Tranylcypromine

Tranylcypromine is an anti-depressant drug which works by restoring the normal balance of neurotransmitters in the brain and re-establishing emotional equilibrium for a patient being treated by the drug.

Overview

Tranylcypromine belongs to a classification of drugs known as monoamine oxidase inhibitors (MAOIs), which work by elevating the levels of specific chemicals in the brain, in this case, chemicals which elevate mood. It is used to treat cases of moderate to severe depression in adults and is generally recommended only after other more conventional methods of treatment have failed to yield favorable results.

Tranylcypromine does not manage the symptoms of bipolar disorder, or of most other types of mental illness, but is primarily prescribed in cases where depression alone has been diagnosed. Whenever it has been administered to a patient, that person must be closely observed for at least three months, to ensure that no evidence of worsening depression or self-harm is observed.

In the past, tranylcypromine has been associated with younger patients developing thoughts of suicide, especially when aged below 24. This drug should not be prescribed to children who are experiencing depression, and to young adults only when close supervision is possible, and no signs of suicide or self-harm are manifested.

Condition Treated

  • Depression

Type of Medicine

  • Monoamine oxidase inhibitor

Side Effects

It’s extremely rare that patients on a treatment program calling for tranylcypromine experience strong negative reactions when taking the drug. If you have any of the following side effects after ingesting tranylcypromine, you should make a note of them and discuss them with your doctor at the earliest opportunity. Even if some of these symptoms seem relatively trivial and unworthy of close attention, the possibility exists that they are indicators of a more serious condition which is either developing or has already developed.

Watch out for any signs of an allergic reaction such as skin which is peeling, blistering, itching, or is red and swollen. If you experience tightness in the throat or chest, or pronounced difficulty with breathing or conversing, very unusual hoarseness, or swelling of the face, mouth, lips, or throat, these can all be signs of an allergic reaction to tranylcypromine and should be reported immediately to your doctor.

Other symptoms can be indicators of problems with your liver, such as dark-colored urine, stomach pain, lack of appetite, persistent fatigue, light-colored stool, nausea and/or vomiting, or yellowish looking skin, especially around the eyes.

Side effects which are indicators of high blood pressure include dizziness or headache, fainting, or abrupt changes in vision. You may also notice changes in sexual performance, mood swings, grouchiness or irritability, nervousness, sensitivity to bright light, profuse sweating, irregular heartbeat, changes in your behavior, regular fever or chills, and more or less constant restlessness. If any of these side effects are manifestations that you do not normally exhibit, and which you’ve had little or no experience with prior to taking tranylcypromine, they should be considered side effects of the drug and should be reported to your doctor.

Some side effects may not be indicators of serious underlying traditions conditions but are simply resulting manifestations of having taken tranylcypromine. If any of these lesser side effects appear soon after taking the drug, take note of them and make sure you have a thorough discussion with your doctor about them. He may want to alter your medication or reduce your dosage, so as to cause less disruption in your body.

Some of these side effects include the following:

  • a persistent feeling of weakness
  • intermittent diarrhea
  • bloating and stomach pain
  • frequent upset stomach, sometimes accompanied by nausea
  • persistent dry mouth
  • insomnia
  • regular headaches
  • sleepiness
  • dizziness which cannot be associated with any other cause.

Dosage

A typical adult dosage for depression calls for 30 mg of tranylcypromine per day administered orally, and in equally divided dosages. If there is no noticeable improvement within the first two weeks, dosage can safely be increased by 10 mg each day for a week or two, until a maximum of 60 mg per day is being administered.

Improvement is noticed in patients over a very wide range of time, with some patients improving within two days and others requiring three weeks or more before any noticeable improvement can be seen. Whenever there is a changeover from some other MAOI, or from a related treatment program, there should be at least one week and probably two weeks allowed in between, where there is no treatment at all, so the body has a chance to purge itself of prior influences.

When a patient is going through this kind of changeover, only half the normal dosage is recommended initially, and then modifications can be made under close observation. Any patient showing a tendency toward high blood pressure must have dosages very carefully monitored, and dosage increases should only be allowed with the doctor’s full knowledge and approval.

The dosage amounts are also very important, because they can indicate how long certain drugs stay in your system, and when it might be safe to administer another medication. It should also be remembered that no prescribed medication should never be started, stopped, or disrupted without first consulting your family doctor. You should not make any changes to prescribed medications or dosages without talking to your family doctor, because this could lead to dangerous reactions with other medications.

Tranylcypromine should always be taken according to any directions given by your family doctor, and these should be followed closely to avoid any kind of complications or dangerous issues. In general, however, there are certain guidelines which can be observed that relate to safe usage with tranylcypromine.

