Tranylcypromine

Tranylcypromine is a prescription medication used to treat depression. Because of its potentially serious side effects, it is often used only after other antidepressants haven't worked. Tranylcypromine belongs to a group of drugs called monoamine oxidase (MAO) inhibitors. It works by increasing the levels of certain natural chemicals in the brain that affect your mood and help maintain mental balance.

Tranylcypromine comes in tablet form. It is usually taken 2 times daily, with or without food.

Common side effects include nausea, dry mouth, and dizziness. Tranylcypromine can cause drowsiness. Do not drive or operate heavy machinery until you know how it affects you.

Tranylcypromine is a prescription medication used to treat depression, when other medications have failed.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Tranylcypromine may be found in some form under the following brand names:

• Parnate

Serious side effects have been reported. See "Drug Precautions" section.

Common side effects include:

• dry mouth
• dizziness
• diarrhea
• headaches
• nausea
• stomach pain
• constipation
• insomnia
• drowsiness
• weakness
• low blood pressure when standing or sitting up
• difficulting urinating
• shakiness

This is not a complete list of tranylcypromine side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all of the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• certain other antidepressants including amitriptyline (Elavil), amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), maprotiline, nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil)
• amphetamines such as amphetamine (in Adderall), benzphetamine (Didrex), dextroamphetamine (Dexedrine, Dextrostat, in Adderall), and methamphetamine (Desoxyn)
• bupropion (Wellbutrin, Zyban)
• buspirone (BuSpar)
• caffeine (No-Doz, Quick-Pep, Vivarin)
• cyclobenzaprine (Flexeril)
• dexfenfluramine (Redux) (not available in the U.S.)
• dextromethorphan (Robitussin, others)
• disulfiram (Antabuse)
• diuretics ('water pills')
• doxepin cream (Zonalon)
• insulin and oral medications for diabetes
• levodopa (Larodopa, in Sinemet)
• medications for allergies, cough and cold symptoms, and hay fever
• medications for high blood pressure such as guanethidine (Ismelin) (not available in the U.S.), methyldopa (Aldomet), and reserpine (Serpalan)
• medications for Parkinson's disease, anxiety, or weight loss (diet pills)
• medications for seizures such as carbamazepine (Tegretol); narcotic medications for painother MAOIs such as isocarboxazid (Marplan), pargyline (not available in the U.S.), phenelzine (Nardil), procarbazine (Matulane), and selegiline (Eldepryl)
• meperidine (Demerol)
• sedatives
• selective serotonin reuptake inhibitors such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
• sleeping pills
• tranquilizers
• medications containing alcohol (Nyquil, elixirs, others)
• medications for nausea or mental illness

This is not a complete list of tranylcypromine drug interactions. Ask your doctor or pharmacist for more information.

Tranylcypromine can remain in your body for several weeks after you stop taking it. Tell your doctor or pharmacist that you recently stopped taking tranylcypromine before you start taking any new medications.

Serious side effects have been reported with tranylcypromine including:

• hypertensive crisis, a life threatening increase in blood pressure. This sometimes fatal side effect can result from taking MAO inhibitors like tranylcypromine with certain drugs and foods (see "Drug Interactions" and "Food Interactions" sections). Symptoms include:
  • headaches
  • stiff or sore neck
  • nausea
  • vomiting
  • palpitations
  • sweating, sometimes with fever and cold, clammy skin
  • either fast or slow heart beat
  • chest pain
  • chest tightness
  • dilated pupils

Get medical help right away if you experience these symptoms.

• severe headaches. If you have frequent headaches, talk to your doctor before starting tranylcypromine as headaches are one of the first symptoms of a hypertensive crisis and you may miss this warning sign.
• suicidal thoughts or behavior. Antidepressants may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.
  • Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
  • Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
• low blood pressure, especially when getting up from a lying position.

Tranylcypromine can cause drowsiness. Do not drive or operate heavy machinery until you know how it affects you.

Do not take tranylcypromine if you:

• are allergic to any ingredient in tranylcypromine
• have heart disease
• have high blood pressure
• have a type of adrenal tumor known as pheochromocytoma
• have a history of a stroke
• have had a transient ischemic attack (TIA)
• have had bleeding in the brain
• are going to have surgery 
• have liver disease
• are taking drugs that should not be taken during treatment with tranylcypromine

Tyramine is a naturally occurring compound found in some cheeses and other foods that may cause dangerously high blood pressure in people taking monoamine oxidase inhibitors (MAOIs) like tranylcypromine.

You should avoid eating very large amounts of foods containing high amounts of tyramine such as:

• cheese (particularly strong or aged varieties)
• sour cream
• Chianti wine
• sherry
• beer (including non-alcoholic beer)
• liqueurs
• pickled herring
• anchovies
• caviar
• liver
• canned figs
• raisins
• bananas
• avocados (particularly if overripe)
• chocolate
• soy sauce
• sauerkraut
• the pods of broad beans (fava beans)
• yeast extracts
• yogurt
• meat extracts
• meat prepared with tenderizers
• dry sausage

Some of the signs and symptoms of dangerously high blood pressure (hypertensive crisis) are:

• severe headache
• vision problems
• confusion
• stupor (mental numbness)
• coma
• seizures
• chest pain
• unexplained nausea or vomiting
• stroke-like symptoms (sudden numbness or weakness - especially on one side of the body)

Get emergency medical help if you experience these symptoms.

Before taking tranylcypromine tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• have heart, liver, or kidney disease
• have high blood pressure
• have had a stroke or heart attack
• have pheochromocytoma
• have frequent headaches
• have or have family members with bipolar disorder
• have tried to commit suicide
• have epilepsy
• have a scheduled surgery or radiology procedure
• have hyperthyroidism
• drink alcohol
• are pregnant or breastfeeding

Tell your doctor about all of the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if tranylcypromine will harm your unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if tranylcypromine is excreted in human breast milk or if it will harm your nursing baby.

• Take tranylcypromine exactly as prescribed.
• Tranylcypromine comes in tablet form and is usually taken twice a day.
• It can be taken with or without food.
• If tranylcypromine upsets your stomach, try taking it with food.
• If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of tranylcypromine at the same time.

Take tranylcypromine exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The tranylcypromine dose your doctor recommends will be based on the following:

• other medical conditions you have
• other medications you are taking
• how you respond to this medication

The usual effective dosage is 30 mg per day, usually given in divided doses. If there are no signs of improvement after a reasonable period (up to 2 weeks), then the dosage may be increased in 10 mg per day increments at intervals of 1 to 3 weeks; the dosage range may be extended to a maximum of 60 mg per day from the usual 30 mg per day.

If you take too much tranylcypromine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If tranylcypromine is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store between 15° and 30°C (59° and 86°F).
• Keep this and all medications out of the reach of children.

Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of tranylcypromine or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Tranylcypromine is not approved for use in pediatric patients.