Tranylcypromine

FDA label

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Titration Increase by 10 mg/day every 1 to 3 weeks if inadequate response (more gradually if hypotension risk)

Renal Undefined

Hepatic Undefined

Instructions

• Give in divided doses
• Discontinue gradually (withdrawal effects including delirium reported)
• Avoid high-tyramine foods/beverages during treatment and for 2 weeks after stopping
• Discontinue at least 10 days before elective surgery
• Switching: allow ≥1 week or 4–5 half-lives after another MAOI, and 4–5 half-lives after a contraindicated antidepressant, before starting; allow ≥1 week after stopping before starting another MAOI

Contraindications

• Concomitant use or use in rapid succession with other MAOIs, SSRIs, SNRIs, tricyclic antidepressants, other antidepressants (e.g., bupropion, nefazodone, trazodone, vortioxetine), sympathomimetics, triptans, and numerous other serotonergic/pressor drugs — risk of hypertensive crisis or serotonin syndrome
• Pheochromocytoma or other catecholamine-releasing paraganglioma

Cautions

• Hypertensive crisis and hypertension
• Serotonin syndrome
• Activation of mania/hypomania (screen before treatment)
• Hypotension including postural hypotension and syncope
• Hypotension/hypertension during anesthesia and perioperative care
• Discontinuation syndrome
• MAO inhibition may persist up to 10 days after stopping
• Hepatotoxicity/elevated liver enzymes
• Seizures
• Hypoglycemia in diabetic patients

Adverse reactions

• Dry mouth
• Dizziness
• Insomnia
• Sedation/drowsiness
• Headache
• Overexcitement
• Constipation
• Blurred vision
• Tremor

Pregnancy Limited reports of placental infarction and congenital anomalies; advise potential fetal risk

Lactation Present in human milk; advise discontinuing breastfeeding during treatment