How does this medication work? What will it do for me?

Tranylcypromine belongs to the class of medications called monoamine oxidase inhibitors (MAOIs). It is used to treat certain types of depression with moderate-to-severe symptoms. Tranylcypromine works by blocking the action of a chemical substance, monoamine oxidase (MAO), in the nervous system, helping to restore the balance of chemicals in the brain. Although improvements may be seen earlier, it may take up to 3 weeks before the full beneficial effects of the medication are seen.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each biconvex, rose-red, film-coated tablet, with "PARNATE" and "SB" monogram printed in black on one side, contains tranylcypromine 10 mg. Nonmedicinal ingredients: carnauba wax, citric acid, croscarmellose sodium, D&C Red No. 7, edible black printing ink, FD&C Blue No. 2, FD&C Yellow No. 6, gelatin, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, talc, propylene glycol 400, purified water, and titanium dioxide.

How should I use this medication?

The recommended starting dose of tranylcypromine is 10 mg taken twice daily: once in the morning and once in the afternoon. After 2 to 3 weeks, your doctor may increase the dose to 30 mg daily (20 mg in the morning and 10 mg in the afternoon) depending on how effective the medication has been and how you are affected by side effects. After your symptoms of depression have been reduced, your doctor may decrease the dose that you continue with.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take tranylcypromine if you:

  • are allergic to tranylcypromine or any ingredients of the medication
  • are also taking (or have taken within the last 2 weeks) certain medications, including:
    • buspirone
    • dextromethorphan
    • dibenzazepine derivatives (e.g., amitriptyline, nortriptyline, protriptyline, desipramine, imipramine, doxepin, perphenazine, carbamazepine, cyclobenzaprine, amoxapine, maprotiline, and trimipramine)
    • dopamine
    • levodopa
    • methyldopa
    • other MAO inhibitors (e.g., phenelzine)
    • selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine (e.g., citalopram, escitalopram, fluvoxamine, paroxetine, or sertraline)
    • serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine
    • sympathomimetics (e.g., amphetamines, ephedrine, pseudoephedrine; over-the-counter preparations for colds, hay fever, and weight reduction)
    • tryptophan
  • have a disorder of the brain caused by blood flow problems
  • have high blood pressure, heart disease, or a history of stroke
  • have a history of recurrent or frequent headaches
  • have a pheochromocytoma tumour (a tumour of the adrenal gland)
  • have eaten any foods with high tyramine content (see "Are there other precautions or warnings for this medication?") in the last 2 weeks
  • have liver damage or blood disorders
  • have taken fluoxetine within the last 5 weeks

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • decreased appetite
  • diarrhea
  • dizziness
  • drowsiness
  • dry mouth
  • nausea
  • trouble sleeping
  • weakness

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • blurred vision
  • difficulty urinating
  • dizziness or lightheadedness (severe), especially when rising from a lying or sitting position
  • fast or pounding heartbeat
  • hallucinations
  • muscle spasms or twitches
  • new or worsened emotional or behavioural problems
  • sweating
  • swelling of feet or lower legs
  • unusual bruising or bleeding
  • unusual hair loss or thinning

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • confusion
  • convulsions (seizures)
  • signs of a hypertensive crisis (e.g., enlarged pupils, fast or slow heartbeat, chest pain [severe], nausea and vomiting, stiff or sore neck, sweating [may be with fever or cool, clammy skin] and severe headache)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angina: Tranylcypromine can mask the pain of angina that might warn of a heart attack. If you have heart disease or are at risk for developing heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Blood pressure: The most serious reaction to tranylcypromine is severe high blood pressure (hypertensive crises). This reaction includes some or all of the following symptoms:

  • dilated pupils
  • extremely fast or slow heart rate, possibly associated with constricting chest pain
  • eyes sensitive to light
  • nausea
  • neck stiffness or soreness
  • palpitation
  • severe headache at the back of the head that may travel to the front
  • sweating (sometimes with fever and sometimes with cold, clammy skin)
  • vomiting

If you notice these symptoms, stop taking the medication and get immediate medical attention.

Diabetes: This medication may cause decreased blood glucose for people with diabetes. If you have diabetes, you may find it necessary to monitor your blood sugar more frequently while using this medication. Make sure you keep a "rescue" source of sugar with you to prevent episodes of severely low blood glucose.

Drowsiness/reduced alertness: Tranylcypromine may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

Food reactions: Tranylcypromine should not be taken in combination with cheese or other foods with a high tyramine content. In general, those taking this medication should avoid protein foods in which aging or protein breakdown is used to increase flavour. In particular, avoid foods such as:

  • alcohol-free and reduced-alcohol beer and wine products
  • avocados (especially if overripe)
  • bananas (if used with the peel)
  • beer and wine
  • broad bean pods (fava beans)
  • canned figs
  • caviar
  • cheese (exceptions: cream cheese and cottage cheese)
  • dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna)
  • excessive amounts of chocolate or caffeine
  • fermented meat (e.g., bologna, pepperoni, salami)
  • liver
  • meat extracts (such as Bovril)
  • pickled herring
  • raisins
  • sauerkraut
  • sour cream
  • soy sauce
  • yeast extracts (such as Marmite)
  • yogurt

These foods should be avoided while taking the medication and for at least 2 weeks after stopping the medication.

