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Nardelzine

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Indications:

Treatment of “atypical” (“nonendogenous” or “neurotic”) depression; management of depression in patients unresponsive to other antidepressant drugs. Unlabeled Uses Treatment of bulimia; treatment of cocaine addiction; control of panic disorder with agoraphobia.

Contraindications:

Hypersensitivity to MAOIs; pheochromocytoma; CHF; abnormal liver function; history of liver disease; severe renal function impairment; cerebrovascular defect; concurrent use of dextromethorphan or CNS depressants (eg, alcohol); sympathomimetic drugs (eg, amphetamine, dopamine, norepinephrine) or related drugs (eg, methyldopa); CV disease.

Adverse reactions:

Cardiovascular Orthostatic hypotension; edema; hypertensive crisis. CNS Dizziness; headache; sleep disturbances; tremors; hyperflexemia; manic symptoms; convulsions; toxic delirium; coma. Dermatologic Rash; sweating; photosensitivity. EENT Blurred vision; glaucoma. GI Constipation; nausea; GI disturbances; anorexia. Genitourinary Sexual dysfunction; urinary retention; incontinence. Hematologic Anemia; leukopenia; agranulocytosis; thrombocytopenia. Hepatic Fatal progressive necrotizing hepatocellular damage; elevated serum transaminases; hepatitis. Metabolic Weight gain; hypermetabolic syndrome (eg, fever, tachycardia, rapid breathing, rigidity, metabolism, acidosis, coma); hypernatremia. Miscellaneous Transient respiratory and circulatory depression following electroconvulsive therapy.

Interactions:

Amine-containing foods May cause severe hypertension or hemorrhagic strokes. Anorexiants May cause exaggerated pharmacologic effects (eg, severe headaches, hypertension, hyperpyrexia) of anorexiants (amphetamines and related compounds). CNS depressants May enhance CNS effects. Dextromethorphan Concurrent use has been associated with severe reactions (eg, hyperpyrexia, hypotension, death). Fluoxetine, paroxetine, sertraline, trazodone Although data are limited, interactions comparable with those of the tricyclic antidepressants and phenelzine may occur. Guanethidine MAOIs may antagonize the antihypertensive effect. Insulin, sulfonylureas May enhance hypoglycemic action. Levodopa May cause hypertensive reactions. Meperidine May lead to severe reactions, including hypotension, convulsions, respiratory depression, and vascular collapse. Sympathomimetics May cause severe headache, hypertensive crisis, and hyperpyrexia. Tricyclic antidepressants, buspirone, cyclobenzaprine, carbamazepine, maprotiline, guanethidine, CNS stimulants, tyramine May lead to potentially fatal reactions, including seizures and hypertensive crisis; mental status changes, hyperthermia.

Warnings:

Pregnancy Category C . Lactation Undetermined. Children Not recommended in patients younger than 16 yr of age. Elderly Drug should be used cautiously in patients older than 60 yr of age because of possibility of existing cerebral sclerosis with damaged vessels. If hypertension develops, the risk of stroke may be increased. Depression associated with drug abuse/alcoholism Use with caution; increased risk of serious drug interactions. Epilepsy May lower seizure threshold. Diabetes May alter glucose control. Hypotension Orthostatic hypotension is significant adverse reaction and may lead to falling and changes in heart rate. Pyridoxine Phenelzine may cause pyridoxine deficiency, with symptoms of numbness, paresthesias and edema. Supplements may be required. Suicidal patients Strict supervision may be necessary in patients at risk.

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