Monoamine Oxidase Inhibitors Information - Drug Interactions, Uses and Benefits

Type of Drug:

Antidepressants; mood-elevating agents; MAOls.

How the Drug Works:

Monoamine oxidase inhibitors (MAOls) prevent the breakdown of the body’s own mood-elevating substances. The effect may take several weeks to be noticed.

Uses:

To treat chronic (long-term) depression in patients who have not responded satisfactorily to other antidepressants. They are rarely used as first-line antidepressant therapy.

Unlabeled Uses: Occasionally doctors may prescribe MAOls for bulimia and panic disorder associated with agoraphobia (fear of open or public places) and glob us hystericus syndrome (choking sensation associated with hysteria). Phenelzine has been investigated for use as an aid in treating cocaine addiction, night terrors, post-traumatic stress disorder, and migraines resistant to other therapies. Tranylcypromine has been used to treat Binswanger’s encephalopathy, seasonal affective disorder, and subjective symptoms of multiple sclerosis.

Drug abuse and dependence: Drug abuse and dependence have been reported in patients using excessive doses of tranylcypromine and isocarboxazid. Some of these patients had a history of substance abuse. The following withdrawal symptoms have been reported: Restless­ness; anxiety; depression; confusion; hallucinations; headaches; weakness; diarrhea.

Hypertensive Crisis: Hypertensive crisis (extreme elevations in blood pressure) can result from coadministraton of MAOls and certain drugs and foods.

Chest pain: MAOls may suppress chest pain that would otherwise serve as a warning of myocardial ischemia (inadequate circulation of blood to the heart, usually as a result of heart disease).

Liver Dysfunction: Discontinue isocarboxazid use at first sign of liver dysfunction or jaundice (yellowing of skin or eyes).

Depression: Tranylcypromine and isocarboxazid may aggravate coexisting symptoms in depression, such as anxiety and agitation.

Tyramine-containing foods: Do not eat foods with high tyramine, dopamine, or tryptophan content (see the following listing) during or for 2 weeks after the discontinuation of MAOI’s. Any high-protein food that is aged or undergoes breakdown by a putrefaction process to improve flavor is suspected of producing a significant increase in blood pressure in patients taking MAOI’s. Do not take any new prescription medication without first reviewing it with your doctor or pharmacist. Do not drink alcoholic beverages or self-medicate with dietary supplements, cold, hay fever, or weight-reducing preparations while undergoing therapy. Do not consume excessive amounts of caffeine in any form, and report headache or other unusual symptoms promptly.

Other Problem Foods: Broad beans (fava beans, overripe); chocolate; caffeine (eg, coffee, tea, colas); ginseng.

Pregnancy: Safety for use during pregnancy has not been established. Use during pregnancy or in women of childbearing age only when clearly needed and when the potential benefits outweigh the potential hazards to the fetus.

Breastfeeding: Tranylcypromine appears in breast milk. It is not known if the other MAOls appear in breast milk. Because of the potential for serious adverse effects in the nursing infant, decide whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Use in children younger than 16 years of age is not recommended.

Elderly: The most serious reactions to MAOI use involve changes in blood pressure. Older patients may suffer more problems than younger patients during and following an episode of increased blood pressure or malignant hyperthermia (extremely high fever). Older patients have less compensatory reserve to cope with any serious adverse reactions. Use with caution in the elderly.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include periodic liver chemistry (isocarboxazid).

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with MAOI’s. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with MAOls:

• anesthetic agents (eg, anesthesia, cocaine)
• anorexiants (eg, amphetamine, phentermine)
• antidiabetic agents (eg, insulin, sulfonylureas, glyburide, tolbutamide)
• beta blockers (eg, metoprolol, nadolol)
• buproprion HCI (eg, Zyban)
• meperidine (eg, Demerol)

Side Effects:

Every drug is capable of producing side effects. Many MAOI users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; constipation; diarrhea; stomach pain; appetite loss.

