tranylcypromine (Rx)

Brand and Other Names:Parnate
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 10mg
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Major Depressive Disorder

For use in patients who have not responded adequately to other antidepressants

Not indicated for nitial treatment due to potential for serious adverse reactions and drug interactions, and need for dietary restrictions

15 mg PO q12hr

Increase by 5 mg/dose at q1-3Weeks to optimum response; not to exceed 60 mg/day

May slowly decrease dosage to maintain dose once response is adequate

Dosing Considerations

Consider discontinuing therapy gradually because of risk for withdrawal effects

Switching from contraindicated antidepressants

  • After stopping treatment with contraindicated antidepressants, a time period of 4-5 half-lives of other antidepressant or any active metabolite should elapse before starting therapy; after stopping treatment with an MAO inhibitor antidepressant, a time period of at least one week or 4-5 half-lives of other MAO inhibitor (whichever is longer) should elapse before starting treatment therapy to reduce risk of additive effects

Switching from to other MAOIs or contraindicated antidepressants

  • After stopping treatment, at least one week should elapse before starting another MAOI (intended to treat MDD) or other contraindicated antidepressants; refer to prescribing information of subsequently used drug for product-specific advice on a medication-free interval

Discontinuing treatment

  • Withdrawal effects, including delirium, reported with abrupt discontinuation therapy; higher daily doses and longer duration of use appear to be associated with a higher risk of withdrawal effects; consider discontinuing therapy by slow, gradual dosage reduction

Safety & efficacy not established

Major Depressive Episode without Melancholia

15 mg PO q12hr

Increase by 5 mg/dose at q1-3Weeks to optimum response; not to exceed 60 mg/day

May slowly decrease dosage to maintain dose once response is adequate

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Interactions

Interaction Checker

and tranylcypromine

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            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)

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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

            Hypertensive Crisis with Significant Tyramine Use

            • Excessive consumption of foods or beverages with significant tyramine content or use of certain drugs during or after therapy discontinuation can precipitate hypertensive crisis; monitor blood pressure and allow for medication-free intervals between administration of therapy and interacting drugs; instruct patients to avoid ingestion of foods and beverages with high tyramine content

            Contraindications

            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), carbamazepine, tapentadol, cyclobenzaprine, methyldopa, tetrabenazine, milnacipran, tryptophan, dopamine, rasagiline, hydroxytryptophan, reserpine

            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

            High tyramine content food (eg, cheese, beer, Chianti wine, avocados, anchovies, herring, overripe fruit, chocolate, soy sauce, yeasts, yogurt, meat tenderizers, sauerkraut, broad beans)

            Pheochromocytoma and catecholamine-releasing paragangliomas

            Cautions

            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, history of seizures, thyroid dysfunction

            Drug may worsen psychosis in patients with bipolar disorder

            Activation of mania/hypomania may be precipitated by antidepressant treatment in patients with bipolar disorder; screen patients prior to treatment

            Hypotension (including syncope) may occur; monitor patients and adjust dosage or concomitant medication as necessary

            Hypotension and hypertension during anesthesia and perioperative care may occur; if possible, discontinue therapy prior to elective surgery

            Hepatitis and elevated liver enzymes may occur; monitor accordingly

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            Pregnancy & Lactation

            Pregnancy

            There are limited published reports of placental infarction and congenital anomalies in association with use during pregnancy; however, these reports may not adequately inform presence or absence of drug-associated risk with use of during pregnancy; animal embryo-fetal development studies were not conducted with tranylcypromine; however, published animal reproduction studies report placental transfer of tranylcypromine in rats and a dose-dependent decrease in uterine blood flow in pregnant sheep; advise pregnant women of the potential risk to a fetus

            Lactation

            Tranylcypromine is present in human milk; there is no available information on effects of tranylcypromine on milk production; there is no available information on effects of tranylcypromine on a breastfed child; however, because of potential for serious adverse reactions in a breastfed infant, advise nursing women to discontinue breastfeeding during treatment

            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

            Half-life elimination: 1.5-3 hr

            Onset: 2 days to 3 weeks

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

            Peak plasma time: 1.5-2 hr

            Peak plasma concentration: 110 ng/mL

            Excretion: Urine

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            Formulary

            FormularyPatient Discounts

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

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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.