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Tranylcypromine oral


Tablets containing tranylcypromine

Drugs List

  • tranylcypromine 10mg tablets
  • Therapeutic Indications


    Depressive illness

    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
    Cerebrovascular disorder
    Congestive cardiac failure
    Hepatic impairment
    Hereditary fructose intolerance
    History of hepatic impairment
    Severe cardiovascular disorder

    Precautions and Warnings

    Electroconvulsive therapy
    Patients over 65 years
    Suicidal ideation
    Cardiovascular disorder
    Diabetes mellitus
    Epileptic disorder
    Glucose-galactose malabsorption syndrome
    Haematological disorder
    History of alcohol abuse
    History of drug misuse
    Severe agitation

    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 ( ) or if this is unavailable at the backup site ( ).


    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

    Side Effects

    Blood dyscrasias
    Blurred vision
    Cardio-respiratory depression
    CNS stimulation
    Delayed ejaculation
    Difficulty in micturition
    Dry mouth
    Gastro-intestinal symptoms
    Hepatic impairment
    Hepatocellular necrosis (progressive)
    Hypertensive crisis in some patients (with normal or low blood pressure)
    Increase in muscle tone
    Increased appetite
    Increases in hepatic enzymes
    Lupus erythematosus-like syndrome
    Metabolic changes
    Neck pain
    Neck stiffness
    Neuroleptic malignant syndrome
    Oedema of the glottis
    Peripheral neuritis
    Peripheral neuropathy
    Postural hypotension
    Psychotic episodes
    Sexual disturbances
    Sleep disturbances
    Speech disturbances
    Substernal pain
    Suicidal tendencies
    Urinary retention
    Weight gain


    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 ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: June 2014

    Reference Sources

    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 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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