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Tranylcypromine (Parnate)

MAOI • Last reviewed 2025-09-27

General information

Tranylcypromine is an irreversible nonselective MAOI used for major depressive disorder after inadequate response to other agents. Its amphetamine-like structure confers stimulant properties (insomnia, agitation).

Hypertensive crisis and serotonin syndrome remain critical safety concerns; patients need extensive education and emergency plans.

Weight loss and insomnia are common; consider evening carbohydrate snacks and sleep hygiene strategies.

Because of sympathomimetic properties, monitor for anxiety, tachycardia, and new-onset hypertension.

Dosing & administration

Start 10 mg twice daily; increase by 10 mg/day every 1–2 weeks to 30 mg twice daily (60 mg/day).

Avoid bedtime dosing due to insomnia; final dose mid-afternoon.

Mechanism of action

Irreversibly inhibits MAO-A and MAO-B, increasing synaptic monoamines; also releases norepinephrine and dopamine.

Metabolism & pharmacokinetics

Short plasma half-life (~2 h) but prolonged enzyme inhibition (≥7 days). Metabolized via CYP2A6/CYP2C19 and acetylation.

Drug interactions

Strict tyramine dietary restrictions and washouts identical to other MAOIs.

Contraindicated with sympathomimetics, serotonergic agents, anesthetics containing epinephrine.

Monitoring & safety checks

  • Blood pressure and heart rate (baseline/each visit)

  • Sleep pattern and agitation

  • Dietary adherence and medication list review

Discontinuation guidance

Taper by 10 mg/day steps; maintain tyramine precautions for 14 days after discontinuation.

References

  1. Tranylcypromine Prescribing Information — DailyMed
  2. Practical strategies for MAOI therapy — Psychopharmacology Bulletin (2022)
  3. Safety considerations with tranylcypromine — Annals of Clinical Psychiatry (2021)

Educational use only — verify details in current prescribing information and authoritative clinical guidelines before making prescribing decisions.