Adult Dosing

Depression without melancholia

• Start 30 mg/day PO divided tid; after 2 wks can increase by 10 mg/day q1–3 wks
• Max: 60 mg/day
• Note: Taper dose gradually to discontinue

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of major depressive episode without melancholia

• Hypersensitivity to any of the ingredients of the product
• General anesthesia within 10 days
• Elective surgery within 10 days
• Hepatic disease
• Elevated LFTS
• Cerebrovascular disease
• Cardiovascular disease
• Hyperthyroidism
• Hypertension
• Pheochromocytoma
• History of headache
• Excessive consumption of caffeine
• Concurrent use of meperidine, SSRIs, SNRIs, tricyclic antidepressants, tetracyclic antidepressants, bupropion, buspirone, sympathomimetics, MAO inhibitors or other dibenzazepine-related entities, dextromethorphan, narcotics, alcohol, general anesthetics, diuretics, antihistamines, or tryptophan
• Concurrent use of foods containing high concentrations of tyramine

• Antidepressants increase the risk compared to placebo of suicidal tendencies and behavioral changes in children, adolescents, and young adults. In short-term studies of antidepressants vs. placebo, suicidality risk was not increased in patients >24 yrs and risk decreased in patients >65 yrs
• Carefully weigh the risks and benefits before starting treatment
• Monitor patients closely for clinical worsening, suicidal tendencies and unusual changes in behavior, particularly early in therapy or after increases in dose
• Tranylcypromine is not approved for use in pediatric patients

Renal Dose Adjustment

• Renal impairment: Use with caution; dose adjustments not defined

Hepatic Dose Adjustment

• Hx of hepatic impairment/Abnormal LFTs: Contraindicated

See Supplemental Patient Information

• Increased risk of suicidal tendencies; observe patients for worsening depression or the emergence of suicidality, anxiety, agitation, panic attacks, particularly early in therapy or after increases in dose
• Antidepressants may increase the likelihood of precipitation of a mixed/manic episode in patients at risk of bipolar disorder; screen patients prior to starting therapy to determine if they are at risk for bipolar disorder
• Hypertensive crisis is the most important reaction associated with tranylcypromine administration. Fatal intracranial bleeding may occur with paradoxical increase in blood pressure. Discontinue treatment immediately upon occurrence of palpitation or frequent headaches
• Risk of suppression of anginal pain, which would otherwise serve as a warning of myocardial ischemia
• Postural hypotension resulting in syncope may occur
• Tranylcypromine may increase the risks associated with electroconvulsive therapy; consider discontinuing, when possible, prior to ECT treatment
• Discontinue at least 48 hrs prior to myelography
• Monitor BP, LFTS periodically; discontinue use at the first sign of liver dysfunction or jaundice
• Gradually taper when discontinuing to avoid withdrawal symptoms

Cautions: Use cautiously in

• Renal impairment
• Hypotension
• Hyperthyroidism
• Hx of diabetes mellitus (may alter glucose control)
• Hx of seizure disorder (may lower seizure threshold)
• Hx of mania
• Bipolar disorder
• Schizophrenia
• Parkinson's disease
• Alcohol use
• Avoid high tyramine-content foods
• Elderly patients

Supplemental Patient Information

• Inform patients on benefits, risks and appropriate use associated with treatment. A medication guide should be given to patient, family members and caregiver
• Alert family members and caregivers about the need to monitor patients for the emergence of agitation, irritability, or any other unusual changes in behavior

Parnate interacts with :

	Abstral
	Actiq
	Adipex-P
	Afrinol
	AK-Dilate
	Amphetamines
	Amrix
	Anafranil
	Aplenzin
	Aramine
	Atomoxetine
	Bontril
	Brintellix
	Brisdelle
	Bupropion
	Celexa
	Children's robitussin cough long-acting
	Children's Sudafed
	Children's Sudafed PE
	Children's triaminic long acting cough
	Citalopram
	Clomipramine
	Cocaine
	Concerta
	Conzip
	Cyclobenzaprine
	Cymbalta
	Darvon
	Darvon-N
	Daytrana
	Delsym
	Demerol
	Desvenlafaxine
	Desyrel
	Dextromethorphan
	Diethylpropion
	Dolene
	Dolophine
	Dopamine
	Duloxetine
	Duragesic
	Effexor
	Effexor XR
	Ephedrine
	Escitalopram
	Fentanyl
	Fentora
	Fetzima
	Fexmid
	Flexeril
	Fluoxetine
	Fluvoxamine
	Forfivo XL
	Imipramine
	Ionamin
	Isometheptene
	Khedezla
	Lazanda
	Levomilnacipran
	Lexapro
	Little Noses Decongestant Nose Drops
	Luvox
	Luvox CR
	Mazindol
	Meperidine
	Metadate CD
	Metadate ER
	Metaraminol
	Methadone
	Methadose
	Methylin
	Methylin ER
	Methylphenidate
	Midrin
	Milnacipran
	Neo-Synephrine
	Neo-Synephrine Extra Strength
	Neo-Synephrine Mild Strength Spray
	Neo-Synephrine Regular Strength
	Nexafed
	Nucynta
	Nucynta ER
	Oleptro
	Onsolis
	Paroxetine
	Paxil
	Paxil CR
	PediaCare Children's Decongestant
	Pexeva
	Phendimetrazine
	Phentermine
	Phenylephrine
	Pristiq
	Propoxyphene
	Prozac
	Prozac Weekly
	Pseudoephedrine
	Quillivant XR
	Ritalin
	Ritalin LA
	Ritalin-SR
	Robitussin cough long-acting
	Robitussin Lingering Cold Long-Acting Cough
	Rybix ODT
	Ryzolt
	Sanorex
	Sarafem
	Savella
	Selfemra
	Sertraline
	Strattera
	Sublimaze
	Subsys
	Sucrets DM cough formula
	Sudafed
	Sudafed 12 Hour
	Sudafed 24 Hour
	Sudafed Children's Nasal Decongestant
	Sudafed PE
	Sudafed PE Congestion
	Suprenza
	Tapentadol
	Tenuate
	Tenuate Dospan
	Tetrabenazine
	Tofranil
	Tofranil-PM
	Tramadol
	Trazodone
	Triaminic Cold
	Ultram
	Ultram ER
	Venlafaxine
	Vicks dayquil cough
	Vicks formula 44 custom care dry cough suppressant
	Vicks Nature Fusion Cough
	Viibryd
	Vilazodone
	Vortioxetine
	Wellbutrin
	Wellbutrin SR
	Wellbutrin XL
	Westadone
	Xenazine
	Zoloft
	Zyban

