Tranylcypromine

DEA Class;  Rx

Common Brand Names; Parnate

Hypersensitivity

Pheochromocytoma, CHF, cerebrovascular defect, CVD, HTN

Schizophrenia

History of severe or frequent headaches, liver disease

Contraindicated with MAOIs or dibenzazepine-related drugs, sympathomimetics (including amphetamines, which may be found in many herbal preparations), methylphenidates and derivatives, some CNS depressants (eg, narcotics, alcohol), antihypertensives, diuretics, antihistamines, sedatives, anesthetics, bupropion, buspirone, dextromethorphan, meperidine, SSRIs (eg, fluoxetine, paroxetine, sertraline), SNRIs (eg, venlafaxine), levodopa, s-adenosyl-L-methionine (SAM-e), tricyclic antidepressants, other antidepressants (eg, amoxapine, bupropion, maprotiline, nefazodone, trazodone, vilazodone, vortioxetine), carbamazepine, tapentadol, cyclobenzaprine, methyldopa, tetrabenazine, milnacipran, tryptophan, dopamine, rasagiline, hydroxytryptophan, reserpine, triptans

Sympathomimetic products (e.g., cold, hay fever or weight-reducing products that contain vasoconstrictors such as pseudoephedrine, phenylephrine, and ephedrine; or dietary supplements that contain sympathomimetics); may cause cerebral hemorrhage

Discontinue 10 days before surgery

• Orthostatic hypotension
• Dizziness
• Headache
• Drowsiness
• Sleep disturbance
• Fatigue
• Weakness
• Tremor
• Hyperreflexia
• Constipation
• Dry mouth
• Confusion
• Decr memory
• Nystagmus
• Paresthesia
• Anorexia
• N/V
• Impotence
• Urinary frequency or retention
• Anxiety
• Irritation
• Hypomania
• “Hypermetabolic syndrome” (hyperpyrexia, tachycardia, tachypnea, incr CPK, acidosis)
• Arthralgia
• Edema
• SIADH (rare)
• Risk of hypertensive crisis (rare,usu d/t drug interaction)
• Ataxia (rare)
• Seizure (rare)
• Jaundice (rare)
• Visual disturbance (rare)

Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 years)

Caution in patients with diabetes mellitus (monitor glucose closely), glaucoma, hepatic/renal impairment, thyroid dysfunction

Some MAOIs have contributed to hypoglycemic episodes in diabetic patients receiving insulin or other blood-glucose-lowering agents; monitor blood glucose in patients receiving both this drug and blood-glucose-lowering agents; a reduction of the dosage of such agents may be necessary

Seizures reported with therapy withdrawal after abuse, and with overdose; patients with history or at risk for seizures should be monitored accordingly

Drug may worsen psychosis in patients with bipolar disorder

Therapy may aggravate coexisting symptoms in depression, such as anxiety and agitation

Although excretion of this drug is rapid, inhibition of MAO may persist up to 10 days following discontinuation; this should be taken into account when considering use of potential interacting substances or consumption of tyramine-rich food or beverages or when interpreting adverse reactions observed after discontinuation; care should be taken to differentiate symptoms of persistent MAO inhibition from withdrawal symptoms

Activation of mania/hypomania may be precipitated by antidepressant treatment in patients with bipolar disorder; screen patients prior to treatment, prior to initiating treatment, screen patients for any personal or family history of bipolar disorder, mania, or hypomania

Hypotension and hypertension during anesthesia and perioperative care may occur; it is recommended that therapy be discontinued at least 10 days prior to elective surgery

There are limited published reports of placental infarction and congenital anomalies in association with use during pregnancy

Tranylcypromine is present in human milk; there is no available information on effects of tranylcypromine on milk production