Iscarboxazid (Marplan)
MAOI antidepressant (serotonin, norepinephrine, dopamine enzyme inhibitor (MAO-A and -B))
- Major Depression3
- Atypical depression3
- Social anxiety3
Features
Dosing
10mg 1 bid x4days, 1 qam 2 qhs x4days then 2 bid
Management
MAOIs have greater risk of mania than other antidepressants. Preferred for atypical depression, and also have high effect size in social phobia.
TOLERABILITY: Mild activation feelings, skin irritation.
RISKS: Serotonin syndrome with drug interactions. Hypertensive crisis with food interactions. Hypotension, edema, vitamin B6 deficiency, and – rarely – seizures and hepatotoxicity.
Must stop antidepressants (including other MAOIs) for 1-2 weeks before starting MAOI (except fluoxetine is 4-6 week wait, vortioxetine 2-3 weeks).
May be able to combine MAOIs with non-serotonergic antidepressants: some tricyclics (desipramine, trimipramine, and doxepin), bupropion, mirtazapine, trazodone, and pramipexole.
EMR Text
Depression
Isocarboxazid use based on FDA approval in depression.
MAOI side effects, including hypotension and dangerous drug and food interactions, reviewed in detail with patient.