Isocarboxazid Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Depression

Major Depressive Episode:

Initial dose: 10 mg orally twice a day; increase by 10 mg increments (1 tablet) every 2 to 4 days up to a dosage of 40 mg daily by the end of the first week, then increase by up to 20 mg/week as needed and as tolerated, to a maximum of 60 mg/day. Daily dosage should be divided into two to four doses.

After maximal clinical response is achieved, an attempt should be made to reduce the dose slowly over a period of several weeks without jeopardizing therapeutic effects.

Maintenance dose: usually 40 mg/day in divided doses is effective; however dosage should be adjusted to individual needs. Dosages exceeding 40 mg/day should be administered with caution due to limited controlled clinical data.

Renal Dose Adjustments

The use of isocarboxazid is contraindicated in patients with severe renal impairment.

Liver Dose Adjustments

The use of isocarboxazid is contraindicated in patients with a history of liver disease and in patients with abnormal liver function tests.

Dose Adjustments

If the patient is being transferred to isocarboxazid from another MAO inhibitor or from a dibenzazepine (e.g., tricyclic antidepressants), allow a medication-free interval of at least a week, then initiate isocarboxazid at half the normal starting dosage for at least the first week of therapy.

Precautions

Blood pressure should be monitored frequently in all patients.

Therapy should be discontinued immediately upon the occurrence of palpitation or frequent headaches, which may be prodromal signs of a hypertensive crisis.

In general, patients should be advised to avoid protein foods in which aging or protein breakdown is used to increase flavor. Foods that should be avoided include: pickled herring, anchovies, caviar, liver, dry sausage, canned figs, dried fruits, avocados, overripe fruit, chocolate, soy sauce, broad bean pods, sauerkraut, cheese, particularly strong or aged varieties (cottage cheese and cream cheese are allowed), sour cream, yogurt, beer (including nonalcoholic beer), Chianti wine, sherry, yeast extract, and meat extract. Patients should also avoid use of over-the-counter medications such as cold and cough preparations, nasal decongestants (tablets, drops, or sprays), appetite control products, and tryptophan-containing preparations.

Isocarboxazid is not recommended for use in pediatric patients under the age of 16 years old.

Isocarboxazid should be used with caution in the elderly population. Older patients may suffer more morbidity than younger patients during and following an episode of hypertension or malignant hyperthermia, and they may have less compensatory reserve to cope with any serious adverse reaction.

Dialysis

Data not available.

Other Comments

Improvement may not been seen in some patients for 3 to 6 weeks after initiation of therapy. If no response is obtained by then, consideration should be given to alternative treatment, as continued administration of isocarboxazid is unlikely to be of benefit.

Improvement of isocarboxazid beyond six weeks has not been systematically evaluated in controlled trials. Patients treated for an extended length of time should be periodically evaluated for continued need of the drug.

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