Tranylcypromine Sulfate

A to Z Drug Facts

 Action Tranylcypromine blocks activity of enzyme MAO, thereby increasing monoamine (g, epinephrine, norepinephrine, serotonin) concentrations in CNS.

 Indications Treatment of reactive depression. Unlabeled use(s): Bulimia; treatment of panic disorders with associated agoraphobia.

 Contraindications Hypersensitivity to MAO inhibitors; pheochromocytoma; CHF; abnormal liver function; history of liver disease; severe renal impairment; cerebrovascular defect; concurrent use of another MAO inhibitor, tricyclic or SSRI antidepressants, dextromethorphan or CNS depressants (eg, alcohol), meperidine, sympathomimetic drugs (eg, amphetamines, dopamine, pseudoephedrine) or related drugs (eg, methyldopa, levodopa), buspirone, cheese or food with high tyramine content; ardiovascular disease; hypertension; history of headache; patients > 60 yr (ossibility of cerebral sclerosis).

 Route/Dosage

ADULTS: PO 10 mg tid initially; if no improvement after 2 weeks, titrate up to 60 mg daily in 10 mg/day increments at intervals of 1–3 weeks.

 Interactions

Amine-containing foods: May cause severe hypertension or hemorrhagic strokes. Anorexiants: May cause exaggerated pharmacologic effects (eg, severe headaches, hypertension, hyperpyrexia) of anorexiants (eg, amphetamines and related compounds). CNS depressants: May enhance CNS effects. Dextromethorphan: Concurrent use has been associated with severe reactions (hyperpyrexia, hypotension, death). Fluoxetine, fluvoxamine, nefazodone, paroxetine, sertraline, trazodone, venlafaxine: Although data are limited, interactions comparable to those of tricyclic antidepressants and tranylcypromine may occur. Guanethidine: MAO inhibitors may antagonize antihypertensive effect. Insulin, sulfonylureas: ay enhance hypoglycemic action. Levodopa: May cause hypertensive reactions. Meperidine: May lead to severe reactions, including agitation, convulsions, diaphoresis, fever, respiratory depression and vascular collapse. Sympathomimetics: May cause severe headache, hypertensive crisis and hyperpyrexia. Tricyclic antidepressants, busipirone, carbamazepine, CNS stimulants, cyclobenzaprine, maprotiline, tyramine: May lead to potentially fatal reactions, including seizures and hypertensive crisis, mental status changes, hyperthermia.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Orthostatic hypotension; edema; hypertensive crisis; palpitations; achycardia. CNS: Dizziness; headache; sleep disturbances; tremors; hyperreflexion; manic symptoms; muscle twitching; convulsions; vertigo; confusion; memory impairment; oxic delirium; hypomania; coma. DERM: Rash; sweating; photosensitivity. EENT: Blurred vision; glaucoma; dry mouth. GI: Constipation; nausea; diarrhea; anorexia; abdominal pain. GU: Sexual dysfunction; urinary retention; incontinence. HEMA: Anemia; leukopenia; agranulocytosis; thrombocytopenia. HEPA: Fatal progressive necrotizing hepatocellular damage; elevated serum transaminases; hepatitis. META: Weight gain; hypermetabolic syndrome (eg, fever, tachycardia, rapid breathing, rigidity, metabolism, acidosis, coma); hypernatremia.

 Precautions

Pregnancy: Category undetermined. Lactation: Excreted in breast milk. Children: Not recommended for patients < 16 yr. Elderly: Use with caution; older patients may suffer more morbidity than younger patients. Diabetes: May alter glucose control. Epilepsy: May lower seizure threshold. Depression: May aggravate coexisting symptoms such as anxiety and agitation. Hyperthyroidism: Use with caution because of increased sensitivity to pressor amines. Suicidal patients: Strict supervision may be necessary in patients at risk.

 Administration/Storage

• Tablets may be crushed before administration and taken with food or fluids if patient has difficulty swallowing pills.
• Avoid administering medication in the evening due to the possibility of insomnia.
• Do not administer unless the patient has been on a tyramine-free diet for at least 2–3 days. Continue this diet for 2 weeks after discontinuing medication.
• Do not administer other antidepressants and MAO inhibitors for at least 2 weeks after discontinuing.
• Store tablets at room temperature in a tightly closed container.

 Assessment/Interventions

• Obtain complete patient history. Note history of liver and cardiac disease, cerebrovascular disorders, hypertension, renal disorders, pheochromocytoma or severe headaches.
• Monitor blood pressure both lying and standing before initiating therapy. Monitor BP frequently during initial therapy and periodically thereafter. Tranylcypromine produces hypertensive reactions more frequently than other MAO inhibitors.
• Obtain baseline liver function, CBC and renal function tests prior to initiating therapy. Monitor periodically during treatment with this medication.
• Observe for onset of desired effects (improved mood, improved sleep patterns, better socialization, improved personal hygiene, lower suicidal potential). These should occur with 7–14 days with maximal response in 6 weeks.
• Monitor for signs of hypertensive crisis (severe headache, chest pain, palpitations, diaphoresis, nausea, vomiting, dilated pupils, photophobia and elevated BP).

 Patient/Family Education

• Advise patient that antidepressants restore depressed people to normal moods.
• Inform patient and family that it may be 3–4 weeks before a noticeable improvement in mood is noted.
• Instruct patient to take the medication at the same time every day.
• Advise patient not to take any other medications, including over-the-counter or prescription medications without checking with their healthcare provider first. This medication interacts with a large number of other medications.
• Teach patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient and family on how to take BP. If the BP is markedly higher than normal, they should notify the healthcare provider.
• Warn patient that eating foods that contain tyramine or tryptophan while taking this medication can produce hypertensive crisis which is potentially fatal. These foods include, but are not limited to, protein foods that are aged or fermented such as cheeses, pickled herring, liver, hard sausage, pods of broad beans, beer, red wine, yeast extract, yogurt, ginseng, soy sauce, bananas, raisins and avocados. Arrange for a consultation with a dietitian.
• Instruct patient to ingest caffeine and chocolate only in small amounts.
• Inform patient to avoid the use of alcohol and other recreational drugs.
• Advise patient to use caution while driving or performing other tasks requiring mental alertness until effect is determined.
• Instruct patient to stop taking the medication and notify the healthcare provider IMMEDIATELY if any of the following occurs: severe headache, chest pain, rapid heart beat, eye pain or photophobia, severe sweating, stiff neck, nausea or vomiting.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts