tranylcypromine (Rx)

Brand and Other Names:Parnate
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 10mg

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

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            Contraindicated (89)

            • amitriptyline

              tranylcypromine and amitriptyline both increase serotonin levels. Contraindicated.

            • amoxapine

              tranylcypromine and amoxapine both increase serotonin levels. Contraindicated.

            • apraclonidine

              apraclonidine, tranylcypromine. Mechanism: unknown. Contraindicated. Contraindicated in mfr. prescribing info.

              tranylcypromine, apraclonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            • armodafinil

              tranylcypromine increases effects of armodafinil by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • atomoxetine

              tranylcypromine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • benzphetamine

              tranylcypromine increases effects of benzphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • brimonidine

              tranylcypromine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            • bupropion

              tranylcypromine and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropion

            • buspirone

              tranylcypromine and buspirone both increase serotonin levels. Contraindicated.

              tranylcypromine, buspirone. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • caffeine

              tranylcypromine increases effects of caffeine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • carbamazepine

              carbamazepine increases toxicity of tranylcypromine by unknown mechanism. Contraindicated. D/C MAO inhibitor 2 weeks before.

            • citalopram

              tranylcypromine and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.

            • clomipramine

              tranylcypromine and clomipramine both increase serotonin levels. Contraindicated.

            • cyclobenzaprine

              tranylcypromine and cyclobenzaprine both increase serotonin levels. Contraindicated. Do not coadminister cyclobenzaprine with MAOIs or within 14 days of discontinuing an MAOI

            • cyproheptadine

              tranylcypromine, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.

            • desipramine

              tranylcypromine and desipramine both increase serotonin levels. Contraindicated.

            • desvenlafaxine

              tranylcypromine and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drug

            • deutetrabenazine

              tranylcypromine, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.

            • dexfenfluramine

              tranylcypromine increases effects of dexfenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dexmethylphenidate

              tranylcypromine increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dextroamphetamine

              tranylcypromine increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dextromethorphan

              tranylcypromine and dextromethorphan both increase serotonin levels. Contraindicated.

            • diethylpropion

              tranylcypromine increases effects of diethylpropion by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dobutamine

              tranylcypromine increases effects of dobutamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dopamine

              tranylcypromine increases effects of dopamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • dosulepin

              tranylcypromine and dosulepin both increase serotonin levels. Contraindicated.

            • doxepin

              tranylcypromine and doxepin both increase serotonin levels. Contraindicated.

            • duloxetine

              tranylcypromine and duloxetine both increase serotonin levels. Contraindicated.

            • eliglustat

              tranylcypromine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

            • entacapone

              entacapone, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Both nonselective MAO inhibitors and entacapone inhibit catecholamine metabolism, leading to increased levels of catecholamines. Potential for dangerously high HR or BP.

            • ephedrine

              tranylcypromine increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • epinephrine

              tranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • epinephrine inhaled

              tranylcypromine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.

            • escitalopram

              tranylcypromine and escitalopram both increase serotonin levels. Contraindicated.

            • fenfluramine

              tranylcypromine increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              fenfluramine, tranylcypromine. Either increases effects of the other by serotonin levels. Contraindicated. Coadministration with drugs that increase serotonin may increase the risk of serotonin syndrome. Do not use concomitantly or within 14 days of MAOIs.

            • fentanyl

              tranylcypromine increases toxicity of fentanyl by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.

            • fentanyl intranasal

              tranylcypromine increases toxicity of fentanyl intranasal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.

            • fentanyl transdermal

              tranylcypromine increases toxicity of fentanyl transdermal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.

            • fentanyl transmucosal

              tranylcypromine increases toxicity of fentanyl transmucosal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.

            • fluoxetine

              tranylcypromine and fluoxetine both increase serotonin levels. Contraindicated.

            • imipramine

              tranylcypromine and imipramine both increase serotonin levels. Contraindicated.

            • isocarboxazid

              isocarboxazid and tranylcypromine both increase serotonin levels. Contraindicated.

            • isometheptene

              tranylcypromine, isometheptene. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Hypertension, V tach.

