Tranylcypromine (Parnate) - MOA, Dosage, Side effects

Tranylcypromine (Parnate) is a non-selective and irreversible monoamine oxidase inhibitor that is used in the treatment of anxiety and unipolar major depression.

Tranylcypromine Uses:

  • Unipolar Major depressive disorder:

    • Used for treatment of major depressive disorder in adult patients who have not responded adequately to other antidepressants.

Tranylcypromine Dose in Adults

Tranylcypromine Dose in the treatment of the Unipolar major depressive disorder:

P/O: Initial:

  • 10 to 30 mg per day, in divided doses
  • If symptoms don't improve after 2 weeks, increase the dose by 10 mg/day increments at 1- to 3-week intervals
  • Maximum dose: 60 mg/day
  • Usual dosage range 30 to 60 mg/day in divided doses.

  • Discontinuation of therapy:

    • When discontinuing antidepressant treatment that has lasted for >3 weeks, gradually taper the dose gradually (eg, over two to four weeks) to minimize withdrawal symptoms and to detect reappearance of symptoms.
    • Reasons for a slowly titrating the drug (eg, over four weeks) include the use of a drug with a half-life of fewer than 24 hours (eg, paroxetine, venlafaxine), prior history of withdrawal symptoms from an antidepressant, or high doses of antidepressants.
    • Symptoms associated with MAOIs are more severe requiring more conservative tapers necessary.
    • If intolerable withdrawal symptoms occur, resume the drug at a previously prescribed dose and/or decrease dose at a more gradual rate.
    • Selective patients (eg, those with a history of discontinuation syndrome) on long-term treatment (>6 months) may benefit from tapering over more than 3 months.
    • Data supporting ideal taper rates is limited.
    • MAO inhibitor recommendations:

  • Switching to or from an MAO inhibitor intended to treat psychiatric disorders:

    • 14 days should be allowed to elapse between discontinuing an alternative antidepressant without long half-life metabolites (eg, TCAs, paroxetine, fluvoxamine, venlafaxine) or MAO inhibitor intended to treat psychiatric disorders and initiation of tranylcypromine.
    • At least 5 to 6 weeks should be allowed to elapse between discontinuing fluoxetine (with long half-life metabolites) intended to treat psychiatric disorders and initiation of tranylcypromine.
    • At least 7 to 14 days should be allowed to elapse between discontinuing tranylcypromine and initiation of an alternative antidepressant or MAO inhibitor intended to treat psychiatric disorders.

Tranylcypromine Dose in Childrens

Not indicated for use in children.

Tranylcypromine Pregnancy Risk Category: Not Assigned

  • Pregnant women who are taking antidepressants during pregnancy should enroll in the National Pregnancy Registry for Antidepressants.

Use of tranylcypromine during breastfeeding

  • Breast milk contains Tranylcypromine.
  • The manufacturer recommends that the mother decide whether to stop breastfeeding or discontinue using the drug.
  • This is taking into consideration the importance of the mother's treatment.

Tranylcypromine Dose in Kidney Disease:

  • No dosage adjustments required, use cautiously.

Tranylcypromine Dose in Liver disease:

  • No dosage adjustments required, use cautiously.

Side effects of Tranylcypromine (Parnate):

  • Cardiovascular:

    • Edema
    • Orthostatic Hypotension
    • Palpitations
    • Tachycardia

  • Central Nervous System:

    • Agitation
    • Anxiety
    • Chills
    • Dizziness
    • Drowsiness
    • Headache
    • Insomnia
    • Mania
    • Myoclonus
    • Numbness
    • Paresthesia
    • Restlessness

  • Dermatologic:

    • Diaphoresis
    • Urticaria

  • Endocrine & Metabolic:

    • SIADH (Syndrome Of Inappropriate Antidiuretic Hormone Secretion)

  • Gastrointestinal:

    • Abdominal Pain
    • Anorexia
    • Constipation
    • Diarrhea
    • Nausea
    • Xerostomia

  • Genitourinary:

    • Sexual Disorder (Anorgasmia, Ejaculatory Disturbance, Impotence)
    • Urinary Retention

  • Hematologic & Oncologic:

    • Agranulocytosis
    • Anemia
    • Leukopenia
    • Thrombocytopenia

  • Neuromuscular & Skeletal:

    • Muscle Spasm
    • Tremor
    • Weakness

  • Ophthalmic:

    • Blurred Vision

  • Otic:

    • Tinnitus

Contraindications to Tranylcypromine (Parnate):

 

  • Because these tumors release pressor substances, they can cause hypertension.

