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    DEA Class;  Rx

    Common Brand Names; Marplan

    • Antidepressants, MAO Inhibitors

    Non-selective monoamine oxidase A and B inhibitor (MAOI) antidepressant
    FDA-approved for the treatment of major depressive disorder (MDD); used off-label as a second- or third-line agent for anxiety disorders such as panic disorder and social anxiety disorder
    Primarily used for treatment-resistant cases of depression and anxiety disorders, due to dietary restrictions, adverse effect profile, and the potential for serious drug-drug interactions and drug-food interactions

    Indicated for use in treatment-resistant depression.


    Pheochromocytoma, CHF, CVD, severe renal impairment

    Confirmed or suspected cerebrovascular defect or any patient with cardiovascular disease, hypertension, or history of headache


    History of liver disease or abnormal liver function tests


    • Orthostatic hypotension

    • Dizziness

    • Drowsiness

    • Fatigue

    • Headache

    • Hyperreflexia

    • Sleep disturbance

    • Weakness

    • Tremor

    • Constipation

    • Dry mouth

    Less Common

    • Confusion

    • Decreased memory

    • Paresthesia

    • Anorexia

    • Nausea

    • Vomiting

    • Impotence

    • Urinary frequency or retention

    • Nystagmus


    • Edema

    • Anxiety

    • Hypomania

    • Irritation

    • Hypermetabolic syndrome (hyperpyrexia, tachycardia, tachypnea, incr CPK, acidosis)

    • SIADH

    • Arthralgia


    • Risk of hypertensive crisis (usually due to drug interaction)

    • Ataxia

    • Seizure

    • Jaundice

    • Visual disturbancea

    Use caution with doses >40 mg/day

    Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 years)

    Caution in patients with diabetes mellitus (monitor glucose closely), glaucoma, hepatic/renal impairment, thyroid dysfunction

    Therapy can cause serious side effects; not recommended as initial therapy; should be reserved for patients who have not responded satisfactorily to other antidepressants

    Hypotension may occur; seen most commonly in patients with preexistent hypertension; blood pressure usually returns rapidly to pretreatment levels upon discontinuation of drug; dosage increases should be made more gradually in patients showing a tendency toward hypotension at beginning of therapy; postural hypotension may be relieved by having the patient lie down until blood pressure returns to normal

    Therapy lowers convulsive threshold in some animal experiments, use caution if epileptic patients treated; therapy appears to have varying effects in epileptic patients; while some have a decrease in frequency of seizures, others have more seizures; discontinue at least 48 hours before myelography; should not resume therapy for at least 24 hours postprocedure

    There is low incidence of altered liver function or jaundice in patients receiving therapy; periodic liver chemistry tests should be performed during therapy; discontinue use at first sign of hepatic dysfunction or jaundice

    MAO inhibitors can suppress anginal pain that would otherwise serve as a warning of myocardial ischemia

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, during pregnancy

    Levels of excretion in human milk have not been determined, and effects on nursing infant are unknown; therapy should be used in women who are nursing only if clearly needed


    60 mg/day PO.


    60 mg/day PO.


    >= 16 years: 60 mg/day PO.
    < 16 years: Safety and efficacy have not been established.


    Safety and efficacy have not been established.



    • 10 mg