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INTRODUCTION

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isocarboxazid (eye-soe-kar-box-a-zid)

Marplan

Classification

Therapeutic: antidepressants

Pharmacologic: monamine oxidase (MAO) inhibitors

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Indications
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Treatment of depression (usually reserved for patients who do not tolerate or respond to other modes of therapy [e.g., tricyclic antidepressants, SSRIs, SSNRIs, or electroconvulsive therapy]).

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Action
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Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the body. Therapeutic Effects: Improved mood in depressed patients.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, dizziness, headache, akathisia, anxiety, ataxia, drowsiness, euphoria, insomnia, restlessness, weakness. EENT: blurred vision. CV: HYPERTENSIVE CRISIS, orthostatic hypotension. GI: nausea, black tongue, constipation, diarrhea, dry mouth. GU: dysuria, sexual dysfunction, urinary incontinence, urinary retention. Derm: photosensitivity.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

  • Measure blood pressure (BP) periodically and compare to normal values (See Appendix F). Immediately report a large, rapid increase in BP (hypertensive crisis). Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, neck stiffness, sweating, and enlarged pupils. The risk of hypertensive crisis is increased when this drug is taken with other antidepressants, excessive caffeine, other drugs that increase BP, or foods that contain tyramine (e.g., fermented wines, cheeses).

  • Assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

  • Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior such as anxiety, euphoria, or severe restlessness.

  • Assess dizziness, drowsiness, and ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall-prevention strategies in patients with dizziness, ataxia, or other conditions that affect balance (See Appendix E).

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

  • Help patient explore nonpharmacologic methods to reduce depression (exercise, counseling, support groups, and so forth).

  • Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

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Patient/Client-Related Instruction
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  • Advise patient that antidepressant effects may not occur ...

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