Nurses Compass
Drug Guide
Tranylcypromine Sulfate
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.