The drug can be taken with or without food, so it's not necessary to plan your meals around daily dosages. To get the most benefit from the drug, have regularly scheduled times throughout the day when you take it and make sure not to miss those scheduled times. Even after you have begun to feel healthier, you should continue to take tranylcypromine until your prescription runs out, or until your doctor has advised you that discontinuance is indicated.

If your doctor has put you on a special diet during the tranylcypromine treatment program, continue to observe the parameters of the special diet at least two weeks beyond the discontinuation of the drug itself.

If you happen to miss a dosage of tranylcypromine, take that dosage as soon as you think about it, unless it's already close to your next regularly scheduled dosage, and then you can just wait for the next dosage. Never double up on your tranylcypromine dosages, or take extra doses because you feel you need more medication at certain times.

Interactions

Tranylcypromine should not be taken in conjunction with other drugs for the treatment of depression – this means you should avoid diet pills, pain drugs, reserpine, and any kind of stimulants such as amphetamines.

There should always be a period in between taking tranylcypromine and any of these types of drugs which are typically used to combat depression. Your doctor will be able to tell you how much time to observe in between changes of medication.

You should avoid using any kind of over-the-counter drugs which have ingredients such as dextromethorphan or pseudoephedrine, since these can cause extremely high blood pressure when used in conjunction with tranylcypromine. For that matter, you should avoid taking tranylcypromine with any over-the-counter drugs which might raise your blood pressure to an unsafe level, for instance, diet pills, ibuprofen, cough and cold medications, and some natural herbal products.

Alcohol should not be consumed in excess when you are on a treatment program calling for tranylcypromine, because the presence of alcohol can escalate your blood level pressure even two weeks beyond the time when you have ended your tranylcypromine treatment program.

You should avoid using products with caffeine as a main ingredient, e.g. coffee, sodas, tea, chocolate, etc., as it may lead to high blood pressure when taking with tranylcypromine, and can also induce shakiness, nervousness, irregular heartbeat, and symptoms of stress and anxiety.

Many types of cheese will need to be minimized in the diet, including mozzarella, Parmesan, Roquefort, Romano, Swiss cheese, cheddar, Camembert, brie, brick cheese, and American cheese. Chocolate will have to be avoided as much as possible because it usually contains high amounts of sugar and caffeine.

Other foods which should be generally avoided include ginseng, sour cream, soy sauce, bean curd, fava beans, yogurt, and yeast extract. Ingesting tyramine in any significant amount while you are on a treatment program including tranylcypromine can cause your blood pressure to rise to dangerous levels, and may even induce life-threatening situations.

Since tranylcypromine can also impact your decision-making ability and your focus, it is not advisable to drive, or do any other kinds of activity which call for alertness in situations which could potentially be dangerous.

Interactions with other drugs can cause serious medical problems when taken at the same time as dosages of tranylcypromine. Each one of the following named drugs has the potential of causing such a serious reaction when taken in tandem with tranylcypromine, so none of these should ever be taken concurrently.

Medications to be avoided are the following:

  • any kind of blood pressure medications such as reserpine, methyldopa, or guanethidine
  • any kind of antidepressant medications
  • diet pills
  • stimulants
  • ADHD medications
  • cold medicines
  • allergy medications
  • any kind of over-the-counter cough medicines
  • doxepin
  • carbamazepine
  • cyclobenzaprine
  • maprotiline
  • procarbazine
  • bupropion
  • venlafaxine
  • buspirone
  • tryptophan
  • levodopa
  • and meperidine.

Warnings

Using tranylcypromine during pregnancy is generally only recommended if there is a powerful motivation for doing so, and when the presumed benefit is greater than the risk involved. There have not been any extensive studies conducted on a human population. This means that any conclusions about the effects of taking tranylcypromine during pregnancy and with breast-feeding, must be in large part based on data which has been obtained through testing on animal subjects.

That data has shown that tranylcypromine will cross the placental barrier, but does not produce any kind of toxicity in doing so. Some epidemiological studies have suggested a slightly higher risk of congenital abnormalities when antidepressants are used during pregnancy, so this is something that should be taken into consideration when using the drug. Again though, it must be remembered that this data is not based on human data.

Neonates which are exposed to a general class of antidepressant drugs into the third trimester of pregnancy have demonstrated a tendency toward withdrawal symptoms such as colic irritability, hypotension, hypertension, spasms, tremors, lethargy, and dyspnea. Data gathered from animal pregnancies show that there is no evidence of increased occurrence of damage to the fetus, so the negative symptoms above are thought to be the worst side effects.

With all this taken into account, the FDA requires labeling on antidepressant medications to include a summary of all known risks, as well as a pointer to the data which has been used to generate that summary. It also requires that all relevant information is posted when it is deemed significant in helping medical personnel to make the most informed decisions about prescriptions, and with counseling women about the risks and benefits during pregnancy.

