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ANTIDEPRESSANTS, MONOAMINE OXIDASE (MAO) INHIBITOR (Systemic)
Some commonly used brand names are:
In the U.S.—
Monoamine oxidase (MAO) inhibitors are used to relieve certain types of mental depression. They work by blocking the action of a chemical substance known as monoamine oxidase (MAO) in the nervous system.
Although these medicines are very effective for certain patients, they may also cause some unwanted reactions if not taken in the right way. It is very important to avoid certain foods, beverages, and medicines while you are being treated with an MAO inhibitor. Your health care professional will help you obtain a list to carry in your wallet or purse as a reminder of which products you should avoid.
MAO inhibitors are available only with your doctor"s prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For monoamine oxidase (MAO) inhibitors, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to any MAO inhibitor. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Diet—Dangerous reactions such as sudden high blood pressure may result when MAO inhibitors are taken with certain foods or drinks. The following foods should be avoided:
Pregnancy—A limited study in pregnant women showed an increased risk of birth defects when these medicines were taken during the first 3 months of pregnancy. In animal studies, MAO inhibitors caused a slowing of growth and increased excitability in the newborn when very large doses were given to the mother during pregnancy.
Breast-feeding—Tranylcypromine passes into the breast milk; it is not known whether isocarboxazid or phenelzine passes into breast milk. Problems in nursing babies have not been reported.
Children—Antidepressants must be used with caution in children with depression. Studies have shown occurrences of children thinking about suicide or attempting suicide in clinical trials for this medicine. More study is needed to be sure antidepressants are safe and effective in children
Animal studies have shown that these medicines may slow growth in the young. Therefore, be sure to discuss with your doctor the use of these medicines in children.
Older adults—Dizziness or lightheadedness may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to these effects of MAO inhibitors.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking MAO inhibitors, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of MAO inhibitors. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
Sometimes this medicine must be taken for several weeks before you begin to feel better. Your doctor should check your progress at regular visits, especially during the first few months of treatment, to make sure that this medicine is working properly and to check for unwanted effects .
Take this medicine only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
MAO inhibitors may be taken with or without food or on a full or empty stomach. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.
Dosing—The dose of MAO inhibitors will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of phenelzine and tranylcypromine. If your dose is different, do not change it unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using an MAO inhibitor .
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is within 2 hours of your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
When taken with certain foods, drinks, or other medicines, MAO inhibitors can cause very dangerous reactions such as sudden high blood pressure (also called hypertensive crisis). To avoid such reactions, obey the following rules of caution :
This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine .
Check with your doctor or hospital emergency room immediately if severe headache, stiff neck, chest pains, fast heartbeat, or nausea and vomiting occur while you are taking this medicine. These may be symptoms of a serious side effect that should have a doctor"s attention.
Do not stop taking this medicine without first checking with your doctor . Your doctor may want you to reduce gradually the amount you are using before stopping completely.
Dizziness, lightheadedness, or fainting may occur , especially when you get up from a lying or sitting position. Getting up slowly may help . When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.
This medicine may cause blurred vision or make some people drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are unable to see well or are not alert .
Antidepressants may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.
Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine or have used it within the past 2 weeks . Taking MAO inhibitors together with medicines that are used during surgery or dental or emergency treatments may increase the risk of serious side effects.
Your doctor may want you to carry an identification card stating that you are using this medicine.
For patients with angina (chest pain):
For diabetic patients:
After you stop using this medicine, you must continue to obey the rules of caution for at least 2 weeks concerning food, drink, and other medicine, since these things may continue to react with MAO inhibitors.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Stop taking this medicine and get emergency help immediately if any of the following side effects occur:
Symptoms of unusually high blood pressure (hypertensive crisis)
Chest pain (severe); enlarged pupils; fast or slow heartbeat; headache (severe); increased sensitivity of eyes to light; increased sweating (possibly with fever or cold, clammy skin); nausea and vomiting; stiff or sore neck
Check with your doctor as soon as possible if any of the following side effects occur:
Dizziness or lightheadedness (severe), especially when getting up from a lying or sitting position
Diarrhea; fast or pounding heartbeat; swelling of feet or lower legs; unusual excitement or nervousness
Dark urine; fever; skin rash; slurred speech; sore throat; staggering walk; yellow eyes or skin
Symptoms of overdose
Anxiety (severe); confusion; convulsions (seizures); cool, clammy skin; dizziness (severe); drowsiness (severe); fast and irregular pulse; fever; hallucinations (seeing, hearing, or feeling things that are not there); headache (severe); high or low blood pressure; muscle stiffness; sweating; troubled breathing; trouble in sleeping (severe); unusual irritability
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Blurred vision; decreased amount of urine; decreased sexual ability; dizziness or lightheadedness (mild), especially when getting up from a lying or sitting position; drowsiness; headache (mild); increased appetite (especially for sweets) or weight gain; increased sweating; muscle twitching during sleep; nausea; restlessness; shakiness or trembling; tiredness and weakness; trouble in sleeping
Less common or rare
Chills; constipation; decreased appetite; dryness of mouth
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, phenelzine and tranylcypromine are used in certain patients with the following medical conditions:
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.
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