular those at high risk should accompany drug therapy especially in early treatment and following dose changes. Patients (and caregivers of patients) should be alerted about the need to monitor for any clinical worsening, suicidal behaviour or thoughts and unusual changes in behaviour and to seek medical advice immediately if these symptoms present.

Some monoamine oxidase inhibitors have occasionally caused hepatic complications and jaundice in patients, therefore regular monitoring of liver function should be carried out during Isocarboxazid therapy. If there is any evidence of a hepatotoxic reaction, the drug should be withdrawn immediately.

The drug should be used cautiously in patients with impaired renal function, to prevent accumulation taking place, and also in the elderly or debilitated and those with cardiovascular disease, diabetes or blood dyscrasias.

In restless or agitated patients, Isocarboxazid may precipitate states of excessive excitement. Isocarboxazid appears to have varying effects in epileptic patients; while some have a decrease in frequency of seizures, others have more seizures.

Isocarboxazid Adverse Reactions

Isocarboxazid Adverse Reactions

In general, Isocarboxazid is well tolerated by the majority of patients. Side-effects, if they occur, are those common to the group of monoamine oxidase inhibitors.

The most frequently reported have been orthostatic hypotension, associated in some patients with disturbances in cardiac rhythm, peripheral oedema, complaints of dizziness, dryness of the mouth, nausea and vomiting, constipation, blurred vision, insomnia, drowsiness, weakness and fatigue. These side-effects can usually be controlled by dosage reduction.

There have been infrequent reports of mild headaches, sweating, paraesthesiae, peripheral neuritis, hyperreflexia, agitation, overactivity, muscle tremor, confusion and other behavioural changes, difficulty in micturition, impairment of erection and ejaculation, and skin rashes. Although rare, blood dyscrasias (purpura, granulocytopenia) have been reported. Response to Isocarboxazid may be accompanied by increased appetite and weight gain.

Cases of suicidal ideation and suicidal behaviours have been reported during Isocarboxazid therapy or early after treatment discontinuation.

Isocarboxazid Contraindications

Isocarboxazid Contraindications

Isocarboxazid is contra-indicated in patients with any impairment of hepatic function, cerebrovascular disorders or severe cardiovascular disease, and in those with actual or suspected phaeochromocytoma.

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