Alcoholic beverages have been known to trigger a severe reaction with tranylcypromine. Therefore those taking this medication should avoid alcoholic drinks, especially red wines (such as Chianti), sherry, beer (including nonalcoholic beer), etc.

People taking tranylcypromine should also avoid consuming too much caffeine in any form (coffee, tea, cola drinks, etc.) because of possible increased effects of caffeine.

People taking tranylcypromine should also avoid any spoiled or improperly refrigerated, handled, or stored protein-rich foods such as meats, fish, and dairy products, including foods that may have undergone protein breakdown by aging, pickling, fermentation, or smoking to improve flavour.

Headache: People taking tranylcypromine should immediately report headaches or other unusual symptoms to their doctor. If you have recurring or frequent headaches, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Identification: People taking tranylcypromine are encouraged to carry a card or other notification of the fact that they are taking this medication.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mental health issues: This medication can worsen mental health issues such as psychosis or bipolar disorder or cause some symptoms of depression, such as anxiety or agitation, to become worse. If you experiences hallucinations (seeing, hearing, or feeling things that are not there), distorted thoughts, or mania (racing thoughts, rapid talking, impulsiveness, extremely elevated mood, extremely high energy), contact your doctor immediately.

Seizures: Tranylcypromine may cause an increase in seizure frequency. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Surgery: If you are scheduled for surgery, let your health professionals know that you are taking this medication. Ask your doctor when you should stop the medication before surgery - it should usually be stopped at least 7 days before surgery.

Thyroid disease: Hyperthyroidism (having an overactive thyroid) may make you more sensitive to the effects of tranylcypromine. If you have an overactive thyroid gland, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: The safety and effectiveness of using this medication have not been established for pregnant women. If you are or may be pregnant, talk to your doctor about the risks and benefits of taking this medication.

Breast-feeding: The safety and effectiveness of using this medication have not been established for breast-feeding women. If you are breast-feeding, talk to your doctor about the risks and benefits of taking this medication.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between tranylcypromine and any of the following:

  • alcohol
  • aclidinium
  • aliskiren
  • alpha/beta agonists (e.g., epinephrine, norepinephrine)
  • alpha agonists (e.g., clonidine, methyldopa)
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • aminophylline
  • amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
  • angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, lisinopril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • anticholinergics (e.g., benztropine, ipratropium, oxybutynin)
  • antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • apraclonidine
  • asenapine
  • atomoxetine
  • barbiturates (e.g., phenobarbital, secobarbital)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
  • bezafibrate
  • brimonidine
  • bromocriptine
  • bupropion
  • buspirone
  • cabergoline
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • carbamazepine
  • clobazam
  • clopidogrel
  • clozapine
  • cocaine
  • cyclobenzaprine
  • dacarbazine
  • desvenlafaxine
  • dexmedetomidine
  • dextromethorphan
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • diazepam
  • disulfiram
  • domperidone
  • donepezil
  • dopamine
  • ephedrine
  • epinephrine
  • entacapone
  • ergot alkaloids (e.g., ergotamine, dihydroergotamine)
  • flavoxate
  • flecainide
  • flutamide
  • galantamine
  • glycopyrrolate
  • guanfacine
  • ifosfamide
  • L-tryptophan
  • L-tyrosine
  • lidocaine
  • linezolid
  • lithium
  • melatonin
  • medications for Parkinson's disease (such as levodopa)
  • meperidine
  • methadone
  • methyldopa
  • methylphenidate
  • metoclopramide
  • mexiletine
  • mirtazapine
  • nefazodone
  • other monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine)
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
  • octreotide
  • olanzapine
  • orphenadrine
  • pentamidine
  • phenylalanine
  • phenylephrine
  • pimozide
  • pizotifen
  • propafenone
  • pseudoephedrine
  • rasagiline
  • reserpine
  • rivastigmine
  • ropinirole
  • St. John's wort
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • serotonin antagonists (e.g., antiemetics; granisetron, ondansetron)
  • tamoxifen
  • tapentadol
  • tegafur
  • tetrabenazine
  • tetrahydrozoline
  • theophylline
  • tiotropium
  • tolterodine
  • tramadol
  • trazodone
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
  • "triptan" migraine medications (e.g., eletriptan, sumatriptan)
  • tryptophan
  • venlafaxine
  • voriconazole
  • xylometazoline

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.