DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.This drug should not be used with the following medications because very serious (possibly fatal) interactions may occur: antidepressants (including maprotiline, mirtazapine, nefazodone, SNRIs such as duloxetine/venlafaxine, SSRIs such as citalopram/fluoxetine/paroxetine, TCAs such as amitriptyline/nortriptyline), appetite suppressants (e.g., diethylpropion), drugs for attention deficit disorder-ADD (e.g., atomoxetine, methylphenidate), certain antihistamines (azatadine, carbetapentane, chlorpheniramine), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, dextromethorphan, herbal products (e.g., ephedra/ma huang), certain drugs for high blood pressure (guanethidine, methyldopa), other MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine), certain narcotic medications (fentanyl, meperidine, methadone, morphine, tapentadol), certain drugs for Parkinson's (entacapone, levodopa, tolcapone), street drugs (e.g., MDMA/"ecstasy," LSD, mescaline), stimulants (e.g., amphetamines, cocaine, dopamine, epinephrine, phenylalanine), tetrabenazine, "triptan" migraine drugs (e.g., sumatriptan, rizatriptan), tramadol.If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting procarbazine. Do not take these medications within the 2 weeks before, during or after treatment with procarbazine. If you have been taking fluoxetine, wait at least 5 weeks before starting procarbazine. Ask your doctor how much time to wait between starting or stopping any of these drugs and taking procarbazine.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: bethanidine, digoxin, other drugs for high blood pressure (e.g., beta blockers such as atenolol, clonidine, rauwolfia alkaloids such as reserpine, "water pills"/diuretics such as hydrochlorothiazide), methotrexate, papaverine, tryptophan.Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., phenytoin), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, lithium, risperidone, trazodone).Check the labels on all your medicines (e.g., allergy, cough-and-cold products, decongestants, diet pills) because they may contain dextromethorphan, decongestants, stimulants, or drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.To prevent a very serious high blood pressure reaction, it is very important that you follow a special diet recommended by your doctor or dietician in order to limit your intake of tyramine while you are taking this medicine. Avoid foods and beverages that are high in tyramine, including: aged cheeses (e.g., bleu, cheddar, parmesan), dried/aged/fermented meats and sausages (e.g., salami, liverwurst), preserved fish (e.g., pickled herring), products containing large amounts of yeast (e.g., concentrated yeast extract, bouillon cubes, powdered soup/gravy, homemade or sourdough bread), fermented foods (e.g., sauerkraut, kim chee), most soybean products (e.g., soy sauce, tofu), broad/fava beans, red wine, sherry, tap beers, vermouth. Limit or avoid foods that are moderate in tyramine, including: avocados, bananas, eggplant, green beans, raisins, raspberries, red plums, spinach, tomatoes, chocolate, cultured dairy products (e.g., buttermilk, yogurt, sour cream), fish eggs, pate, peanuts, coffee, cola, alcohol-free beer, bottled beer, distilled spirits, port, white wine.Consult your doctor or dietician for more details and a complete list of other tyramine-containing foods you should limit or avoid.Seek immediate medical attention if you notice symptoms of very high blood pressure such as unusually fast/slow heartbeat, vomiting, unexplained sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, slurred speech.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
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