            • isoproterenol

              tranylcypromine increases effects of isoproterenol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • levodopa

              tranylcypromine, levodopa. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • levodopa inhaled

              levodopa inhaled increases effects of tranylcypromine by dopaminergic effects. Contraindicated. Levodopa may enhance risk for acute hypertensive episode if coadministered with nonselective MAOIs. Discontinue use of any nonselective MAO inhibitors at least 2 weeks before initiating levodopa inhaled.

            • levomilnacipran

              tranylcypromine and levomilnacipran both increase serotonin levels. Contraindicated. Do not use MAOIs intended to treat psychiatric disorders with levomilnacipran or within 7 days of stopping levomilnacipran due to an increased risk of serotonin syndrome

            • lisdexamfetamine

              tranylcypromine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Contraindicated. Do not use amphetamines during and within 14 days of discontinuation of monoamine oxidase inhibitors. .

            • lofepramine

              tranylcypromine and lofepramine both increase serotonin levels. Contraindicated.

            • maprotiline

              tranylcypromine and maprotiline both increase serotonin levels. Contraindicated.

            • meperidine

              tranylcypromine and meperidine both increase serotonin levels. Contraindicated.

              tranylcypromine increases toxicity of meperidine by unknown mechanism. Contraindicated.

            • methamphetamine

              tranylcypromine increases effects of methamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • methylenedioxymethamphetamine

              tranylcypromine increases effects of methylenedioxymethamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • methylphenidate

              tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • midodrine

              tranylcypromine increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • milnacipran

              tranylcypromine and milnacipran both increase serotonin levels. Contraindicated.

            • modafinil

              tranylcypromine increases effects of modafinil by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • nefazodone

              tranylcypromine and nefazodone both increase serotonin levels. Contraindicated.

            • norepinephrine

              tranylcypromine increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • nortriptyline

              tranylcypromine and nortriptyline both increase serotonin levels. Contraindicated.

            • opicapone

              opicapone, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Both nonselective MAO inhibitors and opicapone inhibit catecholamine metabolism, leading to increased levels of catecholamines. Potential for dangerously high HR or BP.

            • ozanimod

              tranylcypromine and ozanimod both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of ozanimod with MAO-B inhibitors may decrease exposure of the active metabolites of ozanimod, which may inhibit MAO. The potential for a clinical interaction with MAO inhibitors has not been studied; however, the increased risk of nonselective MAO inhibition may lead to a hypertensive crisis. Allow at least 14 days to elapse between discontinuing ozanimod and initiating with MAO inhibitors.

            • paroxetine

              tranylcypromine and paroxetine both increase serotonin levels. Contraindicated.

            • phendimetrazine

              tranylcypromine increases effects of phendimetrazine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine and tranylcypromine both increase serotonin levels. Contraindicated.

            • phentermine

              tranylcypromine increases effects of phentermine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenylephrine

              tranylcypromine increases effects of phenylephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenylephrine PO

              tranylcypromine increases effects of phenylephrine PO by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • procarbazine

              procarbazine and tranylcypromine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.

            • propylhexedrine

              tranylcypromine increases effects of propylhexedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • protriptyline

              tranylcypromine and protriptyline both increase serotonin levels. Contraindicated.

            • pseudoephedrine

              tranylcypromine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline and tranylcypromine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of rasagiline and initiation of another MAOI or discontinuation of another MAOI and initiation of rasagiline.

            • safinamide

              tranylcypromine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration increases risk of nonselective MAO inhibition, that may lead to hypertensive crisis. At least 14 days should elapse between discontinuating safinamide and initiating MAOIs.

            • selegiline

              selegiline and tranylcypromine both increase serotonin levels. Contraindicated.

            • selegiline transdermal

              selegiline transdermal and tranylcypromine both increase serotonin levels. Contraindicated.

            • sertraline

              tranylcypromine and sertraline both increase serotonin levels. Contraindicated.

            • solriamfetol

              tranylcypromine will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.

            • St John's Wort

              tranylcypromine and St John's Wort both increase serotonin levels. Contraindicated.

