The Current Status of Marplan Availability
Despite a history of intermittent supply challenges, the branded MAOI antidepressant Marplan (isocarboxazid) is currently available for prescription in the United States. The manufacturer, Validus Pharmaceuticals, affirms its commitment to ensuring the medication remains accessible for patients and provides an NDC number for pharmacists. However, Marplan is available only in its brand-name form; there is currently no generic equivalent available in the U.S..
For patients and healthcare providers, it is important to understand the nuance of its availability. While not discontinued, its specialized nature and smaller market demand can sometimes lead to localized or temporary supply chain interruptions. The status of this medication requires careful monitoring, and communication with pharmacists and prescribers is essential to ensure a stable supply for those who depend on it.
Understanding Past Supply Challenges and Resolutions
Patient concerns about Marplan's availability are rooted in documented periods of scarcity. A notable event occurred in 2018 when a critical shortage arose due to manufacturing delays. This required the U.S. Food and Drug Administration (FDA) to coordinate with Validus Pharmaceuticals for the temporary importation of Marplan from a Danish manufacturer to address the supply gap.
Earlier in its history, confusion arose from manufacturing changes. In 1994, the original manufacturer, Hoffman-La Roche, announced its intent to discontinue the drug, which led to significant concern among patients and physicians who relied on it. These historical and more recent events highlight the vulnerability of the supply chain for older, less commonly prescribed medications like Marplan, even when they are still considered clinically valuable.
Marplan as a Second-Line Treatment Option
Marplan is a non-selective, irreversible monoamine oxidase inhibitor (MAOI) reserved for patients who have not responded satisfactorily to other antidepressants. Its use requires strict adherence to dietary guidelines to avoid serious side effects, such as hypertensive crisis. For this reason, MAOIs are not a first-line treatment for newly diagnosed depression.
Key dietary restrictions for Marplan users:
- Aged and mature cheeses (e.g., cheddar, parmesan, swiss)
- Cured or fermented meats (e.g., sausage, pepperoni, salami)
- Pickled or smoked fish
- Soy sauce, teriyaki sauce, tofu, miso soup
- Broad bean pods (fava beans)
- Yeast extracts (e.g., Marmite)
- Certain alcoholic beverages (e.g., tap beer, Chianti wine)
A Comparison of MAOI Antidepressants
| Feature | Marplan (isocarboxazid) | Nardil (phenelzine) | Parnate (tranylcypromine) |
|---|---|---|---|
| Availability | Branded only, currently available | Branded only, generally available | Branded only, generally available |
| Chemical Class | Hydrazine MAOI | Hydrazine MAOI | Non-hydrazine MAOI |
| Selectivity | Non-selective (inhibits both MAO-A & MAO-B) | Non-selective | Non-selective |
| Drug Form | Oral tablet | Oral tablet | Oral tablet |
| Tyramine Risk | High risk, requires strict dietary restrictions | High risk, requires strict dietary restrictions | High risk, requires strict dietary restrictions |
| Status in U.S. | One of few remaining classical MAOIs | One of few remaining classical MAOIs | One of few remaining classical MAOIs |
Potential Complications and Safety Measures
Beyond dietary restrictions, Marplan users must be cautious about numerous drug interactions. These include over-the-counter cold and hay fever medications, and certain prescription drugs like SSRIs, other antidepressants, and stimulants, which can lead to serious adverse effects. Patients should always inform their healthcare providers and dentists that they are taking Marplan.
Patients taking Marplan should also be monitored for signs of potential hypertensive crisis, which can manifest as a severe headache, neck stiffness, or palpitations. In addition, due to its older pharmacological profile, Marplan can cause various side effects, such as dizziness, dry mouth, and orthostatic hypotension.
What to Do If You Struggle with Availability
If you or a patient face difficulty in obtaining Marplan, here are a few steps to take:
- Communicate with your pharmacist: Pharmacists can provide the most current information on stock levels and may be able to contact the manufacturer or a specialty pharmacy on your behalf.
- Contact the manufacturer: Validus Pharmaceuticals' customer service can often provide updates on supply and distribution.
- Consult your prescriber: If availability becomes an ongoing issue, your doctor can discuss switching to an alternative MAOI or another class of antidepressant, weighing the risks and benefits of a change.
- Reference the NDC number: When discussing with your pharmacy, having the National Drug Code (NDC) 30698-032-01 can help ensure they are ordering the correct product.
Conclusion
Despite rumors and past shortages, the MAOI antidepressant Marplan (isocarboxazid) is still officially on the market in 2025, though its availability can be inconsistent. Its status as a second-line treatment, combined with the stringent dietary and drug interaction requirements, means it is not as widely prescribed as newer antidepressants. Patients who rely on this medication should maintain open communication with their healthcare providers and pharmacists to proactively manage their supply. Due to the medication's complexities and risks, any decision to start or stop Marplan, or to explore alternatives, must be made in close consultation with a medical professional.
For more detailed prescribing information and dietary guidelines, refer to the manufacturer's website at marplan.com.