Nervous System: Hyperactivity; tremor; muscle twitching; unusual muscle movements; headache; dizziness; faintness; anxiety; jitteriness; memory impairment; sleep disturbances (eg, sleeplessness, excessively long sleeping periods); weakness; fatigue; drowsiness; restlessness; agitation; exaggerated reflexes; mania (eg, irritability, euphoria, distractability, excitability); abnormal skin sensations; lethargy; sedation.

Circulatory System: Changes in heart rate and rhythm; postural and orthostatic hypotension (dizziness or light headedness when rising from a seated or lying position); palpitations (pounding in the chest).

Skin: Rash; itching; sweating; jaundice (yellowing of skin or eyes).

Other: Dilated (widened) pupils; stiff neck; dry mouth; urinary frequoncy; edem (fluid retention) blurred vision; weight g8in; sexual problem; chills; impotence; abnormal blood cell counts; glucome; heavy feeling.

Guidelines for Use:

• Phenelzine - Recommended initial dosage is 15 mg 3 times daily. Increase dose to at least 60 mg/day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dose up to 90 mg/day to obtain sufficient MAO inhibition. Many patients do not show clinical response until treatment at 60 mg has been continued for 4 weeks or more. After maximum benefit is achieved, reduce dose slowly over several weeks. Maintenance dosage may be as low as 15 mg/day or 15 mg every other day; continued for as long as required.
• Tranylcypromine - The usual effective dose is 30 mg/day in divided doses. Improvement should be seen within 48 hours to 3 weeks after starting therapy. If there is no improvement after 2 weeks, increase dose in 10 mg/day increments at 1- to 3-week intervals. Dosage range may be extended to a maximum of 60 mg/day from the usual 30 mg/day. Gradually withdraw tranylcypromine when discontinuing therapy.
• Isocarboxazid - Recommended initial dosage is 10 mg twice daily. If tolerated, increase by 10 mg every 2 to 4 days to achieve a dose of 40 mg by the end of the first week of treatment. Dose can then be increased by increments of up to 20 mg/week, if needed and tolerated, to a maximum recommended dose of 60 mg/day. Daily dose should be divided into 2 to 4 doses. After a maximum clinical response is achieved, attempt to reduce the dose slowly over a period of several weeks with­out jeopardizing therapeutic response. Beneficial effect may not be seen in some patients for 3 to 6 weeks. If no response is obtained by then, discontinue therapy. Caution is indicated in patients for whom a dose of 40 mg/day is exceeded.
• Do not discontinue this medication or adjust dosage except on the advice of your doctor. Consult your doctor before taking any other medication, including nonprescription items, while taking an MAOI.
• This medicine may take several weeks to become effective. Continue to take as directed.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose in order to catch up, unless advised to do so by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor.
• Avoid tyramine-containing foods, alcohol, caffeine, and tryptophan (see Precautions).
• May cause drowsiness or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Dizziness, weakness, or fainting may occur when rising from a lying or sitting position. If this occurs, get up slowly.
• At doses over 30 mg/day, postural hypotension (dizziness or lightheadedness when rising from a seated or lying position) is a major side effect and may result in fainting. Dosage increases will be more gradual in patients showing a tendency toward low blood pressure at the beginning of therapy. Postural hypotension may be relieved by lying down until blood pressure returns to normal.
• Hypertensive crises (increase in blood pressure) as a result of concur­rent use of MAOI and certain foods or drugs (see Precautions) can occur and are potentially fatal. These crises usually occur within several hours after ingestion of the interacting food or drug. Notify your doctor immediately if you experience a headache that starts in the back of the head and moves forward, pounding in the chest, neck stiffness or soreness, nausea, vomiting, sweating (sometimes with fever or cold, clammy skin), dilated pupils, sensitivity to light, or changes in heart rate with or without chest pain or tightness.
• Notify your doctor if you experience rash or intolerable side effects.
• Use may complicate other medical treatment (eg, general anesthesia, surgery). Inform your doctors and dentist about your use of MAOls. Wear a Medic Alert bracelet or carry a card saying that you are taking an MAOI.
• A waiting period of 10 to 14 days is recommended when switching from one MAOI to another or from a dibenzapine-related agent. Other medications that interact with MAOls (eg, fluoxetine) have different waiting periods. Discuss appropriate waiting periods for changes in therapy with your doctor or pharmacist.
• Blood pressure will need to be monitored frequently.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature.

