Drug reference

Tranylcypromine

MAO Inhibitor · Antidepressant

Also known as Tranylcypromine sulfate

MAO InhibitorAntidepressant

CDSCO approvedSchedule X

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

—

not curated

Top interactionssee all 12 →

SympathomimeticsContraindicatedTextbookG&G 14e
Tyramine Containing FoodsContraindicatedTextbookG&G 14e
5ht Reuptake Inhibiting AntidepressantsSevereTextbookG&G 14e
AlbuterolSevereTextbookG&G 14e · p264

Mechanism

Tranylcypromine is an irreversible monoamine oxidase inhibitor (MAOI). It increases the concentration of norepinephrine (NE), dopamine (DA), and serotonin (5-HT) in the brain and other tissues. Inhibition of MAO-A enhances the bioavailability of tyramine, which can lead to NE release from sympathetic neurons.

Indications

Depressive illnessPhobic patients and depressed patients with atypical, hypochondriacal, or hysterical featuresPatients refractory to treatment with other antidepressantsmajor depression (resistant to other antidepressants)

Dosing

Adult: Initially 10 mg twice daily, dose to be taken at a time no later than 3 p.m. Dose may be increased if necessary after 1 week, increased if necessary to 10 mg daily in the morning and 20 mg daily in the afternoon. Doses above 30 mg daily only under close supervision. Maintenance dose is 10 mg daily.
Max dose: 30 mg daily (under close supervision only for doses above this)

Pharmacokinetics

Onset

May be delayed for 3 weeks or more

Peak effect

May take an additional 1 or 2 weeks to become maximal after initial response

Metabolism

acetylation

Contraindications

History of hepatic disease
Hyperthyroidism

Side effects

Common

Chest painDiarrhoeaDrug dependenceExtrasystoleFlushingHypertensionHypomaniaMydriasisPainPallorPhotophobiaSleep disorderThrobbing headacheweight gainsexual dysfunction

Serious

Hepatocellular injury
Hypertensive crisis
Intracranial haemorrhage
hypertensive crisis (with tyramine-containing foods or sympathomimetics)
serotonin syndrome (with 5HT reuptake inhibitors, tryptophan, substituted amphetamines)
hepatotoxicity

Pregnancy & lactation

Lactation

Present in milk in animal studies.

Drug interactions

Sympathomimetics

Contraindicated

Textbook

Potentially life-threatening elevation of blood pressure (hypertensive crisis).

Avoid concurrent use of MAOIs and medications containing sympathomimetic compounds.

Source: G&G 14e

Tyramine Containing Foods

Contraindicated

Textbook

Marked increases in blood pressure (hypertensive crisis).

Patients on MAOIs must avoid foods containing high levels of tyramine, such as soy products, dried meats and sausages, dried fruits, home-brewed and tap beers, red wine, pickled or fermented foods, and aged cheeses.

Source: G&G 14e

5ht Reuptake Inhibiting Antidepressants

Severe

Textbook

Serotonin syndrome, characterized by hyperthermia, muscle rigidity, myoclonus, tremors, autonomic instability, confusion, irritability, and agitation, which can progress to coma and death.

SSRIs should not be started until at least 14 days following discontinuation of treatment with an irreversible MAOI. For all SSRIs except fluoxetine, at least 14 days should pass prior to beginning treatment with an MAOI following the end of SSRI treatment. For fluoxetine, at least 5 weeks should pass. For venlafaxine, a 7-day interval is considered safe between ending MAOI therapy and starting venlafaxine. For duloxetine, a 5-day waiting period is needed before beginning MAOI treatment after ending duloxetine.

Source: G&G 14e

Albuterol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Anticholinergic Antiparkinsonian Drugs

Severe

Textbook

Delirium may occur.

Source: KDT 7e · p121

Bitolterol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Fenoterol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Furazolidone

Severe

Textbook

Risk of hypertensive crisis.

Source: Harrison 22e · p1743

Levalbuterol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Meperidine

Severe

Textbook

Serious drug interaction.

Avoid coadministration.

Source: G&G 14e

Metaproterenol

Severe

Textbook

Increased risk of adverse cardiovascular effects.

At least 2 weeks should elapse between the use of MAO inhibitors and administration of β2 agonists or other sympathomimetics.

Source: G&G 14e · p264

Methylenedioxymethamphetamine

Severe

Textbook

Serotonin syndrome, characterized by hyperthermia, muscle rigidity, myoclonus, tremors, autonomic instability, confusion, irritability, and agitation, which can progress to coma and death.

Avoid coadministration.

Source: G&G 14e