| Major depressive disorder in adults not responding to other antidepressants (label). View labelExact | Label trials initiated at 10 mg twice daily, with increases every 2–4 days as tolerated until effect, up to 80 mg/day in divided doses (label). | Irreversible, nonselective monoamine oxidase inhibitor (MAOI). Generally reserved for treatment-resistant depression because of dietary restrictions and high-risk drug interaction profile (label/clinical). | Not available (label) | No | | - Before starting: review all prescription/OTC/supplement products and provide a written “do-not-combine” list; confirm understanding with teach-back (clinical).
- Diet: counsel on tyramine restriction and continue dietary precautions for at least 14 days after discontinuation (label/clinical).
- Vitals: monitor orthostatic blood pressure during titration and after dose changes; counsel on hydration and slow position changes (label/clinical).
- Emergency symptoms (severe headache, chest pain, palpitations, stiff neck, fever, marked agitation/confusion) require urgent evaluation because they can signal hypertensive crisis or serotonin syndrome (label/clinical).
- Mood: monitor for suicidality early in treatment and for mania/hypomania activation in patients with bipolar risk (class/clinical).
| No | 2025-12-30 |
|---|
| Treatment-resistant depression; atypical depression. View labelExact | Start 15 mg three times daily; increase by 15 mg increments every few days to 45 mg/day (week 1), 60 mg/day (week 2), and up to 75–90 mg/day divided for optimal response. | Irreversible monoamine oxidase inhibitor (MAOI); inhibits MAO-A and MAO-B. | Acetylation, CYP1A2 | Single-dose mean 12 h | No | | - Home blood pressure monitoring during titration (and after medication changes), with a clear plan for hypertensive crisis symptoms and emergency evaluation.
- Medication reconciliation at every visit (prescription, OTC, herbal) to prevent accidental exposure to serotonergic agents or sympathomimetics; reinforce washout timing.
- Dietary adherence and tyramine-risk counseling using teach-back; review common restaurant and packaged-food pitfalls.
- Orthostatic vitals, falls risk, and sleep/activation symptoms; adjust dose timing and supportive treatments to improve adherence.
- Liver-injury symptoms and periodic LFTs when clinically indicated; monitor for rare peripheral neuropathy and consider vitamin B6 support if symptoms develop.
- Mood destabilization (mania/hypomania) and suicidality monitoring during initiation and dose changes, especially in bipolar-spectrum illness.
| No | 2025-10-05 |
|---|
| Major depressive disorder in patients not responding to other therapies. View labelExact | Initiate 10 mg twice daily; increase by 10 mg/day every 1–2 weeks based on response and tolerability. | Irreversible nonselective monoamine oxidase inhibitor (MAOI). | CYP2A6, CYP2C19 | Single-dose mean 2 h | No | — | - Home blood pressure monitoring during titration and after medication changes, with clear hypertensive crisis instructions and emergency contact pathways.
- Medication reconciliation at every visit (prescription/OTC/herbal) to prevent accidental serotonergic or sympathomimetic exposure; enforce washout timing.
- Dietary adherence and teach-back review of tyramine-restricted foods (including restaurant and packaged-food pitfalls).
- Sleep/activation, anxiety, and orthostatic vitals; adjust dose timing and supportive measures to improve tolerability.
- Mood destabilization (mania/hypomania) and suicidality monitoring, especially in bipolar-spectrum illness; coordinate via the bipolar disorder hub.
| No | 2025-10-05 |
|---|
selegilineAdjunctive therapyBrands: Eldepryl, Zelapar | Adjunct for major depressive disorder (under EMSAM brand) and Parkinson disease (oral formulations). View labelExact | Parkinson disease: 5 mg tablet with breakfast and lunch (max 10 mg/day); Zelapar ODT 1.25 mg each morning, titratable to 2.5 mg/day. | Selective MAO-B inhibitor at low doses; becomes nonselective at 10 mg/day, increasing serotonin and norepinephrine. | CYP2B6, CYP2C19, CYP3A4 | Single-dose mean 10 h | No | — | - Blood pressure during titration and after medication changes, with a clear plan for hypertensive crisis symptoms and emergency evaluation.
- Medication reconciliation to prevent accidental exposure to contraindicated serotonergic agents, sympathomimetics, or opioids.
- Sleep and activation (insomnia, jitteriness), especially because amphetamine-like metabolites can be stimulating.
- Mood elevation or mixed features in bipolar-spectrum illness; coordinate plans via the bipolar disorder hub when antidepressant-dose MAOI activity is expected.
| No | 2025-10-05 |
|---|