Pemoline - Guidelines for Using Pemoline - Uses and Benefits

Type of Drug:

Central nervous system stimulant.

How the Pemoline Product Works:

Pemoline stimulates the central nervous system. How it does this is not fully understood.

Uses of The Pemoline:

To aid in treatment of children with behavior problems (attention deficit disorder) characterized by hyperactivity, moderate to severe distractibility, short attention span, impulsive behavior, and extreme mood changes.

Unlabeled Uses: Occasionally doctors may prescribe pemoline for narcolepsy (irresistible periods of sleep lasting less than 15 minutes during normal waking hours) and excessive daytime sleepiness.

Precautions:

• Drug dependence: The similarity of pemoline to other brain stimulants with known dependence liability suggests that psychological and physical dependence might also occur. There have been isolated reports of temporary psychotic symptoms occurring in adults following the long-term misuse of excessive doses. Pemoline should be given with caution to emotionally unstable patients who may increase the dosage on their own initiative.

• CNS stimulants: CNS stimulants, including pemoline, have been reported to precipitate motor and phonic tics, and Tourette syndrome. Therefore, clinical evaluation for tics and Tourette syndrome in children and their families should precede use of stimulant medications.

• Potential liver toxicity: Report any unexplained appetite loss, nausea, vomiting, general body discomfort, weakness, or yellowing of the skin or eyes to your doctor.

• Total treatment program: Pemoline therapy should be part of a total treatment program that includes psychological, educational psychological, educational, and social measures.

• Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

• Breastfeeding: It is not known if pemoline appears in breast milk. Consult your doctor before you begin breastfeeding.

• Children: Safety and effectiveness in children less than 6 years of age have not been established. Pemoline use may worsen symptoms of behavior disturbance and thought disorder in psychotic children. Aggravation of Tourette syndrome and seizure disorders have been reported after starting pemoline therapy. Chronic administration of stimulants to children may be associated with growth inhabiting. Therefore, growth must be monitored during treatment. Long-term effects in children have not been well established. Treatment is not indicated in all cases of attention deficit disorder with hyperactivity. The decision to prescribe pemoline should depend on the assessment of the severity of the child’s symptoms for his or her age, and not depend solely on the presence of one or more of the behavioral characteristics.

• Lab Tests: Lab tests will be required before and during pemoline therapy. Tests may include periodic liver function evaluation.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over-­the-counter or prescription medications or dietary supplements while taking pemoline. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Decreased seizure thresh­old has been reported in patients also taking anti epileptic medications (eg, phenytoin).

Side Effects:

Every drug is capable of producing side effects. Many pemoline users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

• Digestive Tract: Nausea; stomachache; loss of appetite.

• Nervous System: Sleeplessness; seizures; hallucinations; dizziness; drowsiness; increased irritability; involuntary movements of tongue, face, arms, and legs; Tourette syndrome; depression; headache; abnormal eye movements.

• Other: Rash; yellowing of skin or eyes; dark urine; abnormal liver function tests; weight loss; liver dysfunction.

Guidelines for Use:

• Do not use pemoline until you have discussed with your doctor the risks and benefits of treatment. A written informed consent is required before beginning therapy.
• Dosage is individualized. Take exactly as prescribed. Administer as a single dose each morning.
• Do not stop taking or change the dose unless directed your doctor.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Clinical improvement with pemoline is gradual. Significant benefit may not be evident until after 3 to 4 weeks of therapy.
• Because of its association with life-threatening liver failure, pemoline should not ordinarily be considered as first-line drug therapy for attention deficit hyperactivity disorder (ADHD).
• May cause drowsiness or dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Notify your doctor immediately if you experience darkening of urine, appetite loss, general body discomfort, nausea, vomiting, yellowing of the skin or eyes, or uncontrolled movement.
• Notify your doctor if sleeplessness occurs and is bothersome.
• Chronic use may suppress growth in children.
• Your doctor may interrupt treatment occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.
• Pemoline therapy should be stopped if no benefit is noted after 3 weeks of taking the maximum do.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59° to 86°F).

