tranylcypromine

Adjunctive therapy

Brands: Parnate

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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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)?
Irreversible nonselective monoamine oxidase inhibitor (MAOI).
What strengths does Parnate (tranylcypromine) come in?
Scored 10 mg tablets.

Snapshot

Class: Adjunctive therapy
Common US brands: Parnate
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Label indications

Major depressive disorder in patients not responding to other therapies.

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Clinical Highlights

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.

Best suited for specialty care where clinicians can educate patients, provide wallet cards, and coordinate hypertensive crisis protocols (e.g., phentolamine on-call).
The compare view can help contrast dietary restrictions, washouts, and activation, and the Tranylcypromine evidence feed can support adjustments to complex TRD or bipolar depression regimens.
Major depressive disorder (FDA 1961)
Generic: Multiple manufacturers supply intermittent generics; verify availability before titration increases.

Dosing & Formulations

Scored 10 mg tablets. 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 & Risks

Boxed warning: Antidepressants increase suicidality risk in children, adolescents, and young adults—monitor closely during initiation and dose changes. 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.
Hypertensive crisis and serotonin syndrome are rare but life-threatening; teach warning signs and make sure patients know to seek emergency care rather than “waiting it out.”

Drug 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.

Practice Notes

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.

Use teach-back to confirm diet and interaction rules, and review plans before surgeries, dental procedures, or emergency visits so other teams avoid contraindicated medications.
Screen for bipolar spectrum symptoms—tranylcypromine can precipitate mania; engage the bipolar disorder hub for co-management with mood stabilizers.

References

Tranylcypromine sulfate tablets prescribing information — DailyMed (2024)
Tranylcypromine FOR Treatment Resistant Depression: Clinical Considerations — Journal of Affective Disorders (2019)
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)