            • tetrabenazine

              tetrabenazine, tranylcypromine. Other (see comment). Contraindicated. Comment: Risk of acute hypertensive episode; separate by 14 d. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.

            • tolcapone

              tolcapone, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Both nonselective MAO inhibitors and tolcapone inhibit catecholamine metabolism, leading to increased levels of catecholamines. Potential for dangerously high HR or BP.

            • trazodone

              tranylcypromine and trazodone both increase serotonin levels. Contraindicated.

            • trimipramine

              tranylcypromine and trimipramine both increase serotonin levels. Contraindicated.

            • tyramine

              tranylcypromine increases effects of tyramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Tyramine containing foods include cheese, red wine, caviar, herring, canned figs, fermented meats, fava beans, yeast extracts, miso, avocado.

            • venlafaxine

              tranylcypromine and venlafaxine both increase serotonin levels. Contraindicated.

            • vilazodone

              tranylcypromine, vilazodone. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration with MAO-A inhibitors are contraindicated. Do not prescribe vilazodone within 14 days of discontinuing or starting an MAO inhibitor.

            • vortioxetine

              tranylcypromine increases toxicity of vortioxetine by serotonin levels. Contraindicated.

            • xylometazoline

              tranylcypromine increases effects of xylometazoline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • yohimbine

              tranylcypromine increases effects of yohimbine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Serious - Use Alternative (101)

            • 5-HTP

              tranylcypromine and 5-HTP both increase serotonin levels. Avoid or Use Alternate Drug.

            • albuterol

              tranylcypromine increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • alfentanil

              tranylcypromine increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • almotriptan

              almotriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases levels of almotriptan by decreasing metabolism. Contraindicated.

            • arformoterol

              tranylcypromine increases effects of arformoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • belladonna and opium

              tranylcypromine increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • benzhydrocodone/acetaminophen

              tranylcypromine increases toxicity of benzhydrocodone/acetaminophen by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.

            • brompheniramine

              tranylcypromine increases effects of brompheniramine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • buprenorphine

              tranylcypromine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • buprenorphine buccal

              tranylcypromine increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • butorphanol

              tranylcypromine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • carbinoxamine

              tranylcypromine increases effects of carbinoxamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • cetirizine

              tranylcypromine increases effects of cetirizine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.

            • chlorpheniramine

              tranylcypromine increases effects of chlorpheniramine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • clemastine

              tranylcypromine increases effects of clemastine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • cocaine

              tranylcypromine and cocaine both increase serotonin levels. Contraindicated.

            • codeine

              tranylcypromine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • desflurane

              tranylcypromine increases levels of desflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • desloratadine

              tranylcypromine increases effects of desloratadine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.

            • dexchlorpheniramine

              tranylcypromine increases effects of dexchlorpheniramine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • dexfenfluramine

              tranylcypromine and dexfenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dextroamphetamine

              tranylcypromine and dextroamphetamine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dextromoramide

              tranylcypromine increases toxicity of dextromoramide by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • diamorphine

              tranylcypromine increases toxicity of diamorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • difenoxin hcl

              tranylcypromine increases toxicity of difenoxin hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • dihydroergotamine

              tranylcypromine and dihydroergotamine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dihydroergotamine intranasal

              tranylcypromine and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.

            • diphenhydramine

              tranylcypromine increases effects of diphenhydramine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • diphenoxylate hcl

              tranylcypromine increases toxicity of diphenoxylate hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • dipipanone

              tranylcypromine increases toxicity of dipipanone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • dolasetron

              dolasetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • dopexamine

              tranylcypromine increases effects of dopexamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • doxapram

              doxapram increases effects of tranylcypromine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • doxepin cream

              tranylcypromine increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.

            • doxylamine

              tranylcypromine increases effects of doxylamine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. .

            • eletriptan

              eletriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases levels of eletriptan by decreasing metabolism. Contraindicated.

            • epinephrine racemic

              tranylcypromine increases effects of epinephrine racemic by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • ergotamine

              tranylcypromine and ergotamine both increase serotonin levels. Avoid or Use Alternate Drug.