Anorexiants Information - Side Effects, Uses and Benefits

Type of Drug:

Anorectic or anorexigenic drugs.

How the Drug Works:

Benzphetamine, diethylpropion, phendimetrazine, and phentermine ar central stimulants similar to amphetamine. These drugs reduce app title and may have other central or metabolic effects. Sibutramine pr longs the activity of central neurotransmitters.

Uses:

For the management of exogenous obesity as a short term adjunct (a flow weeks) in a regimen of weight reduction based on caloric restriction.

Precautions:

• Psychological disturbances: Psychological disturbances have occurred in patients who received an anorexiant together with a restrictive diet.

• Tolerance: Tolerance may develop within a few weeks. If tolerance develops, do not exceed the recommended dose to increase the effect; rather, discontinue the drug.

• Pregnancy: There are no adequate and well-controlled studies in pregnant women. Anorexiant use in pregnancy is not recommended. Do not use benzphetamine in pregnant women.

• Breastfeeding: Anorexiants are excreted in breast milk. It is not known if sibutramine appears in breast milk. Anorexiants are not recommended for nursing mothers. Consult your doctor before you begin breastfeeding.

• Children: Safety and effectiveness of diethylpropion, phentermine, and sibutramine in children younger than 16 years of age have not been established. Phendimetrazine and benzphetamine are not recommended for use in children younger than 12 years of age.

• Phentermine - Safety and effectiveness of Adipex-P have not been established. lonamin is not recommended in children younger than 16 years of age.

• Elderly: Use sibutramine with caution in elderly patients.

• Lab Tests:Lab tests  or exams may be required to monitor treatment. Tests may include blood pressure, pulse rate, and heart rhythm monitoring.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with an anorexiant. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with anorexiants:

• drugs that may raise blood pressure or increase heart rate (eg, certain decongestants;cough, cold, and allergyrine or pseudoephedrine)
• MAOls (eg, phenelzine)
• methyldopa (Aldomet)
• serotonergic agents (eg, SSRls, medications that contains ephed-oids, lithium, tryptophan)
• igraine drugs, certain opitricyclic antidepressants (eg, amitriptyline)

Side Effects:

Every drug is capable of producing side effects. Many anorexiant users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

• Digestive Tract: Appetite changes; constipation; nausea; indigestion; vomiting; intestinal inflammation; stomach pain; diarrhea; dry mouth; gas.

• Nervous System: Headache; migraine; sleeplessness; dizziness; nervousness; anxiety; depression; drowsiness; restlessness; general body discomfort; euphoria; agitation; jitteriness; emotional instability; abnormal involuntary movements; tremor; leg cramps; abnormal thinking.

• Circulatory System: Increased heart rate; flushing; increased blood pressure; palpitations (pounding in the chest); chest pain; heart rhythm disturbances.

• Respiratory System: Increased cough; shortness of breath.

• Urinary and Reproductive Tract: Irregular vaginal bleeding; difficult or pain fulmination; changes in urinary frequency; impotence; changes in sex drive; increased breast size in males.

• Skin: Rash; sweating; itching; hair loss; flushing.

• Other: Abnormal lab tests; muscle, chest, neck, or back pain; joint pain or disorder; taste sensation changes; fever; fluid retention; double vision; weakness; blurred vision; pupil dilation.

