Tranylcypromine, commonly known as Parnate, is an antidepressant medication classified as a monoamine oxidase inhibitor (MAOI) that is used to treat depressive disorders. This medication can have adverse interactions with certain foods and medications and should be taken only after discussing potential risk factors with the doctor.

Tranylcypromine brand names

Tranylcypromine is sold under the following names:

  • Parnate (brand name)
  • Transamine sulphate 

What is tranylcypromine prescribed for?

Parnate, or tranylcypromine, is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression symptoms in adults. 

Tranylcypromine is most likely to be prescribed when other antidepressant drugs have failed because of the risks and side effects that may occur. People taking this medication also have certain dietary restrictions due to the drug's effects on the body. 

Tranylcypromine may be helpful for some people with phobias or panic disorders through off-label use [1].

How does tranylcypromine work?

Tranylcypromine increases the levels of two neurochemicals linked to depression symptoms: serotonin and noradrenaline [1]. It achieves this by preventing them from breaking down. 

While experts know how tranylcypromine works to change neurochemicals, it remains unclear why it works to reduce depression. 

How is tranylcypromine usually taken?

Parnate, and its generic versions, is available in tablet form to be taken orally. This medication can be taken 1-3 times daily, with most people taking it twice daily [5].

Take this medication around the same times daily. Schedule dosages before 3 p.m. to avoid sleep disturbance [2].

Take missed doses as soon as possible unless it is near time for the next daily dose. Do not double up on dosages.

The doctor will likely prescribe a low dose of Tranylcypromine and gradually increase it until clinical benefits are reached [5]. It can take 3 weeks or longer for symptom relief.

Take this medication exactly as prescribed. Do not share this medication with others. 

Do not stop taking this medication without consulting the doctor, even when depression symptoms have subsided. Stopping this medication too early can cause depression symptoms to return.

Suddenly stopping tranylcypromine can cause unpleasant withdrawal symptoms.

To reduyce the risk of withdrawal effects, the doctor will slowly titrate the dose until it is no longer needed [5].

How long does tranylcypromine stay in your system?

Tranylcypromine has a short half-life of 2-4 hours, meaning that 8 hours after the last dose it has been metabolized and excreted from the system. The effects of this medication can last much longer [2].

The inhibitory effects of tranylcypromine and resulting neurochemical changes in the body can last up to 10 days. Continue following precautions and avoiding medications and foods that can cause adverse interactions during this period of time [2].

Tranylcypromine side effects

Tranylcypromine side effects can range from mild to severe. Some people experience no side effects. 

As with any prescription medication, an allergic reaction may occur. Signs of an allergic reaction include:

  • Swelling of the face, throat, or tongue
  • Fever
  • Hives or a rash
  • Itching
  • Quickened heart rate
  • Trouble breathing 

If an allergic reaction occurs while taking tranylcypromine, seek immediate medical care. 

Some people experience suicidal thoughts or suicidality when first starting antidepressant medication. This risk is higher in children and young adult patients [2].

Notify the doctor immediately if thoughts of suicide or sudden mood changes occur. 

Serious tranylcypromine side effects include [1][5]:

  • Frequent, throbbing headaches
  • Neck stiffness or pain
  • Heart rate changes
  • Chest pain
  • Nausea or vomiting
  • Dark urine
  • Sweating
  • Paleness or flushing of the skin
  • Dilated pupils
  • Muscle weakness
  • Paralysis 
  • Dizziness
  • Unusual bleeding or bruising
  • Abdominal pain
  • Jaundice 
  • Hallucinations
  • Pain in the hands or feet  

If any serious side effects occur, immediately notify the doctor for advisement.

Additional tranylcypromine side effects reported are [1][5]:

  • Difficulty sleeping at night
  • Headaches
  • Restlessness
  • Dry mouth
  • Diarrhea
  • Vomiting
  • Nausea
  • Feeling tired or sleepy
  • Water retention
  • Increased appetite or weight gain
  • Trouble urinating
  • Decreased libido
  • Hair loss
  • Tinnitus 

Report any adverse effects to the doctor. Some side effects may abate on their own, while others may require a change in dosage or a different medication.

There is a rarely reported risk of misusing tranylcypromine. Discuss any concerns about cravings or misuse of this medication with the physician. 

Tranylcypromine precautions

Tranylcypromine is not for use by people with certain risk factors or preexisting conditions. Discuss with the doctor current and past medical conditions or psychiatric disorders before taking this medication to avoid complications.

The doctor should be made aware of any history, or family history, of the following [4]:

  • Cardiovascular diseases
  • Blood pressure problems
  • Circulation problems
  • Stroke
  • Bipolar Disorder
  • Liver disease
  • Thyroid conditions
  • Renal/kidney conditions
  • Adrenal tumor
  • Frequent headaches
  • Diabetes or other blood sugar problems
  • Seizures 

Antidepressant medications can trigger a manic episode in people who have bipolar disorder. Sudden mood changes, including an increase in irritability or agitation, should be shared with the doctor as soon as possible. 

Thoughts of suicide or self-harm may occur for some people who take antidepressants. This risk is higher in children and young adults.

This medication may cause drowsiness. Avoid operating heavy machinery, including driving a vehicle, until its effects are known.

People who are allergic to tranylcypromine should not take it. Discuss any allergies to other medications with the doctor before taking this medication. 

Avoid using alcohol while taking tranylcypromine. Using alcohol with this medication may worsen adverse reactions or cause dangerous complications.

