II. Indications: Comorbid Depression
- Anxiety Disorder
- Atypical Depression
- Refractory Depression
- Bulimia
- Social Phobia
III. Mechanism
- Inhibits monoamine oxidase
- Monoamine Oxidase is enzyme that breaks down biogenic amines (e.g. Norepinephrine, Serotonin, Dopamine)
- Type A Monoamine Oxidase affects Gastrointestinal System
- Type B Monoamine Oxidase affects Central Nervous System
- Older MAO inhibitors are nonspecific and affect both Type A and B (e.g. trancypromine, Phenelzine)
- Selegiline is specific for Type B and is used in Parkinsonism
- Increases synaptic concentration of monoamines
IV. Precautions
- Tyramine-free diet must be followed
- Continue for two weeks after stopping medication
- See Tyramine Containing Foods
- Stop 2 weeks before starting another Antidepressant
- Taper Nardil slowly when stopping
- See Antidepressant Withdrawal
- Reduce dose by 15 mg/day every 2 weeks (or 10%/week)
V. Preparations: Hydrazine
- Isocarboxazid (Marplan): No longer manufactured in U.S.
- Dosing: 10 mg PO bid
- Maximum: 60 mg per day
- Phenelzine (Nardil)
- Dosing: 15 mg PO tid
- Maximum: 90 mg per day
VI. Preparations Non-hydrazine
- Tranylcypromine (Parnate)
- Dosing: 10-40 mg/day in divided doses
- Maximum: 60 mg per day
- Parkinsonian agents
- Selegiline (Eldepryl)
VII. Preparations: Other agents with MAO inhibitor Activity
- Linezolid
-
St John's Wort
- Contains Hypericin and Hyperforin (weak Type A and B MAO inhibitors)
VIII. Complications
-
Hypertensive Crisis (life-threatening)
- Occurs if tyramine or Sympathomimetic exposure
- Treat with phentolamine (alpha-adrenergic antagonist)
-
Hypotension to cardiovascular collapse (occurs with Overdose)
- Treat with Intravenous Fluids and direct acting Vasopressors (e.g. Norepinephrine)
-
Serotonin Syndrome
- Occurs with concurrent use of other Serotoninergic drug, or in Overdose
IX. Drug Interactions (Do not use with these medications)
X. Adverse Effects
- Anti-Histaminergic effects
- Dizziness
- Sedation
- Orthostatic Hypotension
- Weight gain
-
Dopaminergic effects
- Insomnia
- Myoclonal jerks
- Serotoninergic Effects
-
Anticholinergic Toxicity
- Dry Mouth
- Constipation
- Blurred Vision
- Urinary hesitancy
- Nausea
- Memory Dysfunction
- Other Effects
- Peripheral Edema
- Weakness
XI. References
- Nordt and Shoenberger in Herbert (2019) EM:Rap 19(3): 8-9
Images: Related links to external sites (from Bing)
Related Studies
phenelzine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
PHENELZINE SULFATE 15 MG TAB | Generic | $0.48 each |
nardil (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
NARDIL 15 MG TABLET | Generic | $0.48 each |
tranylcypromine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
TRANYLCYPROMINE SULF 10 MG TAB | Generic | $1.67 each |
Ontology: Phenelzine (C0031392)
Definition (MSH) | One of the MONOAMINE OXIDASE INHIBITORS used to treat DEPRESSION; PHOBIC DISORDERS; and PANIC. |
Definition (CSP) | monoamine oxidase inhibitor used to treat depression and phobic disorders. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D010624 |
SnomedCT | 387528000, 9500005 |
LNC | LP17998-3, MTHU024864 |
English | 2 Phenethylhydrazine, 2-Phenethylhydrazine, Fenelzin, Phenelzine, Phenethylhydrazine, beta Phenylethylhydrazine, beta-Phenylethylhydrazine, phenelzine, Hydrazine, (2-phenylethyl)-, Phenelzine [Chemical/Ingredient], fenelzin, PHENELZINE, MAOI - Phenelzine, Phenelzine (product), Phenelzine (substance) |
Swedish | Fenelzin |
Czech | fenelzin |
Finnish | Feneltsiini |
Russian | FENELZIN, ФЕНЕЛЗИН |
Japanese | フェネルジン |
Italian | beta-Feniletilidrazina, Fenelzina |
Spanish | fenelcina, fenelzina (producto), fenelcina (producto), fenelcina (sustancia), fenelzina (sustancia), fenelzina, Fenelzina, Fenelzin |
Polish | Nardil, Fenelzyna |
French | Phénelzine |
German | Fenelzin, Phenelzin |
Portuguese | Fenelzina |
Ontology: Tranylcypromine (C0040778)
Definition (MSH) | A propylamine formed from the cyclization of the side chain of amphetamine. This monoamine oxidase inhibitor is effective in the treatment of major depression, dysthymic disorder, and atypical depression. It also is useful in panic and phobic disorders. (From AMA Drug Evaluations Annual, 1994, p311) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D014191 |
SnomedCT | 372891006, 89092006 |
LNC | LP14552-1, MTHU001574 |
English | trans-2-Phenylcyclopropylamine, Tranylcypromine, trans 2 Phenylcyclopropylamine, Cyclopropanamine, 2-phenyl-, trans-(+-)-, tranylcypromine, SKF 385, Tranylcypromine [Chemical/Ingredient], TRANYLCYPROMINE, MAOI - Tranylcypromine, Tranylcypromine (product), Tranylcypromine (substance) |
Swedish | Tranylcypromin |
Czech | tranylcypromin |
Finnish | Tranyylisypromiini |
Russian | TRANILTSIPROMIN, ТРАНИЛЦИПРОМИН |
Japanese | トラニルシプロミン |
Polish | Tranylcypromina |
Spanish | tranilcipromina (producto), tranilcipromina (sustancia), tranilcipromina, Tranilcipromina |
French | Tranylcypromine |
German | Tranylcypromin |
Italian | Tranilcipromina |
Portuguese | Tranilcipromina |
Ontology: Nardil (C0701388)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D010624 |
English | nardil, Nardil, Parke Davis Brand of Phenelzine Sulfate, Pfizer Brand of Phenelzine Sulfate, United Drug Brand of Phenelzine Sulfate |
Ontology: Parnate (C0701426)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D014191 |
English | parnate, Parnate, Allphar Brand of Tranylcypromine Sulfate, GlaxoSmithKline Brand of Tranylcypromine Sulfate, Goldshield Brand of Tranylcypromine Sulfate, Link Brand of Tranylcypromine Sulfate, SmithKline Brand of Tranylcypromine Sulfate |