Guidelines for Use:

• If there is a patient package insert available with your prescription, read it before starting therapy and reread it each time your prescription is renewed.
• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless directed by your doctor. These drugs can be addicting.
• A single daily dose of benzphetamine is preferably given in the mid­morning or mid-afternoon, according to your eating habits. In an occasional patient, it may be desirable to avoid late afternoon administration.
• Take diet hyperopic 1 hour before meals, and in mid-evening if needed to overcome night hunger. Take diet hyperopic controlled-release once daily at mid-morning.
• Take immediate-release phendimetrazine 1 hour before meals. Take sustained-release phendimetrazine once daily in the morning, 30 to 60 minutes before the morning meal.
• Take 15 or 37.5 mg phentermine as a single daily dose before break­fast or 10 to 14 hours before bedtime. Take Adipex-Pcapsules and tablets before breakfast or 1 to 2 hours after breakfast; the tablet dosage may be adjusted to the patient’s need.
• Swallow loamingcapsules and all sustained-release products whole. Do not crush or chew.
• Take sibutramine once daily with or without food.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Wait at least 2 weeks before starting treatment with an anorexiant after stopping MAOls and before starting MAOls after stopping an anorexiant.
• Notify your doctor immediately if you experience rash, hives, or other allergic reactions; shortness of breath; chest pain; palpitations (pounding in the chest); nervousness; dizziness; fainting; swelling of the legs; pronounced dry mouth or constipation; deterioration of exercise tolerance; seizures; or sleeplessness.
• Discontinue sibutramine and contact your doctor if seizures occur.
• May cause drowsiness, dizziness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Do not take other medications or dietary supplements without your doctor’s approval. This includes nonprescription medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Avoid alcohol and other mental depressants (eg, narcotics, tranquilizers, antidepressants, hypnotics, antihistamines) while you are taking this medicine unless approved by your doctor.
• Inform you doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding. Women of childbearing potential should use adequate contraception while taking these drugs.
• Appetite suppressants are not a substitute for proper dieting. Lifestyle changes (eg, diet, exercise) are necessary to lose and then maintain weight loss.
• Diabetic patients - Insulin requirements in diabetes mellitus may change in association with the use of anorexiants and the concomitant diet restrictions.
• Avoid taking late in the day because of the possibility of sleeplessness.
• The long-term effects of this medicine are unknown.
• Lab tests or exams may be required to monitor treatment. Be sure to keep appointments.
• Store at controlled room temperature (59° to 86°F) in a tightly closed container. Protect from heat and moisture.

Anagrelide - Guidelines for Using Anagrelide - Uses and Benefits

Type of Drug:

Antiplatelet agent.

How the Drug Works:

It is not known exactly how anagrelide reduces blood platelet levels. It is thought that it may slow down how fast platelets are produced and released by the bone marrow

Uses:

For the treatment of patients with essential thom body to the mia (too many blood platelets) to reduce the elevated platelet count and the risk of clothing and associated symptoms.

Precautions:

Do not use in the following situations: Allergy to the drug or any of its ingredients.

Use with caution in the following situations: heart disease, known or suspected kidney disease liver disease

• Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits out­weigh the possible risks to the fetus.

• Breastfeeding: It is not known if this drug is excreted in breast milk. Consult your doctor before you being breastfeeding.

• Children: Safety and effectiveness in patients younger than 16 years of age have not been established.

• Lab Tests: Lab tests will be required to monitor therapy. Tests include cardiovascular exams, blood counts, and kidney and liver function monitoring.

Drug Interactions:

Tell Your doctor or pharmacist if you are taking or planning to take any over the counter or prescription medications or dietary supplements while taking this drug. Drug doses may need to be modified or a different drug prescribed. Sucralfate (Carafate) may interact with anagrelide.

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Circulatory System: Fast heartbeat; pounding in the chest (palpitations); heart failure; chest pain.

• Digestive Tract: Diarrhea; stomach pain; nausea; gas; vomiting; indigestion; appetite loss.

• Other : Headache; weakness; swelling; pain; dizziness; difficulty breathing; rash; hives; abnormal skin sensations; back pain; general body discomfort.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• Dosage will usually be slowly increased to achieve maximum benefit.
• Take without regard to meals. Take with food if stomach upset occurs.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Women of childbearing potential must use adequate contraception while· taking this drug. It may cause fetal harm when administered to a pregnant woman.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature (59° to 71° F) in a light-resistant container.