Use in concomitant or rapid succession with:

 

  • Non-selective antagonists of the H-1 receptor
  • Antidepressants (including, but not limited to, other [MAOIs],[SSRIs] or [SNRIs], tricyclic and tricyclic antidepressants such as amoxapine. bupropion. maprotiline. nefazodone. vilazodone. vortioxetine.
  • Amphetamines & Methylphenidates & Derivatives
  • Symphomimetic products are products that contain pseudoephedrine and phenylephrine or dietary supplements containing sympathomimetics
  • Triptans
  • buspirone
  • Carbamazepine
  • Cyclobenzaprine
  • dextromethorphan
  • Dopamine
  • Hydroxytryptophan
  • Levodopa
  • meperidine
  • Methyldopa
  • Milnacipran
  • rasagiline
  • reserpine
  • s-adenosyl L-methionine,
  • Tapentadol
  • Tetrabenazine
  • Tryptophan

Canadian labeling: Additional contraindications not in US labeling

  • Blood dyscrasias; previous hypersensitivity to tranylcypromine and any component of this formulation.
  • There is not much evidence of cross-reactivity between MAOI and allergenic MAOI. Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects.

Warnings and precautions

  • Depression in the CNS:

    • CNS depression can lead to impairment of mental or physical abilities. Patients must be careful when operating machinery or driving.

  • Hypertensive crisis

    • Hypertensive crisis can sometimes be fatal. Symptoms include an occipital headache that radiates to the front, nausea/vomiting and neck stiffness/soreness.
    • Bradycardia and Tachycardia can be present. Constricting chest pain and pupillary dilatation could also occur.
    • All patients should be monitored closely for BP; if there is any palpitation or frequent headaches, stop immediately.
    • An underlying hypertensive crisis can be disguised by a history of headaches.
    • This may occur when you consume foods/supplements high in tryptophan, tryptophan, and phenylalanine.
    • Patients who have not consumed tyramine-rich foods and beverages have had clinically significant increases in BP.

  • Hypotension

    • Orthostatic hypotension may occur, especially at doses greater than 30 mg/day. It may also cause syncope.
    • Patients with hypotension should be given a gradual increase in dosage.

  • Intracranial bleeding

    • Intestinal bleeding, sometimes fatal, has been linked to the paradoxical rise in BP.

  • Serotonin syndrome

    • Serotonergic drugs (eg SSRIs, SNRIs), can cause potentially life-threatening serotonin Syndrome (SS), especially when combined with other serotonergic medications (eg triptans TCAs, fentanyl and buspirone, lithium, tramadol or tramadol), or agents that impair serotonin metabolism (eg MAO inhibitors to treat psychiatric conditions, other MAO inhibitors [ie linezolid, intravenous methylene]
    • Pay attention to signs of SS such as
      • Mental status changes (eg: agitation, hallucinations and delirium, coma, etc.)
      • Autonomic instability (eg tachycardia or labile blood pressure, diaphoresis, etc.)
      • Neuromuscular changes (eg tremors, rigidity, myoclonus, etc.)
      • GI symptoms (eg nausea, vomiting, diarrhea)
      • And/or seizures
    • Stop taking any serotonergic agents or treatment if you notice signs or symptoms.

  • Cardiovascular disease

    • Patients with severe hypertension, cerebrovascular disease or other cardiovascular conditions should be treated cautiously.

  • Diabetes:

    • Diabetes patients should be cautious. It may increase the chance of hypoglycemic episodes.
    • Patients who are taking insulin or oral hypoglycemic drugs should closely monitor their blood glucose.

  • Use of drugs:

    • Patients with a history of drug abuse or acute drinking problems should be cautious.
    • There may be a risk of developing drug dependence, particularly if the dose is higher than prescribed.

  • Hepatic impairment

    • Patients suffering from cirrhosis need to be closely monitored for potential adverse effects on the central nervous system, such as drowsiness and sedation.
    • Patients with hepatitis or elevated aminotransferases may develop. Stop taking this medication if you have hepatotoxicity.

  • Hypomania and mania:

    • Patients with bipolar disorder can experience mania or hypomania.
    • Patients with bipolar disorder should avoid monotherapy.
    • Patients with depressive symptoms should be screened.
    • Bipolar depression is not treated with Tranylcypromine.

