- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Tablets containing tranylcypromine
Symptoms of depressive illness, especially with phobic symptoms, or where treatment with other types of antidepressants has failed.
Initially 10 mg twice daily in morning and afternoon (no later than 3 p.m.). If response is inadequate after a week, add a further 10 mg tablet at midday, and continue for at least another week.
Doses above 30 mg daily should only be given under close supervision.
When a satisfactory response has been obtained, dosage may be reduced; usual maintenance dose is 10 mg daily.
When given concurrently with electroconvulsive therapy, usual dosage is 10 mg twice a day during the series, and 10 mg daily afterwards as maintenance therapy.
(See Dosage; Adult)
Use with caution in the elderly. Doses lower than that recommended for adults may be required.
Children under 18 years
Concomitant medication consider washout period, see prescribing information
Abnormal liver function test
Congestive cardiac failure
Hereditary fructose intolerance
History of hepatic impairment
Severe cardiovascular disorder
Precautions and Warnings
Patients over 65 years
Glucose-galactose malabsorption syndrome
History of alcohol abuse
History of drug misuse
Patients at risk of suicide should be closely supervised
Advise ability to drive/operate machinery may be affected by side effects
Contains soya or soya derivative
Preparation contains sucrose
Monitor blood pressure
Monitor liver function. Withdraw if evidence of hepatotoxic reaction
Monitor patients undergoing spinal or epidural anaesthesia closely
Tolerance and dependence may occur
Advise patient that postural hypotension may occur
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
Reduce dose in elderly
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 excessive intake of tea, coffee or other stimulants
Avoid foods that interact with MAOIs for 2 weeks after discontinuing drug
Monoamine oxidase inhibitors have a great potential for interactions with other drugs. Drug - drug interactions are not covered in this monograph, but can be viewed in the coded data. This data includes information on washout periods of interacting drugs.
Depression is associated with an increased risk of suicidal thoughts, self harm and suicide (suicide related events). This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs. It is general clinical experience that the risk of self harm is highest shortly after presentation and the risk of suicide may increase again in the early stages of recovery. Furthermore, there is evidence that in children and adolescents, antidepressants may increase the risk of suicidal thoughts and self harm
Patients with a history of suicide related events, those exhibiting a significant degree of suicidal ideation prior to commencement of treatment, and young adults, are at a greater risk of suicidal thought or suicide attempt, and should receive careful monitoring during treatment.
Patients, (and caregivers of patients) should be alerted about the need to monitor for the emergence of suicidal thoughts and behaviour, and to seek medical advice immediately if these symptoms present.
Discontinue 2 weeks prior to elective surgery requiring general anaesthesia. The anaesthetist should be warned that a patient is being treated with tranylcypromine, in the event of emergency surgery being necessary.
Patients under treatment with tranylcypromine should avoid high protein food that has undergone breakdown by ageing, fermentation, pickling, smoking or bacterial contamination. Patients should avoid cooked or plain cheese, Oxo, Bovril, Marmite, brewer's yeast, etc during treatment and up to 14 days after ceasing treatment. Flavoured textured vegetable protein, hung game, pickled herrings, dry sausage (salami, pepperoni etc), liver, yoghurt, broad bean pods, fermented soya bean extract and excessive amounts of chocolate may also present a hazard. Patients should not consume alcoholic drink or non-alcoholic beers, lagers and wines and excessive amounts of tea and coffee should be avoided.
Pregnancy and Lactation
Use tranylcypromine with caution in pregnancy.
There is a potential increased risk of neonatal malformations when tranylcypromine is used during pregnancy though little data is available for its use in pregnancy. The manufacture advises against its use in pregnancy unless essential.
Schaefer notes that exposure to MAOIs is not an indication for termination of pregnancy and that detailed foetal ultrasonography may be offered in such cases to control normal development.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Use tranylcypromine with caution in breastfeeding.
Highly limited evidence in relation to safety of use in humans so other antidepressants are recommended. Tranylcypromine is excreted into milk in dogs and its molecular weight would indicate its excretion into human breast milk.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Difficulty in micturition
Hepatocellular necrosis (progressive)
Hypertensive crisis in some patients (with normal or low blood pressure)
Increase in muscle tone
Increases in hepatic enzymes
Lupus erythematosus-like syndrome
Neuroleptic malignant syndrome
Oedema of the glottis
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 ).
Last Full Review Date: June 2014
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com Accessed on June 10, 2014
Summary of Product Characteristics: Tranylcypromine 10mg tablets. Amdipharm Mercury. Revised March 2014.
MHRA 4th February 2008
Last accessed: June 10, 2014
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.