            • fedratinib

              tranylcypromine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

            • fenfluramine

              tranylcypromine and fenfluramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • fexofenadine

              tranylcypromine increases effects of fexofenadine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.

            • fluvoxamine

              fluvoxamine and tranylcypromine both increase serotonin levels. Contraindicated.

            • formoterol

              tranylcypromine increases effects of formoterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • frovatriptan

              frovatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases levels of frovatriptan by decreasing metabolism. Contraindicated.

            • granisetron

              granisetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • hydrocodone

              tranylcypromine increases toxicity of hydrocodone by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.

            • hydromorphone

              tranylcypromine increases toxicity of hydromorphone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • hydroxyzine

              tranylcypromine increases effects of hydroxyzine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.

            • iobenguane I 131

              tranylcypromine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • isoniazid

              tranylcypromine and isoniazid both increase serotonin levels. Avoid or Use Alternate Drug.

            • ketamine

              tranylcypromine increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • L-tryptophan

              tranylcypromine and L-tryptophan both increase serotonin levels. Avoid or Use Alternate Drug.

            • levalbuterol

              tranylcypromine increases effects of levalbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • levocetirizine

              tranylcypromine increases effects of levocetirizine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.

            • levorphanol

              tranylcypromine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • linezolid

              linezolid and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

            • lithium

              tranylcypromine and lithium both increase serotonin levels. Avoid or Use Alternate Drug.

            • lonafarnib

              tranylcypromine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • loratadine

              tranylcypromine increases effects of loratadine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines.

            • lorcaserin

              tranylcypromine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

            • lsd

              tranylcypromine and lsd both increase serotonin levels. Avoid or Use Alternate Drug.

            • metaproterenol

              tranylcypromine increases effects of metaproterenol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • metformin

              tranylcypromine will increase the level or effect of metformin by unspecified interaction mechanism. Avoid or Use Alternate Drug.

            • methadone

              tranylcypromine increases toxicity of methadone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • methyldopa

              tranylcypromine, methyldopa. Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine inhibits the hypotensive effects of methyldopa. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with methyldopa.

            • methylene blue

              methylene blue and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

            • metoclopramide intranasal

              metoclopramide intranasal increases toxicity of tranylcypromine by Other (see comment). Avoid or Use Alternate Drug. Comment: Metoclopramide may enhance the hypertensive effect of monoamine oxidase inhibitors.

            • metrizamide

              tranylcypromine, metrizamide. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Do not coadminister because tranylcypromine may lower seizure threshold. D/C MAO inhibitor 24h before admin of metrizamide.

            • mirtazapine

              tranylcypromine and mirtazapine both increase serotonin levels. Avoid or Use Alternate Drug.

            • morphine

              tranylcypromine and morphine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases toxicity of morphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • nalbuphine

              tranylcypromine increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • naratriptan

              naratriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases levels of naratriptan by decreasing metabolism. Contraindicated.

            • netupitant/palonosetron

              netupitant/palonosetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • ondansetron

              ondansetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • opium tincture

              tranylcypromine increases toxicity of opium tincture by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • oxycodone

              tranylcypromine increases toxicity of oxycodone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • oxymetazoline intranasal

              tranylcypromine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. MAOIs cause norepinephrine accumulation within adrenergic neurons. Significant hypertension can result if coadministered with alpha1 agonists.

            • oxymorphone

              tranylcypromine increases toxicity of oxymorphone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • palonosetron

              palonosetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • papaveretum

              tranylcypromine increases toxicity of papaveretum by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • pentazocine

              tranylcypromine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • pirbuterol

              tranylcypromine increases effects of pirbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • pirfenidone

              tranylcypromine will increase the level or effect of pirfenidone by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid; coadministration of pirfenidone and moderate CYP1A2 inhibitors result in moderately increased exposure to pirfenidone; if unable to avoid, decrease dose of moderate CYP1A2 inhibitor

            • promethazine

              tranylcypromine increases effects of promethazine by Other (see comment). Avoid or Use Alternate Drug. Comment: Tranylcypromine should not be administered in combination with antihistamines because of potential additive CNS depressant effects. MAO inhibitors also prolong and intensify anticholinergic effects of antihistamines. Combination of tranylcypromine and promethazine may result in additive hypotensive effects.