  • Seizure disorder

    • Patients at high risk of seizures should be treated with caution. Seizures have been reported in combination with withdrawal from abuse or overdose.

  • Thyroid dysfunction

    • Patients with hyperthyroidism should be cautious; they may be at greater risk of developing hypertensive crises.

Tranylcypromine: Drug Interaction

Risk Factor C (Monitor therapy)

Acetylcholinesterase Inhibitors

May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.

Alfuzosin

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Altretamine

May enhance the orthostatic hypotensive effect of Monoamine Oxidase Inhibitors.

Amantadine

May enhance the anticholinergic effect of Anticholinergic Agents.

Amifampridine

Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine.

Anticholinergic Agents

May enhance the adverse/toxic effect of other Anticholinergic Agents.

Antiemetics (5HT3 Antagonists)

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Antipsychotic Agents

Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Antipsychotic Agents (Second Generation [Atypical])

Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]).

Barbiturates

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Benperidol

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Beta2-Agonists

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Beta2Agonists.

Betahistine

Monoamine Oxidase Inhibitors may increase the serum concentration of Betahistine.

Blood Glucose Lowering Agents

Monoamine Oxidase Inhibitors may enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Blood Pressure Lowering Agents

May enhance the hypotensive effect of HypotensionAssociated Agents.

Botulinum Toxin-Containing Products

May enhance the anticholinergic effect of Anticholinergic Agents.

Brexanolone

Tranylcypromine may enhance the CNS depressant effect of Brexanolone.

Brimonidine (Ophthalmic)

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Brimonidine (Ophthalmic). Monoamine Oxidase Inhibitors may increase the serum concentration of Brimonidine (Ophthalmic).

Brimonidine (Topical)

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Brimonidine (Topical). Monoamine Oxidase Inhibitors may increase the serum concentration of Brimonidine (Topical).

Brimonidine (Topical)

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Cannabinoid-Containing Products

Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol.

Cerebrolysin

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Chloral Betaine

May enhance the adverse/toxic effect of Anticholinergic Agents.

Chlorphenesin Carbamate

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Clemastine

Monoamine Oxidase Inhibitors may enhance the anticholinergic effect of Clemastine.

Codeine

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Codeine.

Diazoxide

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Dihydrocodeine

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Domperidone

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Domperidone. Monoamine Oxidase Inhibitors may diminish the therapeutic effect of Domperidone. Domperidone may diminish the therapeutic effect of Monoamine Oxidase Inhibitors.

Doxapram

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Doxapram.

Doxylamine

Monoamine Oxidase Inhibitors may enhance the anticholinergic effect of Doxylamine. Management: The US manufacturer of Diclegis (doxylamine/pyridoxine) and the manufacturers of Canadian doxylamine products specifically lists use with monoamine oxidase inhibitors as contraindicated.

EPINEPHrine (Nasal)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of EPINEPHrine (Nasal).

Epinephrine (Racemic)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Epinephrine (Racemic).

EPINEPHrine (Systemic)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of EPINEPHrine (Systemic).

Esketamine

May enhance the hypertensive effect of Monoamine Oxidase Inhibitors.

Gastrointestinal Agents (Prokinetic)

Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).

Glucagon

Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.

Herbs (Hypotensive Properties)

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Hypotension-Associated Agents

Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.

Itopride

Anticholinergic Agents may diminish the therapeutic effect of Itopride.

Lormetazepam

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Metaraminol

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Metaraminol.

Metaxalone

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Methadone

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Metoclopramide

Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome.

Mirabegron

Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.

Molsidomine

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Naftopidil

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Nicergoline

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Nicorandil

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Nitroglycerin

Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.

Nitroprusside

Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.

Norepinephrine

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Norepinephrine.

Opioid Agonists

Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination.

Opioid Agonists

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Pentoxifylline

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Phosphodiesterase 5 Inhibitors

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Prostacyclin Analogues

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Quinagolide

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Ramosetron

Anticholinergic Agents may enhance the constipating effect of Ramosetron.

Serotonin Modulators

May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid.

Thiazide and Thiazide-Like Diuretics

Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.

Topiramate

Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.

TraMADol

Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Risk Factor D (Consider therapy modification)

Amifostine

Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.

Benzhydrocodone

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Management: The use of benzhydrocodone is not recommended for patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation.

COMT Inhibitors

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

DOPamine

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of DOPamine. Management: Initiate dopamine at no greater than one-tenth (1/10) of the usual dose in patients who are taking (or have taken within the last 2 to 3 weeks) monoamine oxidase inhibitors. Monitor for an exaggerated hypertensive response to dopamine.