Pregnancy Category:C

Breastfeeding: Safety unknown; alternative drugs should be preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 4 August 2010).

• CNS: Agitation, akinesia, ataxia, confusion, disorientation, dizziness, drowsiness, headache, fatigue, memory loss, hyper-reflexia, paresthesias, CNS stimulation, parkinsonian syndrome, seizures
• PSYCHIATRIC: Suicidality, behavior changes, worsening of depression, anxiety, mania, restlessness, insomnia, sleep disturbances, hallucinations, toxic delirium
• CV: Hypertensive crisis, edema, orthostatic hypotension, palpitation, tachycardia
• DERM: Alopecia, rash, urticaria
• METABOLIC: SIADH
• GI: Abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting, xerostomia, hepatitis
• GU: Urinary retention, ejaculatory dysfunction
• HEMA: Agranulocytosis, anemia, leukopenia, thrombocytopenia
• MUSC: Myoclonus, muscle spasms
• EENT: Blurred vision, tinnitus
• MISC: Diaphoresis, chills

• MAO inhibitor; non-selectively blocks activity of monoamine oxidase, thereby increasing MAO (eg, epinephrine, norepinephrine, serotonin) concentrations in CNS
• Metabolized by liver to active metabolites; CYP450: Unknown
• Excreted in urine and feces
• Half-Life: 4.4-8 hrs

US Trade Name(s)

• Parnate

US Availability

tranylcypromine (generic)

• TABS: 10 mg

Parnate

• TABS: 10 mg

Canadian Trade Name(s)

• Parnate

Canadian Availability

Parnate

• TABS: 10 mg

UK Availability

tranylcypromine (generic)

• TABS: 10 mg

Australian Trade Name(s)

• Parnate

Australian Availability

Parnate

• TABS: 10 mg

[Outline]

Neurologic

Antidepressants

Monoamine Oxidase Inhibitors

Psychiatric

Antidepressants

Monoamine Oxidase Inhibitors

Pricing data from www.DrugStore.com in U.S.A.

• Tranylcypromine Sulfate 10 MG TABS [Bottle] (PAR)
  100 mg = $112.6
  300 mg = $319.64
• Parnate 10 MG TABS [Bottle] (GLAXO SMITH KLINE)
  60 mg = $205.99
  180 mg = $595.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

Drug Name: Parnate 10 MG (as tranylcypromine sulfate) Oral Tablet

Ingredient(s): Tranylcypromine

Imprint: PARNATE;SB

Color(s): Red

Shape: Round

Size (mm): 8.00

Score: 1

Inactive Ingredient(s): cellulose, microcrystalline / citric acid / croscarmellose sodium / d&c red no. 7 / fd&c blue no. 2 / fd&c red no. 40 / fd&c yellow no. 6 / gelatin / lactose / magnesium stearate / talc / titanium dioxide

Drug Label Author:
GlaxoSmithKline LLC

DEA Schedule:
Non-Scheduled

Drug Name: Tranylcypromine 10 MG Oral Tablet

Ingredient(s): Tranylcypromine

Imprint: 250;K

Color(s): Pink

Shape: Round

Size (mm): 9.00

Score: 1

Inactive Ingredient(s): colloidal silicon dioxide / croscarmellose sodium / dibasic calcium phosphate dihydrate / magnesium stearate / cellulose, microcrystalline / fd&c red no. 40 / polyethylene glycol 3350 / polyvinyl alcohol / titanium dioxide / talc

Drug Label Author:
Par Pharmaceutical, Inc.

DEA Schedule:
Non-Scheduled