Dosing and uses of Parnate (tranylcypromine)
Adult dosage forms and strengths
tablet
- 10mg
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
Pediatric dosage forms and strengths
Safety & efficacy not established
Geriatric dosage forms and strengths
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
Parnate (tranylcypromine) adverse (side) 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)
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
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), some CNS depressants (eg, narcotics, alcohol), antihypertensives, diuretics, antihistamines, sedatives, anesthetics, bupropion, buspirone, dextromethorphan, meperidine, SSRIs (eg, fluoxetine, paroxetine, sertraline), SNRIs (eg, venlafaxine)
Coadministration with 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)
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
Pregnancy and lactation
Pregnancy category: C
Lactation: unknown; use caution
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.
Pharmacology of Parnate (tranylcypromine)
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
