tranylcypromine (Parnate)

Introduction

Tradename: Parnate. (tranylcypromine sulfate)

Indications

• symptomatic treatment of depression
  • refractory to or intolerant of tricyclic antidepressants or electroconvulsive therapy

Contraindications

• incontrolled hypertension
• pheochromocytoma
• congestive heart failure
• patients < 16 years or > 60 years of age
• severe renal insufficiency
• severe liver disease

Caution:

• avoid tyramine-containing foods
  • red wine
  • cheese (except cottage, ricotta & cream cheese)
  • smoked or pickled fish
  • beef or chicken liver
  • dried sausage
  • fava or broad bean pods
  • yeast vitamin supplements
  • yeast spreads
• use with caution in hyperactive or hyperexcitable patients
• glaucoma

pregnancy category = c

safety in lactation = ?

Dosage

• start 10 mg PO BID
• increase by 10 mg increments at 103 week intervals
• maximum: 60 mg/day

Tabs: 10 mg.

Pharmacokinetics

• 2-3 weeks to obtain full therapeutic effect
• when the drug is discontinued MAO activity is recovered in 3-5 days (possibly up to 10 days)
• more rapid onset of action than other MAO inhibitors

elimination via liver

1/2life = 2 hours

Monitor

plasma levels in patients with hepatic impairment

Adverse effects

• not common (1-10%)
  • orthostatic hypotension
• uncommon (< 1%)
  • edema, hypertensive crises*, drowsiness, hyperexcitability, rash, dry mouth, constipation, blurred vision, urinary retention, headache, photosensitivity, hepatitis

* more severe hypertensive reactions than other MAO inhibitors

• drug adverse effects of MAO inhibitors
• drug adverse effects of antidepressants
• drug adverse effects of psychotropic agents
• drug adverse effects of sympathomimetic(s)

Drug interactions

• sympathomimetic drugs
• meperidine
• tricyclic antidepressants (TCA)
• phenothiazines
• antihypertensive agents
• disulfiram
• selective serotonin reuptake inhibitor (SSRI)
  • fluoxetine
  • sertraline

• drug interaction(s) of benzodiazepines with antidepressants
• drug interaction(s) of antidepressants with benzodiazepines
• drug interaction(s) of beta-adrenergic receptor antagonists with MAO inhibitors
• drug interaction(s) of NSAIDs with antidepressants
• drug interaction(s) of MAO inhibitor with caffeine

More general terms

• adrenergic neuron stimulant
• monoamine oxidase [MAO] inhibitor
• amine
• aromatic compound

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5530
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=19493
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441233
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=26069
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441359