            • propofol

              tranylcypromine increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • rizatriptan

              rizatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated.

              tranylcypromine increases levels of rizatriptan by decreasing metabolism. Contraindicated.

            • salmeterol

              tranylcypromine increases effects of salmeterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • SAMe

              tranylcypromine and SAMe both increase serotonin levels. Avoid or Use Alternate Drug.

            • sevoflurane

              tranylcypromine increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • sufentanil

              tranylcypromine increases toxicity of sufentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • sufentanil SL

              tranylcypromine increases toxicity of sufentanil SL by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.

            • sumatriptan

              sumatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated.

              tranylcypromine increases levels of sumatriptan by decreasing metabolism. Contraindicated.

            • sumatriptan intranasal

              sumatriptan intranasal and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated.

              tranylcypromine increases levels of sumatriptan intranasal by decreasing metabolism. Contraindicated.

            • tapentadol

              tranylcypromine increases toxicity of tapentadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • tedizolid

              tedizolid, tranylcypromine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Interaction with MAOIs were not studied in clinical trials; drugs within the same class(eg linezolid) are contraindicated with MAOIs.

            • terbutaline

              tranylcypromine increases effects of terbutaline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • tramadol

              tranylcypromine and tramadol both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • umeclidinium bromide/vilanterol inhaled

              tranylcypromine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

            • valbenazine

              tranylcypromine, valbenazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of valbenazine with MAOIs may increase monoamine neurotransmitter concentration in synapses, potentially increasing risk of serotonin syndrome or attenuating valbenazine effect.

            • vilanterol/fluticasone furoate inhaled

              tranylcypromine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

            • zolmitriptan

              zolmitriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.

              tranylcypromine increases levels of zolmitriptan by decreasing metabolism. Contraindicated.

            Monitor Closely (87)

            • aripiprazole

              tranylcypromine, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • asenapine

              tranylcypromine, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • atogepant

              tranylcypromine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avapritinib

              tranylcypromine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              tranylcypromine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • benztropine

              tranylcypromine, benztropine. Other (see comment). Use Caution/Monitor. Comment: Anti-parkinsonism drugs should be used with caution in patients receiving tranylcypromine since severe reactions have been reported.

            • bretylium

              tranylcypromine increases effects of bretylium by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. Bretylium produces release of catecholamines from nerve endings. This increased catecholamine release is potentiated by MAOIs.

            • brexpiprazole

              tranylcypromine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.

            • buprenorphine subdermal implant

              tranylcypromine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

            • buprenorphine, long-acting injection

              tranylcypromine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Concomitant use could result in life-threatening serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Buprenorphine long-acting injection is not recommended for patients taking MAOIs or within 14 days of stopping such treatment.

            • cannabidiol

              tranylcypromine will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP2C19 inhibitor.

            • captopril

              tranylcypromine increases effects of captopril by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • cariprazine

              tranylcypromine, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • chlorpromazine

              tranylcypromine, chlorpromazine. Other (see comment). Use Caution/Monitor. Comment: Coadministration of MAOI and phenothiazines may lead to additive hypotensive effects.

            • chlorpropamide

              tranylcypromine increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor.

            • cilostazol

              tranylcypromine increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).

            • clozapine

              tranylcypromine, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • codeine

              tranylcypromine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

            • diazepam intranasal

              tranylcypromine will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

              diazepam intranasal, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • difenoxin hcl

              difenoxin hcl, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.

            • diphenoxylate hcl

              diphenoxylate hcl, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.

            • disulfiram

              disulfiram, tranylcypromine. Mechanism: unknown. Use Caution/Monitor. Possible CNS delirium including agitation, visual hallucinations, and disorientation may occur. .

            • eluxadoline

              tranylcypromine increases levels of eluxadoline by decreasing metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2A6 inhibitors.

