Marplan Warnings and Precautions (Cont.)

• Marplan should be used only after other treatments have failed. Anyone taking Marplan should be under close supervision of a healthcare provider.
   
• Marplan has several potentially lethal food and drug interactions. In order to take Marplan safely, you must commit to avoiding many foods and medications, including many non-prescription medications. Always check with your healthcare provider before taking any medications (see Marplan Drug Interactions and Marplan Food Interactions for more information).
   
• Marplan can cause a hypertensive crisis, which is a life-threatening increase in blood pressure. Because of this, you should not take Marplan if you have heart problems including heart disease, cerebrovascular disease (such as a history of a stroke, TIA, or any bleeding in the brain), or if you already have high blood pressure, since increases in blood pressure can be especially dangerous if you have these conditions. Tell your healthcare provider right away if you have symptoms of a hypertensive crisis, such as:

o Headaches

o Feelings of a rapidly or forcefully beating heart (palpitations)

o A sore or stiff neck

o Nausea or vomiting

o Sweating, with a high fever (or sometimes with cold, clammy skin)

o Sensitivity to light

o A rapid heart rate (tachycardia) or a low heart rate (bradycardia)

o Chest pain or throat tightness

o Dilated (wide open) pupils.

• If you have frequent or severe headaches, Marplan may not be the best choice for you, as headaches are often the first symptom of a hypertensive crisis. If you have headaches often, you might not notice this warning sign.
   
• Antidepressants (including Marplan) may increase the risk of suicidal thoughts or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or develop new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thoughts or behavior (see Marplan and Suicide for more information).
   
• Before prescribing Marplan for depression, your healthcare provider should make sure that you do not have bipolar disorder (instead of depression). Sometimes, the symptoms of bipolar disorder and depression are very similar, and Marplan can cause problems in people with bipolar disorder.
   
• Be sure to tell all your healthcare providers (including dentists and surgeons) that you are taking Marplan.
   
• In addition to causing dangerously high blood pressure, Marplan can also cause low blood pressure (hypotension). Let your healthcare provider know if you have symptoms of low blood pressure, such as lightheadedness, dizziness, or fainting.
   
• There have been cases of people becoming dependent upon Marplan, especially when taking doses that are higher than recommended. Stopping Marplan suddenly can lead to withdrawal symptoms, especially after taking high doses of Marplan for a long time (see Marplan Withdrawal).
   
• For people taking Marplan, caution should be used when driving, operating heavy machinery, or performing other tasks that require concentration, especially when first starting Marplan or when switching dosages. This is because Marplan may affect a person's mental or physical ability to perform these tasks. Make sure to understand how Marplan affects you before performing any task that requires mental or physical concentration.
   
• Marplan may not be safe for use during pregnancy. Discuss the benefits and risks of using Marplan during pregnancy with your healthcare provider (see Marplan and Pregnancy for more information).
   
• It is not known if Marplan passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about what makes the most sense for your particular situation (see Marplan and Breastfeeding).
   
• It is recommended to stop taking Marplan at least 48 hours before certain radiology procedures (such as myelography), as Marplan should not be taken with certain contrast materials (dyes or other substances that help provider better images).
   
• Special care should be used when taking Marplan if you have a history of seizures, as Marplan can make seizures worse.
   
• The elderly appear to be more sensitive to Marplan, and certain Marplan side effects may be more dangerous in elderly people.
   
• Marplan can cause low blood sugar (hypoglycemia) in people taking diabetes medications. When starting Marplan or changing dosages, make sure to check your blood sugar levels more often.
   
• Talk to your healthcare provider before taking Marplan if you have hyperthyroidism (overactive thyroid) or take thyroid medication.
   
• Do not stop taking Marplan without first discussing it with your healthcare provider. Stopping the medicine abruptly may increase the risk for withdrawal symptoms (see Marplan Withdrawal).