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tranylcypromine (Parnate)
Tradename: Parnate. (tranylcypromine sulfate)
Indications:
- symptomatic treatment of depression
- refractory to or intolerant of tricyclic antidepressants or electroconvulsive therapy
Contraindications:
1) incontrolled hypertension
2) pheochromocytoma
3) congestive heart failure
4) patients < 16 years or > 60 years of age
5) severe renal insufficiency
6) severe liver disease
Caution:
1) avoid tyramine-containing foods
a) red wine
b) cheese (except cottage, ricotta & cream cheese)
c) smoked or pickled fish
d) beef or chicken liver
e) dried sausage
f) fava or broad bean pods
g) yeast vitamin supplements
f) yeast spreads
2) use with caution in hyperactive or hyperexcitable patients
3) glaucoma
Dosage:
1) start 10 mg PO BID
2) increase by 10 mg increments at 103 week intervals
3) maximum: 60 mg/day
Tabs: 10 mg.
Monitor: plasma levels in patients with hepatic impairment
Pharmacokinetics:
1) 2-3 weeks to obtain full therapeutic effect
2) when the drug is discontinued MAO activity is recovered in 3-5 days (possibly up to 10 days)
3) more rapid onset of action than other MAO inhibitors
Adverse effects:
1) not common (1-10%)
- orthostatic hypotension
2) 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 interactions:
1) sympathomimetic drugs
2) meperidine
3) tricyclic antidepressants (TCA)
4) phenothiazines
5) antihypertensive agents
6) disulfiram
7) selective serotonin reuptake inhibitor (SSRI)
a) fluoxetine
b) sertraline
Interactions
drug interactions
drug adverse effects (more general classes)
General
adrenergic neuron stimulant
amine
aromatic compound
monoamine oxidase [MAO] inhibitor
Properties
MISC-INFO: elimination route LIVER
1/2life 2 HOURS
therapeutic-range 10-100 NG/ML
toxic-range >100 NG/ML
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed.,
W.B. Saunders, 1995
- Department of Veterans Affairs, VA National Formulary