HYDROcodone

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of HYDROcodone. Management: Consider alternatives to this combination when possible.

Iohexol

Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.

Iomeprol

Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.

Iopamidol

Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.

Levodopa-Containing Products

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Of particular concern is the development of hypertensive reactions when levodopa is used with nonselective MAOI. Management: The concomitant use of nonselective monoamine oxidase inhibitors (MAOIs) and levodopa is contraindicated. Discontinue the nonselective MAOI at least two weeks prior to initiating levodopa. Monitor patients taking a selective MAOIs and levodopa.

Lithium

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Lithium. Management: This combination should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.

Obinutuzumab

May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion.

OxyCODONE

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Management: Seek alternatives when possible. Avoid use of oxycodone/naltrexone during and within 14 days after monoamine oxidase inhibitor treatment. Non-US labeling for some oxycodone products states that such use is contraindicated.

Pindolol

Monoamine Oxidase Inhibitors may enhance the hypotensive effect of Pindolol. Management: Canadian labeling for pindolol states that concurrent use with a monoamine oxidase inhibitor is not recommended.

Pramlintide

May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.

Reserpine

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Reserpine. Existing MAOI therapy can result in paradoxical effects of added reserpine (e.g., excitation, hypertension). Management: Monoamine oxidase inhibitors (MAOIs) should be avoided or used with great caution in patients who are also receiving reserpine.

Secretin

Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.

Risk Factor X (Avoid combination)

Aclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

Alcohol (Ethyl)

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Alpha-/Beta-Agonists (Indirect-Acting)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Alpha-/Beta-Agonists (Indirect-Acting). While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details.

Alpha1-Agonists

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Alpha1Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details.

Amphetamines

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Amphetamines. While linezolid and tedizolid may interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details.

Apraclonidine

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Apraclonidine. Monoamine Oxidase Inhibitors may increase the serum concentration of Apraclonidine.

AtoMOXetine

Monoamine Oxidase Inhibitors may enhance the neurotoxic (central) effect of AtoMOXetine.

Atropine (Ophthalmic)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Atropine (Ophthalmic).

Bezafibrate

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Bezafibrate.

Bromperidol

Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.

Buprenorphine

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

BuPROPion

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of BuPROPion.

BusPIRone

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Specifically, blood pressure elevations been reported.

CarBAMazepine

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Management: Avoid concurrent use of carbamazepine during, or within 14 days of discontinuing, treatment with a monoamine oxidase inhibitor.

Cimetropium

Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.

Cyclobenzaprine

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Cyproheptadine

Monoamine Oxidase Inhibitors may enhance the anticholinergic effect of Cyproheptadine. Cyproheptadine may diminish the serotonergic effect of Monoamine Oxidase Inhibitors.

Dapoxetine

May enhance the adverse/toxic effect of Serotonin Modulators.

Deutetrabenazine

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Deutetrabenazine.

Dexmethylphenidate

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Dexmethylphenidate.

Dextromethorphan

Monoamine Oxidase Inhibitors may enhance the serotonergic effect of Dextromethorphan. This may cause serotonin syndrome.

Diethylpropion

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Diethylpropion.

Diphenoxylate

May enhance the hypertensive effect of Monoamine Oxidase Inhibitors.

Droxidopa

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Droxidopa.

Eluxadoline

Anticholinergic Agents may enhance the constipating effect of Eluxadoline.

EPINEPHrine (Oral Inhalation)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of EPINEPHrine (Oral Inhalation).

FentaNYL

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Glycopyrrolate (Oral Inhalation)

Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).

Glycopyrronium (Topical)

May enhance the anticholinergic effect of Anticholinergic Agents.

Guanethidine

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Heroin

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Heroin.

HYDROmorphone

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of HYDROmorphone.

Indoramin

Monoamine Oxidase Inhibitors may enhance the hypotensive effect of Indoramin.

Iobenguane Radiopharmaceutical Products

Monoamine Oxidase Inhibitors may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose.

Ipratropium (Oral Inhalation)

May enhance the anticholinergic effect of Anticholinergic Agents.

Isometheptene

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Isometheptene.

Levomethadone

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Levonordefrin

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Levonordefrin.

Levosulpiride

Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.

Linezolid

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Linezolid.

Maprotiline

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Meperidine

Monoamine Oxidase Inhibitors may enhance the serotonergic effect of Meperidine. This may cause serotonin syndrome.