            • esketamine intranasal

              esketamine intranasal, tranylcypromine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with MAO-Is. .

            • etomidate

              tranylcypromine increases levels of etomidate by pharmacodynamic synergism. Use Caution/Monitor.

            • finerenone

              tranylcypromine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              tranylcypromine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluphenazine

              tranylcypromine, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • gabapentin

              gabapentin, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • glimepiride

              tranylcypromine increases effects of glimepiride by unknown mechanism. Use Caution/Monitor.

            • glipizide

              tranylcypromine increases effects of glipizide by unknown mechanism. Use Caution/Monitor.

            • glyburide

              tranylcypromine increases effects of glyburide by unknown mechanism. Use Caution/Monitor.

            • green tea

              green tea, tranylcypromine. Other (see comment). Use Caution/Monitor. Comment: Avoid combination or excessive consumption of green tea. Combination may increase risk of cardiac arrhythmias or severe hypertension can occur due to caffeine component of green tea.

            • haloperidol

              tranylcypromine, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • hydralazine

              hydralazine, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • iloperidone

              tranylcypromine, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • indacaterol, inhaled

              indacaterol, inhaled, tranylcypromine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with MAO inhibitors. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • insulin aspart

              tranylcypromine increases effects of insulin aspart by unknown mechanism. Use Caution/Monitor.

            • insulin degludec

              tranylcypromine, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin degludec/insulin aspart

              tranylcypromine, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin detemir

              tranylcypromine increases effects of insulin detemir by unknown mechanism. Use Caution/Monitor.

            • insulin glargine

              tranylcypromine increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.

            • insulin glulisine

              tranylcypromine increases effects of insulin glulisine by unknown mechanism. Use Caution/Monitor.

            • insulin inhaled

              tranylcypromine, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin lispro

              tranylcypromine increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.

            • insulin NPH

              tranylcypromine increases effects of insulin NPH by unknown mechanism. Use Caution/Monitor.

            • insulin regular human

              tranylcypromine increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.

            • isavuconazonium sulfate

              tranylcypromine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ivacaftor

              tranylcypromine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • lasmiditan

              lasmiditan, tranylcypromine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              tranylcypromine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

            • lemborexant

              tranylcypromine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

              lemborexant, tranylcypromine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • lithium

              lithium, tranylcypromine. Mechanism: unknown. Use Caution/Monitor. Risk of malignant hyperpyrexia. Interactions esp. expected w/non selective MAOIs.

            • lomitapide

              tranylcypromine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • loxapine

              tranylcypromine, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • loxapine inhaled

              tranylcypromine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • lurasidone

              lurasidone, tranylcypromine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              tranylcypromine, lurasidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              tranylcypromine, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • maraviroc

              maraviroc, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

            • midazolam intranasal

              tranylcypromine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • molindone

              tranylcypromine, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • olanzapine

              tranylcypromine, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • oliceridine

              tranylcypromine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

              tranylcypromine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.

            • olodaterol inhaled

              tranylcypromine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. MAO inhibitors prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • opium tincture

              opium tincture, tranylcypromine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.

            • oxymetazoline topical

              oxymetazoline topical and tranylcypromine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • paliperidone

              tranylcypromine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • perphenazine

              tranylcypromine, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • phenylephrine ophthalmic

              tranylcypromine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

            • pimavanserin

              tranylcypromine, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pimozide

              tranylcypromine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pregabalin

              pregabalin, tranylcypromine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • quetiapine

              tranylcypromine, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • remifentanil

              remifentanil increases toxicity of tranylcypromine by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • remimazolam

              remimazolam, tranylcypromine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              tranylcypromine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • tamsulosin

              tranylcypromine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • tapentadol

              tranylcypromine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • tazemetostat

              tranylcypromine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • thiothixene

              tranylcypromine, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • tinidazole

              tranylcypromine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tolazamide

              tranylcypromine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.

            • tolbutamide

              tranylcypromine increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor.