Other precautions to take and warnings to heed:

  • Before taking tranylcypromine, all patients should have a thorough discussion with the family physician, including a full review of their medical history. You should of course bring out the fact that you are allergic to tranylcypromine or any of the ingredients which are used in its manufacture.
  • If you should discover that you are allergic to tranylcypromine after beginning a program of treatment, you should immediately alert your family doctor, and describe whatever symptoms have been appearing, e.g. rashes, hives, wheezing, coughing, itching, difficulty breathing, and any kind of inflammation or swelling of the face, tongue, throat, or lips.
  • Make sure your doctor is aware if you have had a history of headaches, liver disease, high blood pressure, stroke, brain problems, or pheochromocytoma. To be on the safe side, compile a list of all prescription drugs you are currently taking, as well as a list of all vitamins, supplements, and herbal medications you are routinely ingesting, along with the dosages for each.
  • Make sure that anyone who is involved with your medical care or treatment is aware that you are taking tranylcypromine, and that means not only the medical personnel like doctors and nurses, but also your neighborhood pharmacist, and any dental specialists that you are seeing as well.
  • If you have any kind of medical procedure coming up, or some kind of dental surgery, your tranylcypromine medication treatment may need to be temporarily interrupted, so that other procedures can be safely conducted. If any such interruption is necessary, your doctor will be able to advise you on when it can safely be resumed.
  • You should always avoid driving and other actions which require concentration and alertness on your part, until you are sure about how tranylcypromine affects you or reduces your ability to perform those actions.
  • It's a good idea to rise up slowly after you've been sitting or lying down for an extended period of time, so that you don't get dizzy, or risk fainting on the spot. By the same token, you should exercise caution going up and down stairs, as well as any other situation where serious exertion is called for.
  • When you embark on a treatment program calling for tranylcypromine, make sure to monitor your blood pressure at home, as well as in the doctor's office, since blood pressure is one of the more commonly affected medical conditions when taking tranylcypromine. Since the drug has triggered episodes of high blood pressure in the past, it's a possibility that everyone should be aware of, so that no dangerous situations develop.
  • There is a greater risk of seizures and stroke when taking tranylcypromine, and you should at the very least be aware that it's a possibility in your own case. If you are already a diabetes patient, you'll have to monitor your blood sugar levels very closely, because taking tranylcypromine can influence the level of blood sugar in your body, and lead to potential problems.
  • You should be aware that if you suddenly stop taking tranylcypromine on your own without your doctor's recommendation, you may observe symptoms of withdrawal. For that reason, doctors generally recommend a gradual weaning off from tranylcypromine, so as not to incur the withdrawal symptoms.
  • Any patient aged 65 and above should take tranylcypromine with extreme caution, because any side effects which occur naturally could be made more extreme in older people.
  • If you are pregnant or plan on becoming pregnant, you should discuss this with your doctor, since there are certain risks associated with taking tranylcypromine during pregnancy. In a related issue, you should also discuss any plans to breast-feed with your doctor, since there may be some risk involved to your infant with the drug coming through in mother’s milk.
  • When you are in a treatment program including tranylcypromine, it will be necessary to avoid eating foods that contain high amounts of tyramine, including bananas, figs, avocados, raisins, and sauerkraut, beef or chicken livers, fish, any tenderized meats, meat extracts, dried fish, herring, caviar, shrimp paste, summer sausage, game meat, baloney, and pepperoni.
  • It will also be necessary to avoid drinking any large amounts of beer, red wine, Sherry, vermouth, or other distilled spirits. Drinks which have significant amounts of caffeine in them should be avoided as much as possible, including tea, most sodas, and coffee.

Storage

Tranylcypromine should be stored at room temperature in a dry place, and not in the bathroom medicine cabinet, where at times the temperature can be very warm, and humidity can be very high. This drug should be stored in a safe place, well out of the reach of children and pets, and safe disposal should be discussed with your family doctor when you have unused tablets of the medication left over after treatment.

Summary

If your symptoms do not improve after three weeks, or if they should worsen during that time, be sure to call your doctor immediately and discuss. Your prescription of tranylcypromine should never be shared with anyone else, regardless of whether or not you feel they would benefit by taking it.

It's a good idea to keep a copy of this list handy in case you ever have to make a visit to an emergency medical care unit, because any doctor there will need to know what your medications and dosages are before safely proceeding with any kind of treatment program. Without this kind of list, you might easily overlook an important medication you are using, and leave yourself open to an interaction with something prescribed by the emergency room physician.

Whenever you are considering taking a new drug, vitamin, or herbal supplement, make sure to discuss this with your doctor first, so that any potential interactions are known and considered. Tranylcypromine will always be issued with a patient fact sheet known as a Medication Guide. This should be carefully read, and all instructions should be adhered to carefully, and each time a prescription is renewed, the Medication Guide should be re-read, in case any changes have been made since last time.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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