phenelzine (Rx)

Brand and Other Names:Nardil
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 15mg
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Depression

Initial 15 mg PO q8hr, increase not to exceed 20-30 mg q8hr

Decrease dose after maximum response (2-6 weeks) over 2-6 week period to maintain dose as low as 15 mg qDay or every other day

Monitor blood pressure

Safety & efficacy not established

Depression

Initial 15 mg PO q8hr, increase not to exceed 20-30 mg q8hr

Decrease dose after maximum response (2-6 weeks) over 2-6 week period to maintain dose as low as 15 mg qDay or every other day

Monitor blood pressure

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Interactions

Interaction Checker

and phenelzine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Common

            • Orthostatic hypotension
            • Asthenia
            • Dizziness
            • Headache
            • Drowsiness
            • Fatigue
            • Hyperreflexia
            • Sleep disturbance
            • Somnolence
            • Weakness
            • Tremor
            • Constipation
            • Dry mouth
            • Weight gain

            Less Common

            • Confusion
            • Decreased memory
            • Paresthesia
            • Anorexia
            • Nausea
            • Vomiting
            • Impotence
            • Increased LFT's
            • Nystagmus
            • Urinary frequency or retention

            Uncommon

            • Edema
            • Anxiety
            • Irritation
            • Hypomania
            • Hypermetabolic syndrome (hyperpyrexia, tachycardia, tachypnea, increased CPK, acidosis)
            • Arthralgia
            • SIADH

            Rare

            • Hypertensive crisis
            • Ataxia
            • Seizure
            • Worsening depression
            • Suicide
            • Edema of glottis
            • Leukopenia
            • Hepatic necrosis, jaundice
            • Drug-induced lupus erythematosus
            • Visual disturbance
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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            In children and young adults, risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Pheochromocytoma, CHF, HTN

            Concomitant sympathomimetic drugs, meperidine, dextromethorphan

            Liver disease, abnormal liver function tests

            Severe renal impairment, ESRD

            Elective surgery using general anesthesia

            Cautions

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

            Hypertensive reactions may occur from consumption of foods high in tyramine or supplements containing caffeine, tyrosine, tryptophan, phenylalanine, or phenylalanine

            Orthostatic hypotension may occur

            Discontinue STAT at signs/symptoms of hypertensive crisis, eg, palpitations, occipital HA, N/V

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

            Bipolar disorder

            Hypertensive reactions may occur from consumption of foods high in tyramine or supplements containing caffeine, tyrosine, tryptophan, phenylalanine, or phenylalanine

            Not first-line therapy

            Discontinue 10 days before surgery

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: unknown; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Nonselective monoamine oxidase inhibitor; may inhibit the enzyme monoamine oxidase, which is responsible for the breakdown of dopamine, serotonin, epinephrine, and norepinephrine, in turn causing an increase in endogenous concentrations of these neurotransmitters.

            Pharmacokinetics

            Peak Plasma Time: 43 min

            Metabolism: by MAO

            Onset of action: 2-4 weeks

            Duration: Therapeutic effects and interactions may continue for up to 2 weeks after discontinuing therapy

            Metabolites: phenylacetic acid & parahydroxyphenylacetic acid

            Half-Life, Elimination: 11.6 hr

            Excretion: Urine

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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