Phenelzine oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of phenelzine.
Drugs List
Therapeutic Indications
Uses
Depressive illness
Dosage
Adults
15mg initially three times daily.
If there is no response after two weeks, dose may be increased to a maximum of 15mg four times daily.
Doses of up to 30mg three times daily may be used in hospitals.
After a satisfactory response has been achieved, reduce the dosage very gradually to the lowest possible maintenance dose (15mg on alternate days may be adequate).
Children
Children aged 16 years and over
15mg initially three times daily.
If there is no response after two weeks, dose may be increased to a maximum of 15mg four times daily.
Doses of up to 30mg three times daily may be used in hospitals.
After a satisfactory response has been achieved, reduce the dosage very gradually to the lowest possible maintenance dose (15mg on alternate days may be adequate).
Contraindications
Children under 16 years
Concomitant medication consider washout period, see prescribing information
Breastfeeding
Cerebrovascular disorder
Congestive cardiac failure
Hepatic impairment
History of hepatic impairment
Phaeochromocytoma
Pregnancy
Precautions and Warnings
Anaesthesia
Electroconvulsive therapy
Patients over 65 years
Suicidal ideation
Surgery
Agitation
Cardiovascular disorder
Diabetes mellitus
Epileptic disorder
Haematological disorder
Hypertension
Hypotension
Porphyria
Schizophrenia
Patients at risk of suicide should be closely supervised
Advise impaired alertness may affect ability to drive or operate machinery
Previous/Concurrent medicine consider washout period: See prescribing info
Monitor blood pressure
Monitor liver function. Withdraw if evidence of hepatotoxic reaction
Advise patients/carers to seek medical advice if suicidal intent develops
Consider hyponatraemia in all patients with drowsiness/confusion/seizures
May activate mania or hypomania
May aggravate anxiety and agitation
May cause postural hypotension
Avoid abrupt withdrawal
Discontinue 2 weeks prior to elective surgery
Discontinue if headaches occur
Discontinue if palpitations occur
Discontinue if patient enters a manic phase
Discontinue if significant rise in blood pressure occurs
Advise patient against self medication, particularly cold remedies
Advise patient to avoid alcohol during treatment
Advise patient to avoid non-alcoholic beers, lagers and wines
Advise patient to avoid foods or beverages with a high tyramine content
Avoid foods that interact with MAOIs for 2 weeks after discontinuing drug
Phenelzine is not indicated in the manic phase.
It is general clinical experience that there is an increase in the risk of suicide in the first stages of recovery.
Pregnancy and Lactation
Pregnancy
Phenelzine is contraindicated during pregnancy.
The manufacturer advises that phenelzine should not be used during pregnancy, especially during the first and the last trimesters. There is no evidence of drug safety in human pregnancy or evidence from animal studies.
Lactation
Phenelzine is contraindicated during breastfeeding.
The manufacturer states that it is not known if phenelzine is excreted in breast milk and advises that the patient either discontinues phenelzine or discontinues breastfeeding. However, due to the molecular weight (about 234) and the long elimination half-life of 11.6 hours, it suggests phenelzine will be excreted into the breast milk. Briggs (2015) suggests that if the drug is used during breastfeeding, that the infant needs to be monitored for the most common side effects that happen in adults (dizziness, headache, drowsiness, fatigue, sleep disturbances, weakness, tremors, twitching, myoclonic movements, hyperreflexia, constipation, dry mouth and oedema).
Side Effects
Agitation
Anorgasmia
Anxiety
Arrhythmias
Ataxia
Behavioural disturbances
Blood dyscrasias
Blurred vision
Coma
Confusion
Constipation
Convulsions
Delirium
Difficulty in micturition
Dizziness
Drowsiness
Dry mouth
Euphoria
Fatigue
Fever
Gastro-intestinal symptoms
Glaucoma
Hallucinations
Headache
Hepatocellular necrosis (progressive)
Hypernatraemia
Hyperreflexia
Hypertensive crisis
Hypomania
Hyponatraemia
Impotence
Increase in muscle tone
Increase in serum transaminases
Increased appetite
Increases in hepatic enzymes
Insomnia
Intracranial bleeding
Jaundice
Leucopenia
Lupus erythematosus-like syndrome
Mania
Muscle twitch
Myoclonus
Nausea
Nervousness
Neuroleptic malignant syndrome
Nystagmus
Oedema
Oedema of the glottis
Palilalia
Paraesthesia
Peripheral neuritis
Peripheral neuropathy
Postural hypotension
Pruritus
Psychotic episodes
Purpura
Rash
Schizophrenia
Sexual disturbances
Suicidal tendencies
Sweating
Tremor
Vomiting
Weakness
Weight gain
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: July 2022
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Nardil 15mg film-coated tablets. Neon Healthcare Ltd. Revised May 2022.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 08 July 2022
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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