phenelzine
Brands: Nardil
Last reviewed 2025-10-05
Reviewed by PsychMed Editorial Team.
Quick answers
What is phenelzine?
Phenelzine (Nardil) is a non-selective, irreversible monoamine oxidase inhibitor reserved for treatment-resistant depression, atypical depression, and select anxiety disorders managed in specialty settings.
What is Nardil?
Nardil is a brand name for phenelzine.
What is Nardil (phenelzine) used for?
Label indications include: Treatment-resistant depression; atypical depression.
What drug class is Nardil (phenelzine)?
Irreversible monoamine oxidase inhibitor (MAOI); inhibits MAO-A and MAO-B.
What strengths does Nardil (phenelzine) come in?
Tablets 15 mg.
Snapshot
- Class: Adjunctive therapy
- Common US brands: Nardil
- Therapeutic drug monitoring not routinely recommended.
- Last reviewed: 2025-10-05
Clinical Highlights
Phenelzine (Nardil) is a non-selective, irreversible monoamine oxidase inhibitor reserved for treatment-resistant depression, atypical depression, and select anxiety disorders managed in specialty settings. Because it permanently inactivates MAO-A/B, strict dietary tyramine restrictions, comprehensive interaction screening, and crisis planning are mandatory throughout therapy.
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- Safe use depends on education and consistent safeguards (MAOI wallet card/medical alert, avoiding OTC cold/decongestant products, and verifying interactions before adding new medications or supplements).
- Therapy often requires reliable pharmacy access, medical alert identification, and a rehearsed plan for hypertensive symptoms or serotonin syndrome.
- The compare view can help align dietary and washout plans across MAOIs, and the Phenelzine evidence feed can support titration or switching decisions.
- Major depressive disorder (FDA 1961)
- Generic: Generics intermittently available; verify supply.
Dosing & Formulations
Tablets 15 mg. Start 15 mg three times daily; increase by 15 mg increments every few days to 45 mg/day (week 1), 60 mg/day (week 2), and up to 75–90 mg/day divided for optimal response.
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- Once stabilized, taper to the lowest effective maintenance dose (often 15 mg BID/TID) while maintaining dietary restrictions.
- Maintain tyramine-restricted diet and interaction precautions during therapy and for at least 14 days after discontinuation (30 days for fluoxetine transitions).
Monitoring & Risks
Boxed warning: Antidepressants increase suicidality risk in young adults; monitor closely. Orthostatic hypotension: orthostatic vitals and hydration counseling are common during titration.
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- Insomnia: earlier dosing (e.g., last dose mid-afternoon) and sleep support strategies are sometimes used.
- Weight gain: Track weight/BMI and reinforce diet/activity plans.
- Sexual dysfunction: Discuss expectations and management options.
- Hypertensive crisis may occur with tyramine ingestion or sympathomimetics—education typically covers warning signs (sudden severe headache, palpitations, chest pain) and emergency management.
- Serotonin syndrome can occur with interacting serotonergic agents; education typically covers symptoms (agitation, tremor/clonus, fever, diarrhea) and the need for urgent evaluation if suspected.
Drug Interactions
Contraindicated with SSRIs, SNRIs, TCAs, other MAOIs, mirtazapine, bupropion, buspirone, meperidine, tramadol, methadone, dextromethorphan, linezolid, methylene blue, atomoxetine, and sympathomimetics; observe ≥14-day washouts (≥30 days for fluoxetine). Tyramine restrictions typically include avoiding high-tyramine foods (aged cheeses, cured meats, soy products, tap beers) and OTC decongestants/stimulants; detailed dietary and medication lists are usually provided.
Practice Notes
Medical alert identification, wallet interaction cards, and emergency protocols for hypertensive symptoms are commonly used. Seated/standing blood pressure, weight, mood, and liver enzymes are commonly tracked; dietitian support can reinforce dietary education.
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- Home blood pressure logs during titration and teach-back education can reduce diet/interaction errors; plans are typically reviewed before surgery, dental procedures, or emergency care visits.
- Screen for bipolar spectrum symptoms—phenelzine can precipitate mania/hypomania; collaborate with the bipolar disorder hub when activation appears.
References
- Phenelzine sulfate tablets prescribing information — DailyMed (2025)
- Gillman2011 Maoi Pharmacology
- CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
- APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
- Monoamine oxidase inhibitors: Seriously underused in the treatment of major depression — Acta Psychiatrica Scandinavica (2024)