- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Tablets containing isocarboxazid
A daily dose of 30 mg, in single or divided doses, should be given until improvement is obtained. The maximal effect is only observed after a period varying from 1 to 4 weeks. If no improvement has been seen by 4 weeks, doses up to 60 mg may be tried, according to the patient's tolerance, for no longer than 4 to 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 to 20 mg daily but up to 40 mg daily may be required in some cases.
A daily dose of 5 to 10 mg is recommended.
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.
Children under 18 years
Concomitant medication consider washout period, see prescribing information
Abnormal liver function test
Severe cardiovascular disorder
Precautions and Warnings
Glucose-galactose malabsorption syndrome
Patients at risk of suicide should be closely supervised
Advise ability to drive/operate machinery may be affected by side effects
Monitor blood pressure
Monitor liver function. Withdraw if evidence of hepatotoxic reaction
Advise patients/carers to seek medical advice if suicidal intent develops
Consider hyponatraemia in all patients with drowsiness/confusion/seizures
May activate mania or hypomania
May aggravate anxiety and agitation
Avoid abrupt withdrawal
Discontinue 2 weeks prior to elective surgery
Discontinue if headaches occur
Discontinue if palpitations occur
Discontinue if patient enters a manic phase
Reduce dose in elderly
Advise patient against self medication, particularly cold remedies
Advise patient to avoid alcohol during treatment
Advise patient to avoid non-alcoholic beers, lagers and wines
Advise patient to avoid foods or beverages with a high tyramine content
Avoid foods that interact with MAOIs for 2 weeks after discontinuing drug
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 self harm is highest shortly after presentation and the risk of suicide may increase again in the early stages of recovery. Furthermore, there is evidence that in children and adolescents, antidepressants may increase the risk of suicidal thoughts and self harm
Patients with a history of suicide related events, those exhibiting a significant degree of suicidal ideation prior to commencement of treatment, and young adults, are at a greater risk of suicidal thought or suicide attempt, and should receive careful monitoring during treatment.
Patients, (and caregivers of patients) should be alerted about the need to monitor for the emergence of suicidal thoughts and behaviour, and to seek medical advice immediately if these symptoms present.
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.
Patients should be warned to avoid foodstuffs and beverages with a high tyramine content: mature cheeses (including processed cheeses), hydrolysed yeast or meat extracts, alcoholic beverages, particularly heavy red wines, non-alcoholic beers, lagers and wines, and other foods which are not fresh and are fermented, pickled, 'hung', 'matured' or otherwise subject to protein degradation before consumption. Broad bean pods (which contain levodopa) and banana skins may also present a hazard. In extreme cases interactions may result in severe hypertensive episodes. Isocarboxazid should therefore be discontinued immediately upon the occurrence of palpitations or frequent headaches.
Isocarboxazid should be discontinued for at least 2 weeks prior to elective surgery requiring general anaesthesia. The anaesthetist should be warned that a patient is being treated with isocarboxazid, in the event of emergency surgery being necessary.
All patients taking isocarboxazid should be warned against self-medication with proprietary 'cold-cure' preparations and nasal decongestants.
The danger of interaction persists for up to 2 weeks after treatment with isocarboxazid is discontinued.
Consider hyponatraemia in those presenting with drowsiness, confusion or convulsions.
Pregnancy and Lactation
Isocarboxazid is contraindicated in pregnancy.
The manufacturer recommends not to use isocarboxazid in pregnancy, especially during the first and last trimesters, unless there are compelling reasons. There is no evidence as to drug safety in human pregnancy, nor is there evidence from animal work that it is free from hazard. In addition, the effect of psychotropic drugs on the fine brain structure of the foetus is unknown.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Isocarboxazid is contraindicated in breastfeeding.
Since there is no information on the secretion of the drug into breast milk, (though its molecular weight is low enough that excretion into the breast milk is expected) isocarboxazid is contraindicated during lactation.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Patients and caregivers should be alerted about the need to monitor for the emergence of suicidal thoughts and behaviour, and the need to seek medical advice immediately if they present.
Patients should be warned to avoid foodstuffs and beverages with a high tyramine content: mature cheeses (including processed cheeses), hydrolysed yeast or meat extracts, alcoholic beverages, particularly heavy red wines, non-alcoholic beers, lagers and wines, and other foods which are not fresh and are fermented, pickled, 'hung', 'matured' or otherwise subject to protein degradation before consumption. Broad bean pods (which contain levodopa) and banana skins may also present a hazard.
Patients should be warned against self-medication with any substance, particularly with 'cold-cure' preparations and nasal decongestants.
Patients should be advised that their ability to drive and operate machinery may be impaired by treatment.
Altered liver function tests
Difficulty in micturition
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: September 2014
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com Accessed on September 04, 2014 .
Summary of Product Characteristics: Isocarboxazid 10 mg tablets. Alliance Pharmaceuticals. Revised November 2011.
MHRA Drug Safety Update February 2008
Available at: https://www.mhra.gov.uk/NewsCentre/Pressreleases/CON2033960
Last accessed: September 04, 2014
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.