Tranylcypromine
PARNATE
Pronunciation: tran-il-SIP-roe-meen (PAR-nayt)
“Train sightin’ Parrot”
Mao Zedong → monoamine oxidase (MAO) inhibitor
What it isIrreversible MAO-A and MAO-B inhibitor with amphetamine-like structure; treatment-resistant depression.
Why this oneIt is more activating than phenelzine and more prone to hypertensive reactions, fitting anergic depression at the cost of vigilance.
What limits itTyramine can trigger hypertensive crisis and serotonergic drugs can trigger serotonin syndrome; observe drug-specific washout intervals.
FDA-approved for
- depression (~1961)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Adults | 30 mg/day in divided doses | 30 mg/day | 60 mg/day (30 mg BID) |
Titration Increase by 10 mg/day every 1 to 3 weeks if inadequate response (more gradually if hypotension risk)
Renal Undefined
Hepatic Undefined
Instructions
- Give in divided doses
- Discontinue gradually (withdrawal effects including delirium reported)
- Avoid high-tyramine foods/beverages during treatment and for 2 weeks after stopping
- Discontinue at least 10 days before elective surgery
- Switching: allow ≥1 week or 4–5 half-lives after another MAOI, and 4–5 half-lives after a contraindicated antidepressant, before starting; allow ≥1 week after stopping before starting another MAOI
Available strengths
- tab 10 mg
Contraindications
- Concomitant use or use in rapid succession with other MAOIs, SSRIs, SNRIs, tricyclic antidepressants, other antidepressants (e.g., bupropion, nefazodone, trazodone, vortioxetine), sympathomimetics, triptans, and numerous other serotonergic/pressor drugs — risk of hypertensive crisis or serotonin syndrome
- Pheochromocytoma or other catecholamine-releasing paraganglioma
Cautions
- Hypertensive crisis and hypertension
- Serotonin syndrome
- Activation of mania/hypomania (screen before treatment)
- Hypotension including postural hypotension and syncope
- Hypotension/hypertension during anesthesia and perioperative care
- Discontinuation syndrome
- MAO inhibition may persist up to 10 days after stopping
- Hepatotoxicity/elevated liver enzymes
- Seizures
- Hypoglycemia in diabetic patients
Adverse reactions
- Dry mouth
- Dizziness
- Insomnia
- Sedation/drowsiness
- Headache
- Overexcitement
- Constipation
- Blurred vision
- Tremor
Pregnancy Limited reports of placental infarction and congenital anomalies; advise potential fetal risk
Lactation Present in human milk; advise discontinuing breastfeeding during treatment
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 10 mg | tab | per unit | $0.59/ea | out of stock |
Generic entry2006
⚠ BOXED WARNINGS
- Suicidal thoughts and behaviors in patients under 25
- Hypertensive crises
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypertensive crisis and serotonin toxicity can occur with interacting foods or drugs; washout periods are essential.
Serotonin and MAOI
Provisional washout figures
Elevating mechanismMAO-A inhibitor
Non-elevating actionNone recorded
Exposure dependenceTherapeutic exposure
Washout AFTER an MAOI14 days
Evidence confidenceHigh
InterpretationNonselective irreversible MAOI; defining high-risk partner for significant SRIs.
Open Tranylcypromine in the interactive console ↗
Memory aids: interaction avatars