            • trifluoperazine

              tranylcypromine, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • trihexyphenidyl

              tranylcypromine, trihexyphenidyl. Other (see comment). Use Caution/Monitor. Comment: Anti-parkinsonism drugs should be used with caution in patients receiving tranylcypromine since severe reactions have been reported.

            • valerian

              valerian and tranylcypromine both increase sedation. Use Caution/Monitor.

            • yohimbe

              yohimbe increases effects of tranylcypromine by pharmacodynamic synergism. Use Caution/Monitor.

            • ziprasidone

              tranylcypromine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            Minor (15)

            • amobarbital

              tranylcypromine increases levels of amobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • butabarbital

              tranylcypromine increases levels of butabarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • butalbital

              tranylcypromine increases levels of butalbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • celandine

              celandine increases effects of tranylcypromine by pharmacodynamic synergism. Minor/Significance Unknown. Based on animal studies.

            • cordyceps

              cordyceps increases effects of tranylcypromine by pharmacodynamic synergism. Minor/Significance Unknown.

            • panax ginseng

              panax ginseng increases effects of tranylcypromine by pharmacodynamic synergism. Minor/Significance Unknown.

            • pentobarbital

              tranylcypromine increases levels of pentobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • phenobarbital

              tranylcypromine increases levels of phenobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • pleurisy root

              pleurisy root decreases effects of tranylcypromine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

            • primidone

              tranylcypromine increases levels of primidone by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • ruxolitinib

              tranylcypromine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • secobarbital

              tranylcypromine increases levels of secobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • sulfadiazine

              tranylcypromine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

            • sulfamethoxazole

              tranylcypromine increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

            • sulfisoxazole

              tranylcypromine increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

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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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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            tranylcypromine oral
            -
            10 mg tablet
            tranylcypromine oral
            -
            10 mg tablet
            tranylcypromine oral
            -
            10 mg tablet
            Parnate oral
            -
            10 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            tranylcypromine oral

            TRANYLCYPROMINE - ORAL

            (tran-il-SIP-roe-meen)

            COMMON BRAND NAME(S): Parnate

            WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug interactions can increase this risk. Food and drinks that contain tyramine can also increase this risk. See also Side Effects and Drug Interactions sections. Check your blood pressure regularly. Tell your doctor and pharmacist about all prescription/nonprescription drugs and herbal products you take before starting tranylcypromine. Ask them before starting any other drugs while taking tranylcypromine, and even when you stop taking tranylcypromine since it can still cause these interactions for a period of time.

            USES: Tranylcypromine is an antidepressant (monoamine oxidase inhibitor). This medication treats depression by restoring the balance of certain natural substances (neurotransmitters) in the brain. Tranylcypromine can improve your mood and feelings of well-being. Usually, this medication is used in persons who have not responded to treatment with other drugs.

            HOW TO USE: Read the Medication Guide available from your pharmacist before you start using tranylcypromine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth, usually in divided doses or as directed by your doctor. This medication may be taken with or without food. Dosage is based on your medical condition and response to therapy and usually will not be more than 60 milligrams per day.To reduce your risk of side effects, your doctor may start you at a low dose and gradually increase your dose. Once your condition improves and you are better for a while, your doctor may work with you to reduce your regular dose. Follow your doctor's instructions carefully. Do not take more or less medication or take it more frequently than prescribed. Your condition will not improve any faster and your risk of side effects will increase.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day. It may take several weeks for the full benefits of this medication to be noticed. Do not stop taking this medication without consulting your doctor.If you suddenly stop using this medication, you may have withdrawal symptoms (such as restlessness, confusion, hallucinations, headache, weakness, and diarrhea). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used tranylcypromine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.Inform your doctor if your condition persists or worsens.

