Tranylcypromine (Parnate)
MAOI antidepressant (serotonin, norepinephrine, dopamine enzyme inhibitor (MAO-A and -B), releaser (DA, NE))
- Major Depression (atypical features)2
- Treatment resistant depression2
- Panic2
- Social anxiety3
- Less sedation/weight gain than other MAOIs
Features
Dosing
10mg 1 bid x7days, 1 qam 2 qhs x7days, then 2 bid. Max 60mg but can go to 120mg in treatment resistant cases.
Management
Less sedating than phenelzine. Has dopaminergic effects. MAOIs have greater risk of mania than other antidepressants. Preferred for atypical depression, and also have high effect size in social phobia. Does not cause B6 deficiency like some other MAOIs.
TOLERABILITY: Insomnia. Transient increases in blood pressure. Minimal weight gain, fatigue, and sexual dysfunction.
RISKS: Serotonin syndrome with drug interactions. Hypertensive crisis with food interactions. Hypotension. Rare seizures and hepatotoxicity.
Must stop antidepressants (including other MAOIs) for 1-2 weeks before starting MAOI (except fluoxetine is 4-6 week wait, vortioxetine 2-3 weeks).
May be able to combine MAOIs with non-serotonergic antidepressants: some tricyclics (desipramine, trimipramine, and doxepin), bupropion, mirtazapine, trazodone, and pramipexole.
EMR Text
Depression
Tranylcypromine use based on FDA approval in depression.
MAOI side effects, including hypotension and dangerous drug and food interactions, reviewed in detail with patient.
Panic
Tranylcypromine use based on controlled trials in panic disorder.
MAOI side effects, including hypotension and dangerous drug and food interactions, reviewed in detail with patient.