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tranylcypromine

Adjunctive therapy

Brand: Parnate

Published 2025-09-28 · Last reviewed 2025-10-05 · 5 references

Content sourced from FDA labeling (DailyMed) and peer-reviewed literature.

Print sheet Review evidence

At a glance

Class: Adjunctive therapy·Typical dose: Initiate 10 mg twice daily; increase by 10 mg/day every 1–2 weeks based on response and tolerability.·Half-life: Single-dose mean 2 h·LAI available: No

Class: Adjunctive therapy
Typical dose: Initiate 10 mg twice daily; increase by 10 mg/day every 1–2 weeks based on response and tolerability.
Half-life: Single-dose mean 2 h
LAI available: No

Quick answers

What is tranylcypromine?: Tranylcypromine (Parnate) is an irreversible nonselective MAOI reserved for treatment-resistant depression and select bipolar depression cases, prescribed within MAOI-experienced programs that can manage dietary counselling, blood pressure surveillance, and emergency response.
What is Parnate?: Parnate is a brand name for tranylcypromine.
What is Parnate (tranylcypromine) used for?: Label indications include: Major depressive disorder in patients not responding to other therapies.
What drug class is Parnate (tranylcypromine)?: MAOI Antidepressant.
What is the mechanism of action of Parnate (tranylcypromine)?: Irreversible nonselective monoamine oxidase inhibitor (MAOI).
What strengths does Parnate (tranylcypromine) come in?: Scored 10 mg tablets.

General information

Tranylcypromine (Parnate) is an irreversible nonselective MAOI reserved for treatment-resistant depression and select bipolar depression cases, prescribed within MAOI-experienced programs that can manage dietary counselling, blood pressure surveillance, and emergency response.

Generic supply is intermittent; coordinate refills with pharmacies to prevent abrupt interruptions and reinforce written dietary and medication precautions at every visit.

The compare view and the Tranylcypromine evidence feed can help weigh augmentation, ECT sequencing, and bipolar depression plans alongside the bipolar disorder hub.

U.S. approvals

Major depressive disorder (1961)

Formulations & strengths

Scored 10 mg tablets.

Generic availability

Multiple manufacturers supply intermittent generics; verify availability before titration increases.

Best suited for specialty care where clinicians can educate patients, provide wallet cards, and coordinate hypertensive crisis protocols (e.g., phentolamine on-call).

View labelExact

Mechanism of action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Irreversibly inhibits MAO-A and MAO-B, increasing synaptic serotonin, norepinephrine, dopamine, and trace amines; enzyme regeneration requires 10–14 days, mandating long washout intervals.

Amphetamine-like structure contributes to activation and mild sympathomimetic effects, necessitating early daytime dosing and monitoring for agitation.

Irreversible inhibitor of MAO-A and MAO-B.

Metabolism & pharmacokinetics

Rapidly absorbed with peak plasma concentrations in ~2 hours; food delays Tmax but not overall exposure.
Metabolized via hepatic CYP2A6/CYP2C19 pathways and acetylation; plasma half-life ~2 hours, yet pharmacodynamic MAO inhibition persists 7–14 days.
Metabolites are primarily renally eliminated; use slower titration and closer monitoring in hepatic or renal impairment despite lack of formal dose adjustments.

Dosing & administration

Initiate 10 mg twice daily; increase by 10 mg/day every 1–2 weeks based on response and tolerability.
Typical maintenance 30–60 mg/day divided BID; refractory cases may require up to 70–80 mg/day under specialist supervision.
Schedule the final dose before mid-afternoon to reduce insomnia and activation.
Maintain tyramine restriction throughout therapy and for 14 days post-discontinuation; observe ≥14-day washouts (5 weeks after fluoxetine) when switching serotonergic or sympathomimetic agents.

Monitoring & labs

Home blood pressure monitoring during titration and after medication changes, with clear hypertensive crisis instructions and emergency contact pathways.
Medication reconciliation at every visit (prescription/OTC/herbal) to prevent accidental serotonergic or sympathomimetic exposure; enforce washout timing.
Dietary adherence and teach-back review of tyramine-restricted foods (including restaurant and packaged-food pitfalls).
Sleep/activation, anxiety, and orthostatic vitals; adjust dose timing and supportive measures to improve tolerability.
Mood destabilization (mania/hypomania) and suicidality monitoring, especially in bipolar-spectrum illness; coordinate via the bipolar disorder hub.

Tranylcypromine monitoring prioritizes BP and interaction avoidance. Its activating profile can affect sleep and anxiety, so early follow-up and teach-back education are key.

Adverse effects

FDA boxed warnings

Antidepressants increase suicidality risk in children, adolescents, and young adults—monitor closely during initiation and dose changes.

Common side effects (≥10%)

Orthostatic hypotension: Monitor seated/standing vitals and counsel on hydration and slow positional changes.
Insomnia/agitation: Dose earlier in the day; consider non-serotonergic sleep aids if needed.
Weight changes: Early weight loss common—track BMI and encourage nutritional support.
Dry mouth/constipation: Reinforce hydration and bowel regimens.
Sexual dysfunction: Discuss expectations and adjunctive strategies to support adherence.

Other notable effects

Hypertensive crisis with tyramine ingestion or sympathomimetic exposure—provide emergency instructions and ensure access to phentolamine per institutional protocols.
Serotonin syndrome when combined with contraindicated serotonergic agents—enforce washouts and educate on symptoms.
Rare hepatotoxicity; evaluate for jaundice, abdominal pain, or unexplained fatigue.

Interactions

Absolute contraindications include SSRIs/SNRIs, TCAs, mirtazapine, bupropion, buspirone, meperidine, tramadol, methadone, dextromethorphan, linezolid, methylene blue, sympathomimetic agents, and tyramine-rich foods.
Require ≥14-day washout (≥5 weeks for fluoxetine) before initiating or discontinuing interacting medications.
Advise patients to avoid OTC decongestants, weight-loss supplements, and excess caffeine; alert anesthesia providers prior to procedures to avoid indirect sympathomimetics.

Other useful information

Provide wallet cards/medical alert identification listing MAOI therapy and emergency contact instructions.
Encourage home blood pressure monitoring during titration and coordinate with pharmacies to secure consistent supply.
Provide written “interaction check before adding anything new” guidance (cold medicines, cough syrups, supplements) and ensure the EHR carries a visible “MAOI alert” for other prescribers.

References

Related hubs:SMI toolkit·Support resources