Home Drug Guide Tranylcypromine Sulfate

Drug Guide

Generic Name

Tranylcypromine Sulfate

Brand Names Parnate

Classification

Therapeutic: Antidepressant (Monoamine Oxidase Inhibitor)

Pharmacological: Irreversible monoamine oxidase inhibitor (MAOI)

FDA Approved Indications

  • Major depressive disorder, particularly when other antidepressants have failed or are contraindicated

Mechanism of Action

Tranylcypromine irreversibly inhibits monoamine oxidase enzymes (MAO-A and MAO-B), leading to increased levels of monoamine neurotransmitters (e.g., serotonin, norepinephrine, dopamine) in the central nervous system, which helps alleviate depressive symptoms.

Dosage and Administration

Adult: Typically start with 30 mg per day, divided into doses, and may increase based on response and tolerability, up to 60-90 mg per day.

Pediatric: Not typically used in children; safety and efficacy not established.

Geriatric: Start at lower end of dosing range; monitor closely for side effects and interactions.

Renal Impairment: Use with caution; dose adjustments may be necessary based on patient response.

Hepatic Impairment: Use with caution; hepatic function should be monitored.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed in body tissues; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver, primarily through oxidation.

Excretion: Excreted mainly in urine.

Half Life: Approximately 1.5 hours for plasma clearance, but effects last much longer due to irreversible enzyme inhibition.

Contraindications

  • History of intracranial hemorrhage
  • Severe hepatic impairment
  • Concurrent use with other MAOIs, TCAs, SSRIs, or serotonin syndrome risk drugs
  • Narrow-angle glaucoma

Precautions

  • Hypertension or risk factors for hypertensive crises
  • Severe cardiovascular disease
  • History of cerebrovascular disease
  • Liver disease
  • Use with caution in elderly and patients with a history of mania or psychosis

Adverse Reactions - Common

  • Dizziness (Common)
  • Dry mouth (Common)
  • Insomnia (Common)
  • Weight gain or loss (Common)

Adverse Reactions - Serious

  • Hypertensive crisis (Serious and potentially life-threatening)
  • Serotonin syndrome (Rare but serious)
  • Liver toxicity (Rare)
  • Seizures (Rare)

Drug-Drug Interactions

  • Other antidepressants (especially SSRIs, SNRIs, TCAs), certain analgesics (meperidine), sympathomimetics, other MAOIs

Drug-Food Interactions

  • Aged cheeses, fermented foods, cured meats, alcohol, certain yeasts and soy products (due to tyramine content)

Drug-Herb Interactions

  • St. John's Wort, ginseng, ephedra

Nursing Implications

Assessment: Monitor blood pressure regularly, assess mental status and response to therapy, evaluate for signs of hypertensive crisis.

Diagnoses:

  • Risk for hypertensive crisis
  • Risk for serotonin syndrome
  • Impaired skin integrity (from hypertensive crisis or adverse reactions)

Implementation: Administer at prescribed dose; advise patient to avoid tyramine-rich foods and certain medications; educate about signs of adverse effects.

Evaluation: Effectiveness of antidepressant action, absence of hypertensive episodes, tolerability of medication.

Patient/Family Teaching

  • Do not consume foods high in tyramine.
  • Report signs of hypertensive crisis (severe headache, palpitations, neck stiffness).
  • Avoid other medications unless approved by healthcare provider.
  • Notify provider before starting new medications or treatments.

Special Considerations

Black Box Warnings:

  • Serious and sometimes fatal hypertensive reactions with dietary tyramine and certain medications

Genetic Factors: No specific genetic testing recommended, but pharmacogenetics may influence metabolism.

Lab Test Interference: None noted.

Overdose Management

Signs/Symptoms: Severe hypertension, hyperthermia, convulsions, coma.

Treatment: Immediate hospitalization; administer antihypertensives such as IV vasodilators; manage seizures with anticonvulsants; supportive care.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.