Notify the doctor about using tranylcypromine before undergoing any type of surgery, including dental surgery [5].

Tranylcypromine is not safe for use during pregnancy or while breastfeeding. Do not stop taking this medication during pregnancy without consulting with the doctor.

Tranylcypromine carries a risk of misuse or dependence. Discuss any history of substance misuse with the doctor before taking this medicine [2].

Tranylcypromine interactions

Tranylcypromine, and medications like it, can have dangerous interactions with other prescriptions, dietary supplements, and certain foods. Discuss all prescription, over-the-counter medications, and any vitamin or herbal supplements with the physician.

A dangerous increase in blood pressure can occur from eating foods high in tyramine while taking this medication. 

Tyramine is in foods like [5]:

  • Smoked or aged meat, poultry, fish, and cheese
  • Spoiled or improperly stored meats
  • Certain fruits and vegetables, including citrus fruitslike lemons, limes, and grapefruits
  • Pickled foods
  • Banana skins
  • Beans
  • Alcoholic drinks, especially beer
  • Fermented yeast products

The doctor will discuss foods that need to be avoided, foods that can be consumed in lesser amounts, and foods that can be eaten freely. 

Avoid consuming caffeine while taking this medication [5].

People taking the following medications should not take tranylcypromine [1][3]:

  • Sympathomimetic agents (ephedrine, pseudoephedrine, adrenaline, noradrenaline)
  • Bupropion
  • Appetite-controlling medications (amphetamine, fenfluramine)
  • Medications for Parkinson's disease (levodopa)
  • Dopamine
  • Pethidine
  • Nefopam
  • General anesthetics
  • Other antidepressant medications
  • Buspirone
  • Metrizamide

Sympathomimetic agents are common in over-the-counter cold and flu medications. Check with the doctor or pharmacist before taking any over-the-counter medications while taking tranylcypromine.

People taking tranylcypromine should take the following medications under close medical monitoring [1]:

  • Other MAOI medications
  • Pain killers
  • Seizure medications
  • Barbiturates
  • Selective Serotonin Reuptake Inhibitors (SSRIs)

Taking tranylcypromine concurrently with other medications that affect serotonin levels, such as SSRIs or other antidepressant medications, can increase the risk of serotonin syndrome. This is a life-threatening condition with symptoms including [2]:

  • Hallucinations
  • Agitation
  • Delirium
  • Coma
  • Instability of automatic processes in the body such as breathing and heart rate
  • Dizziness
  • A rapid change in vital signs
  • Tremors
  • Muscle rigidity
  • Incoordination
  • Seizures
  • Gastrointestinal symptoms

Wait at least 14 days from the use of another antidepressant medication before starting tranylcypromine. If any signs of serotonin syndrome develop, immediately seek emergency medical care.

Taking these medications concurrently with tranylcypromine may cause sweating, agitation, confusion, and muscle rigidity [1]:

  • High blood pressure medicines
  • Diabetes medicines
  • Antihistamines 

Avoid using St. John's Wort while taking tranylcypromine [2].

Tranylcypromine storage

Tranylcypromine should be stored in a tightly closed container at room temperature. Keep this medication away from excessive light and moisture [1].

Keep tranylcypromine, and all prescription medications, out of the reach of children, teenagers, and pets to avoid accidental ingestion or overdose. Most daily pill containers do not have child-safety locks. 

To prevent prescription drug misuse amongst teens, keep all medications in a safe location where they cannot be accessed. 

Avoid disposing of tranylcypromine by throwing it in the garbage or flushing it down the toilet. Speak with a health professional to determine the safest way to dispose of unused medications.

What to do if you overdose on tranylcypromine

An overdose of tranylcypromine can be fatal. Seek immediate emergency medical care if an overdose occurs or is suspected.

Signs of a tranylcypromine overdose include [5]:

  • Insomnia
  • Restlessness
  • Anxiety and agitation
  • Confusion and dizziness
  • Slurred speech
  • Muscle weakness
  • Drowsiness
  • Headache
  • Muscle spasms
  • Fever
  • Muscle stiffness
  • Coma

Additional information on what to do if an overdose on tranylcypromine occurs can be provided by the poison control hotline at 1-800-222-1222.

Frequently asked questions about tranylcypromine

Tranylcypromine vs Phenelzine: What’s the difference?

Both tranylcypromine and phenelzine are monoamine oxidase inhibitors (MAOIs) and work similarly in reducing depression symptoms. Some believe that phenelzine may be more effective at reducing anxiety symptoms than tranylcypromine.

Phenelzine has the same risk factors and adverse drug interactions associated with tranylcypromine use. 

Resources:

  1. Package leaflet: Information for the patient Tranylcypromine 10mg Film Coated Tablets. (2022, June). Electronic Medicines Compendium. https://www.medicines.org.uk/emc/files/pil.2788.pdf
  2. PARNATE® (tranylcypromine) tablets, for oral use. (2018, January). U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/012342s064lbl.pdf
  3. Tranylcypromine Interactions. (n.d.). Drugs.com. Retrieved November 3, 2022, from https://www.drugs.com/drug-interactions/tranylcypromine.html
  4. Tranylcypromine. (n.d.). Drugs.com. Retrieved November 3, 2022, from https://www.drugs.com/mtm/tranylcypromine.html
  5. Tranylcypromine: MedlinePlus Drug Information. (n.d.). Retrieved November 3, 2022, from https://medlineplus.gov/druginfo/meds/a682088.html