BLACK BOX WARNING
- suicidality in children, adolescents, and young adults
tranylcypromine
Brand: Parnate
⚠ BBW Beers Criteria Prototype: phenelzine
Drug Class: monoamine oxidase inhibitor (MAOI)
Drug Family: antidepressant
Subclass: irreversible, non-selective MAOI
Organ Systems: cns
Mechanism of Action
Irreversibly inhibits both MAO-A and MAO-B through covalent binding. Unlike phenelzine, tranylcypromine has amphetamine-like structural properties and mild dopamine reuptake inhibitory activity, contributing to its slightly stimulant character. Enzyme inhibition is restored only by new protein synthesis over 2-3 weeks.
MAO-A (monoamine oxidase A)MAO-B (monoamine oxidase B)
Indications
- major depressive disorder (particularly treatment-resistant)
- atypical depression
Contraindications
- concurrent serotonergic drugs
- concurrent sympathomimetics
- tyramine-rich foods
- cerebrovascular disease
- pheochromocytoma
Adverse Effects
Common
- insomnia (more than phenelzine)
- agitation
- dry mouth
- orthostatic hypotension
- sexual dysfunction
Serious
- hypertensive crisis with tyramine
- serotonin syndrome
- intracerebral bleeding (rare)
Pharmacokinetics (ADME)
| Absorption | well absorbed orally |
| Distribution | widely distributed; crosses BBB |
| Metabolism | hepatic; forms amphetamine as a minor metabolite |
| Excretion | renal |
| Half-life | 2-2.5 hours (but effect duration 2-3 weeks) |
| Onset | antidepressant 2-4 weeks |
| Peak | 1-3 hours |
| Duration | pharmacodynamic effect persists 2-3 weeks |
| Protein Binding | minimal |
| Vd | not well characterized |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| serotonergic agents | serotonin syndrome; potentially fatal | contraindicated |
| tyramine-rich foods | hypertensive crisis | contraindicated |
| sympathomimetics | hypertensive crisis | contraindicated |
| meperidine | excitatory serotonin syndrome (distinct from typical pattern; may include seizures) | contraindicated |
Nursing Considerations
- Tranylcypromine has more stimulant properties than phenelzine due to its amphetamine-like structure; insomnia is the most prominent complaint and is managed by morning-only dosing.
- Same dietary tyramine restrictions as phenelzine apply; review tyramine food list at every visit and document patient acknowledgment.
- 14-day washout period required before switching to serotonergic agents; document clearly in chart.
- Blood pressure should be monitored at each visit; both orthostatic hypotension and, with interactions, hypertensive crisis are possible extremes.
Clinical Pearls
- Tranylcypromine's stimulant properties (derived from its amphetamine-like structure) make it the preferred MAOI for patients with anergic depression or hypersomnia-predominant features.
- The interaction between meperidine and MAOIs is distinctly more dangerous than with other opioids; meperidine is absolutely contraindicated due to risk of excitatory serotonin syndrome with seizures, hyperthermia, and cardiovascular collapse.
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.