isocarboxazid: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
isocarboxazid: clinical details
Prescribing considerations
- Provide clear written advice about food and medicine interactions.
- Review all prescribed, non-prescription and complementary products before initiation and whenever treatment changes.
- Use caution with renal impairment, diabetes, epilepsy, blood dyscrasias, cardiovascular disease, agitation, frailty and older age.
- Plan antidepressant switches with specialist input; cross-tapering with serotonergic antidepressants is generally unsuitable.
- Account for persistent MAO inhibition when planning surgery, dental anaesthesia or interacting treatment.
Contraindications and cautions
- Any hepatic impairment
- Cerebrovascular disease
- Severe cardiovascular disease
- Actual or suspected phaeochromocytoma
- Hypersensitivity to isocarboxazid or an excipient
- Incompatible antidepressant treatment, including SSRIs, other MAOIs and most tricyclic antidepressants
- Breastfeeding
Monitoring
- Liver function regularly; stop and assess promptly if hepatotoxicity is suspected.
- Mood, suicidal thinking, agitation and unusual behavioural change, particularly early in treatment and after treatment changes.
- Blood pressure and postural symptoms.
- Glycaemic control when clinically relevant.
- Adverse effects or interaction symptoms whenever another medicine is started, stopped or changed.
Clinical pharmacology
A non-selective MAOI associated with reduced metabolism of physiological amines including serotonin and noradrenaline. It is readily absorbed orally, and most drug-related material is excreted in urine as metabolites. Its pharmacological effect is cumulative and persistent.
Formulation and product differences
- The selected product is an oral tablet supplied in a child-resistant bottle.
- The tablets contain lactose, gelatin, starch, talc, magnesium stearate and iron oxide colourants.
- People with galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this formulation.
isocarboxazid preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg
isocarboxazid interactions
Isocarboxazid has numerous potentially serious interactions. A pharmacist or prescriber should review all prescribed, non-prescription and complementary products.
SSRIs, SNRIs and other serotonergic antidepressants
Combining or switching without specialist planning can cause potentially fatal serotonin toxicity.
Other MAOIs and most tricyclic antidepressants
Co-administration can intensify toxicity, hypotension or serotonin-related reactions and generally must be avoided.
Pethidine and other opioid analgesics
Pethidine can cause a potentially fatal reaction; other opioids require careful specialist assessment.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.