            SIDE EFFECTS: See also Warning section.Dizziness, drowsiness, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, mental/mood changes (e.g., agitation, confusion), muscle stiffness, changes in sexual ability/interest, shaking (tremor), shivering, swollen ankles/legs, unusual weight gain, eye pain/swelling/redness, vision changes (e.g., double/blurred vision), signs of liver problems (e.g., nausea/vomiting that doesn't stop, stomach/abdominal pain, yellowing eyes/skin, dark urine), seizures.Stop taking tranylcypromine and get medical help right away if any of these symptoms of extremely high blood pressure (hypertensive crisis) occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, sudden sensitivity to light (photophobia).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking tranylcypromine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (e.g., stroke), high blood pressure, heart problems (e.g., coronary artery disease, chest pain, heart attack, heart failure), severe/frequent headaches, mental/mood disorders (e.g., schizophrenia, bipolar disorder), liver problems, kidney disease, certain nervous system diseases (Parkinson's syndrome, seizures), overactive thyroid (hyperthyroidism), personal/family history of glaucoma (angle-closure type).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery or any procedures requiring use of contrast dye (e.g., myelography), tell your doctor or dentist you are on this medication. You may need to stop taking this drug beforehand. Follow your doctor's instructions carefully.If you have heart disease, this medication may mask chest pain. Avoid strenuous exercise while taking this medication.If you have diabetes, tranylcypromine may lower your blood sugar. Check your blood sugar regularly and share the results with your doctor. Tell your doctor right away if you have symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the effects on blood pressure.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Since untreated mental/mood problems (such as depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other antidepressants (including maprotiline, mirtazapine, nefazodone, TCAs such as amitriptyline/nortriptyline), appetite suppressants (such as diethylpropion), drugs for attention deficit disorder (such as atomoxetine, methylphenidate), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, deutetrabenazine, dextromethorphan, certain drugs for high blood pressure (such as guanethidine, methyldopa, beta blockers such as atenolol, clonidine, rauwolfia alkaloids), other MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline), certain opioid medications (such as fentanyl, methadone, tapentadol), metoclopramide, certain drugs for Parkinson's (such as entacapone, levodopa, tolcapone), s-adenosyl-L-methionine (SAM-e), street drugs (such as LSD, mescaline), stimulants (such as amphetamines, cocaine, dopamine, epinephrine, phenylalanine), tetrabenazine, "triptan" migraine drugs (such as sumatriptan, rizatriptan), tramadol, tyrosine, tryptophan, valbenazine.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/ "ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), meperidine, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Tell your doctor or pharmacist if you are using any of these medications before, during, or within 2 weeks after treatment with tranylcypromine. Tell your doctor or pharmacist if you have taken fluoxetine during at least 5 weeks before starting tranylcypromine. Discuss with your doctor how much time to wait between starting or stopping any of these drugs and taking tranylcypromine.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy, cough-and-cold products, diet pills) because they may contain dextromethorphan, decongestants, stimulants, or ingredients that cause drowsiness. Ask your pharmacist about the safe use of those products.It is very important that you follow special dietary restrictions in order to limit the amount of tyramine in your diet. Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate. Caffeine can increase the side effects of this medication. Foods and beverages high in tyramine should be avoided while you are taking this medication and for at least 2 weeks after you stop using this medication.Foods high in tyramine include: aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, brick, bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, colby, edam), aged/dried/fermented/salted/smoked/pickled/processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring), banana peel, beef/chicken liver (stored, not fresh), bouillon cubes, commercial gravies, concentrated yeast extracts, fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread, kim chee (Korean fermented cabbage), orange pulp, overripe or spoiled fruits, packaged soups, red wine, sauerkraut, sherry, snow pea pods, sourdough bread, soy sauce, soybeans, soybean paste/miso, tofu, tap beer and ale, vermouth.Moderate-to-low tyramine content foods include: alcohol-free beer, avocados, bananas, bottled beer and ale, chocolate and products made with chocolate, coffee, cola, cultured dairy products (such as buttermilk, yogurt, sour cream), distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.Tell your doctor or pharmacist right away if you notice symptoms of high blood pressure such as fast/slow heartbeat, vomiting, sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, or trouble speaking.Contact your healthcare professionals (e.g., doctor, pharmacist, dietician) for more information, including recommendations for your diet.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., blood pressure, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take as soon as you remember unless the next scheduled dose is within 2 hours. In that case, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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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            • View the formulary and any restrictions for each plan.
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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.