Meptazinol

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Meptazinol.

Mequitazine

Monoamine Oxidase Inhibitors may enhance the anticholinergic effect of Mequitazine.

Methyldopa

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Methyldopa.

Methylene Blue

Monoamine Oxidase Inhibitors may enhance the serotonergic effect of Methylene Blue. This could result in serotonin syndrome.

Methylene Blue

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Methylphenidate

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Methylphenidate.

Mianserin

Monoamine Oxidase Inhibitors may enhance the neurotoxic effect of Mianserin.

Mirtazapine

Monoamine Oxidase Inhibitors may enhance the neurotoxic (central) effect of Mirtazapine. While methylene blue and linezolid are expected to interact, specific recommendations for their use differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details.

Moclobemide

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Moclobemide.

Monoamine Oxidase Inhibitors

May enhance the hypertensive effect of other Monoamine Oxidase Inhibitors. Monoamine Oxidase Inhibitors may enhance the serotonergic effect of other Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Morphine (Systemic)

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Morphine (Systemic).

Nefopam

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Nefopam.

Opium

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Opium.

Oxatomide

May enhance the anticholinergic effect of Anticholinergic Agents.

OxyMORphone

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Pheniramine

May enhance the anticholinergic effect of Monoamine Oxidase Inhibitors.

Pholcodine

May enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Pizotifen

Monoamine Oxidase Inhibitors may enhance the anticholinergic effect of Pizotifen.

Potassium Chloride

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.

Potassium Citrate

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.

Reboxetine

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Reboxetine.

Revefenacin

Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.

Selective Serotonin Reuptake Inhibitors

Monoamine Oxidase Inhibitors may enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details.

Serotonin 5-HT1D Receptor Agonists

Monoamine Oxidase Inhibitors may decrease the metabolism of Serotonin 5-HT1D Receptor Agonists. Management: If MAO inhibitor therapy is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Exceptions: Eletriptan; Frovatriptan; Naratriptan.

Serotonin Reuptake Inhibitor/Antagonists

Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Serotonin Reuptake Inhibitor/Antagonists. While methylene blue and linezolid are expected to interact, specific recommendations for their use differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details.

Serotonin/Norepinephrine Reuptake Inhibitors

Monoamine Oxidase Inhibitors may enhance the serotonergic effect of Serotonin/Norepinephrine Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details.

Solriamfetol

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Solriamfetol.

SUFentanil

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Specifically, the risk for serotonin syndrome or opioid toxicities (eg, respiratory depression, coma) may be increased. Management: Sufentanil should not be used with monoamine oxidase (MAO) inhibitors (or within 14 days of stopping an MAO inhibitor) due to the potential for serotonin syndrome and/or excessive CNS depression.

Tapentadol

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Specifically, the additive effects of norepinephrine may lead to adverse cardiovascular effects. Tapentadol may enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome.

Tetrabenazine

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Tetrahydrozoline (Nasal)

Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Tetrahydrozoline (Nasal).

Tianeptine

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Tiotropium

Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.

Tricyclic Antidepressants

Monoamine Oxidase Inhibitors may enhance the serotonergic effect of Tricyclic Antidepressants. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details.

Tryptophan

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Umeclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

Valbenazine

May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.

Monitoring parameters:

  • Blood glucose
  • Hepatic and renal function
  • BP
  • Heart rate
  • Mental health
  • Worsening depression
  • Suicidality and unusual behavior changes (especially when therapy is just starting or doses are changed)

Mechanism of action of Tranylcypromine (Parnate):

  • Nonhydrazine monoamine-oxidase inhibitor Tranylcypromine can be used as a tranylcypromine.
  • It increases the endogenous levels of epinephrine and norepinephrine as well as serotonin, by inhibiting the enzyme (monoamineoxidase), which is responsible to the breakdown of these neurotransmitters.

TimeMAO inhibition can persist up to ten more days after discontinuation

AbsorptionRapid

Eliminating half-life- 2.5 hours

Time to peak, serum: 1.5 hours

International Brands of Tranylcypromine:

  • Jatrosom
  • Parnate
  • Parnetil

Tranylcypromine Brand Names in Pakistan:

Tranylcypromine injection 250 mg/ml
Xavene Wilshire Laboratories (Pvt) Ltd.

 

Tranylcypromine Capsules 250 mg
Zamic Cherwel Pharmaceuticals (Pvt) Ltd
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