Tranylcypromine

What is the most important information I should know about tranylcypromine?

There are many other medicines that can cause serious medical problems if you take them together with tranylcypromine. Do not take tranylcypromine before telling your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

While you are taking tranylcypromine, you must not drink alcohol or eat foods that are high in tyramine, listed in the "What should I avoid while taking tranylcypromine?" section of this leaflet. Eating tyramine while you are taking tranylcypromine can raise your blood pressure to dangerous levels, causing life-threatening symptoms such as sudden and severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, seizure (convulsions), and sudden numbness or weakness (especially on one side of the body). Call your doctor at once if you have any of these symptoms.

You should become very familiar with the list of foods you must avoid while you are taking tranylcypromine.

Tranylcypromine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What is tranylcypromine?

Tranylcypromine is a monoamine oxidase inhibitor (MAOI) that works by increasing the levels of certain chemicals in the brain.

Tranylcypromine is used to treat major depressive episode in adults. This medication is usually given after other anti-depressants have been tried without successful treatment of symptoms. Tranylcypromine will not treat bipolar disorder (manic depression).

Tranylcypromine may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking tranylcypromine?

Do not use this medication if you have used another MAOI such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 14 days. Serious, life-threatening side effects can occur if you take tranylcypromine before another MAOI has cleared from your body. If you are switching to tranylcypromine from another MAOI, your doctor may start you at a low dose.

There are many other medicines that can cause serious medical problems if you take them together with tranylcypromine. The following drugs should not be used while you are taking tranylcypromine:

• antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil);
• antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft);
• blood pressure medicine such as guanethidine (Ismelin), methyldopa (Aldomet), and reserpine;
• diet pills, stimulants, ADHD medications, over-the-counter cough and cold or allergy medicines;
• doxepin (Adapin, Sinequan);
• carbamazepine (Carbatrol, Tegretol);
• cyclobenzaprine (Flexeril);
• maprotiline (Ludiomil);
• procarbazine (Matulane);
• bupropion (Wellbutrin, Zyban);
• dexfenfluramine (Redux);
• buspirone (BuSpar);
• tryptophan (also called L-tryptophan);
• levodopa (Larodopa, Parcopa, Sinemet); or
• meperidine (Demerol, Mepergan).

Before using this medication, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease, high blood pressure, circulation problems, or a history of stroke;
• a history of headaches (migraine, cluster, or other types);
• diabetes; or
• a seizure disorder such as epilepsy.

If you have any of these conditions, you may not be able to use tranylcypromine, or you may need a dosage adjustment or special tests during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

This medication may be habit-forming. You may have withdrawal symptoms such as anxiety, confusion, headache, weakness, depression, or hallucinations) when you stop using tranylcypromine after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Tranylcypromine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more likely to have side effects from tranylcypromine.

Do not give tranylcypromine to anyone younger than 18 years old without the advice of a doctor.

How should I take tranylcypromine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take each dose with a full glass of water.

You may need to stop using the medicine for a short time if you need to have any type of surgery, or if you will have an x-ray, CT scan, or MRI of your spinal cord. Tell any doctor who treats you that you are taking tranylcypromine.

To be sure this medication is not causing harmful effects, your blood pressure will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

Take this medication for the entire length of time prescribed by your doctor. It may take 4 weeks or longer before you notice improvement in your symptoms.

Store tranylcypromine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a tranylcypromine overdose may include feeling restless or anxious, sleep problems (insomnia), agitation, confusion, weakness, severe headache, neck pain or stiffness, fast or pounding heart beats, chest pain, cold sweats, feeling light-headed, or fainting.

What should I avoid while taking tranylcypromine?

While you are taking tranylcypromine, you must not eat foods that are high in tyramine, including:

• avocados, bananas, figs, raisins, and sauerkraut;
• beef or chicken liver, fish, meats prepared with tenderizer, bologna, pepperoni, salami, summer sausage, game meat, meat extracts, caviar, dried fish, herring, and shrimp paste;
• beer (alcoholic and nonalcoholic), red wine (especially Chianti), sherry, vermouth, and other distilled spirits;
• caffeine (including coffee, tea, cola); and
• cheeses, including American, blue, boursault, brick, brie, camembert, cheddar, emmenthaler, gruyere, mozzarella, parmesan, romano, roquefort, stilton, and swiss;
• chocolate;
• ginseng;
• sour cream and yogurt;
• soy sauce, miso soup, bean curd, fava beans; or
• yeast extracts.

Eating tyramine while you are taking tranylcypromine can raise your blood pressure to dangerous levels, causing life-threatening side effects.

Avoid drinking alcohol or using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can worsen the low blood pressure caused by tranylcypromine.

Tranylcypromine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of tranylcypromine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Stop using tranylcypromine and call your doctor at once if you have any of these serious side effects:

• frequent headaches, vision problems, sensitivity to light;
• fast or pounding heart beats, tight feeling in your chest or throat;
• swelling of your ankles or feet;
• pale skin, easy bruising or bleeding, unusual weakness;
• nausea, vomiting, dizziness, sweating, stiffness in your neck;
• confusion, lack of coordination, feeling light-headed, fainting; or
• tremors, muscle twitches you cannot control.

Continue taking this medication and talk to your doctor if you have any of these less serious side effects:

• feeling restless, weak, or drowsy;
• nausea, diarrhea or constipation, loss of appetite, stomach pain;
• chills, numbness or tingly feeling;
• dry mouth, decreased urination;
• blurred vision, ringing in your ears; or
• impotence, difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect tranylcypromine?

There are many other medicines that can cause serious medical problems if you take them together with tranylcypromine. Do not take tranylcypromine before telling your doctor about all other prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.

Where can I get more information?

Your pharmacist has information about tranylcypromine written for health professionals that you may read.

What does my medication look like?

Tranylcypromine is available with a prescription under the brand name Parnate. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• Parnate 10 mg--round, red tablets

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2003 Cerner Multum, Inc. Version: 2.05. Revision date: 05/30/2007.