Side effects, dietary considerations and drug interactions

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Because Marplan is different, you'll be asked to take it in a different way than the other medications for depression:

1. You'll be asked to stop taking your current medication for at least two weeks prior to initiating Marplan. During this period your physician will monitor you closely. If you experience any symptoms, contact him or her immediately.
2. Be mindful that Marplan may interact with some other prescription medicines, some OTC cough/cold, weight control, and hay fever/allergy preparations, and some herbal supplements, and may cause adverse events. Be sure to tell your doctor about all the medications and supplements you are taking.
3. When taking Marplan therapy, you need to avoid certain foods that might interact with its MAO-I effects. You'll need to avoid foods that have a high tyramine level. You can enjoy a wide variety of fresh and pasteurized foods-and we've posted a handy Dietary Guide that lists them all for you.

SAFETY INFORMATION FOR PATIENTS

DO

• Consult with your physician or other health care professionals about the benefits and risks of using Marplan, and how to take it appropriately.
• Promptly tell your doctor if you experience any of the following symptoms while using Marplan:
  • headache
  • palpitation/tachycardia (rapid heart beat)
  • a sense of constriction in the throat or chest
  • dizziness
  • neck stiffness
  • nausea or vomiting
• Be vigilant for changes in behavior while using Marplan, especially when you are beginning Marplan therapy, or when the dose of Marplan is being changed. These changes in behavior may indicate a worsening of the patient's depression and an increased risk of suicide. From day-to-day, patients, their families and caregivers should be alert to the emergence of increased symptoms as anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsive behavior, akathisia (inner restlessness), mania, hypomania (a mind in persistent overdrive), worsening of the depression, and thoughts of suicide.
• Report any of these symptoms to the doctor, especially if they were not part of the patient's initial symptoms, are severe, or abrupt in onset.
• Be aware that Marplan may cause drowsiness, hypotension and faintness. If these symptoms occur, you should not perform potentially dangerous tasks, such as driving or operating machinery.
• Inform other healthcare professionals who are providing you with care (other doctors, your dentist, and other health professionals) that you are taking Marplan.

DON'T

• Don't eat certain tyramine-containing foods while taking Marplan. Tyramine may interact with Marplan to cause serious untoward effects. A helpful Dietary Guide is provided on this Website that lists foods to avoid.
• Don't drink alcoholic beverages, especially those containing high amounts of tyramine (including white wine and tap beer). The Dietary Guide and Menu on this Website lists alcoholic beverages to avoid. As with all antidepressants, it is unwise to drink any alcohol since it may aggravate the symptoms of depression.
• Don't take other prescription medicines or over-the-counter drugs without consulting with your doctor or pharmacist. Some OTC cough/cold, weight control, and hay fever/allergy preparations may interact with Marplan to cause serious untoward effects.
• Don't consume excessive amounts of caffeine. Caffeine is found in such products as coffee, tea, chocolate, cola drinks, and OTC stay-awake drugs. See the Dietary Guide for limits in the amount of these beverages.

Always discuss the results of your Marplan therapy with your doctor.

A few foods can cause dangerous interactions with Marplan - but most of the foods that you like may be just fine to eat. Here's information about:

• Why food interactions can happen
• The new information about the many foods you can enjoy
• The few foods and beverages to avoid

The Cause of Food Interactions

In the gut, MAO-Inhibitors can cause an increase in levels of a chemical called tyramine. Tyramine is also present in foods and beverages, particularly when those foods and beverages are aged or fermented.

If there is too much tyramine in the body, a dangerous rise in blood pressure may occur and possibly lead to a stroke. That's why it is important that you minimize the tyramine you consume while you are taking Marplan.

Years ago, when Marplan was first introduced, nutritionists didn't have advanced ways to measure tyramine in foods and beverages. So, to be as safe as possible, a diet restricting foods containing tyramine was developed, but that old diet was difficult to stay with because so many foods were incorrectly thought to be 'off limits'.

Fortunately--based on newer scientific studies--things have changed. While there still are some foods and drinks you should avoid--or have only in moderation, we now know that most foods that were once restricted are very low in tyramine and are now considered safe to consume when you are taking Marplan.

The Good News about the many foods you can enjoy

Look below at the Menu for a New Beginning and you'll see that freshness is the key - fresh dairy, fresh poultry, fresh fish, and fresh packaged or processed meats are safe food choices when you are taking Marplan.

So go right ahead and enjoy a burger or a hot dog at the barbecue. Nearly all fruits and vegetables are OK too.

However, you'll want to avoid any aged cheeses, fermented/dry/aged meats such as salami, most soy products, and any foods that haven't been stored properly or have passed their expiration dates.

Don't drink alcoholic beverages, especially those containing high amounts of tyramine (including white wine and tap beer). The Dietary Guide and the Menu for a new beginning on this Website list alcoholic beverages to avoid. As with all antidepressants, it is unwise to drink any alcohol since it may aggravate the symptoms of depression.

More information about safely consuming dairy, alcoholic beverages, and other foods can be found below in the Menu for a New Beginning or obtained from other on-line resources listed on this web site or from your doctor.

Take a "fresh" look at the diet guidelines and envision a bright future where you can enjoy a healthy, varied diet and the symptom relief that Marplan offers.

Avoiding Medication Interactions While Taking Marplan

Here is a list of medication combinations that should be avoided:

• Marplan should be administered with caution to patients receiving Antabuse^® (disulfiram)
• The use of Marplan in combination with other psychotropic agents is not recommended without your doctor's knowledge, because one product can potentially magnify the effects of the other.
• The MAO-Inhibiting effects of Marplan can persist for a substantial period after it has been discontinued, so it is best to wait at least 10 days before taking any other psychotropic medication.
• Marplan should not be used with other MAO-Inhibitors, tri-cyclic medications (dibenzazepine-related and other); Wellbutrin^® (buproprion); SSRI antidepressants; Buspar^® (buspirone); sympathomimetic drugs including amphetamines and over-the-counter cold, hay fever or weight-reducing preparations containing vasoconstrictors (decongestants); tryptophan; Demerol^® (meperidine); the cough-preventative dextromethorphan; anestheic agents; blood pressure drugs, including thiazide diuretics; or excessive amounts of caffeine; or central nervous system depressants such as narcotics, barbiturates, and alcohol.

Please see Full Prescribing Information including BOXED WARNINGS regarding increased risk of suicidality in children and adolescents. MAO-Inhibitors are contraindicated with certain drugs. Potential hypertensive crises may occur with foods that contain tyramine. As with all antidepressants, patients should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment.