Phenelzine (Nardil)
MAOI antidepressant (serotonin, norepinephrine, dopamine enzyme inhibitor (MAO-A and -B))
- Major Depression (anxious, atypical)2
- Treatment resistant depression2
- Social anxiety2
Features
Dosing
15mg 1 bid x4 days, then 1 tid, may go up to 120 mg in treatment resistant cases but higher risk of orthostasis.
Management
MAOIs have greater risk of mania than other antidepressants. Preferred for atypical depression, and also have high effect size in social phobia.
RISKS: Serotonin syndrome with drug interactions. Hypertensive crisis with food interactions. Hypotension. Hypotension, edema, vitamin B6 deficiency, and – rarely – 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
Phenelzine use based on FDA approval in depression.
MAOI side effects, including hypotension and dangerous drug and food interactions, reviewed in detail with patient.
Social Anxiety
Phenelzine use based on multiple controlled trials in social anxiety disorder.
MAOI side effects, including hypotension and dangerous drug and food interactions, reviewed in detail with patient.