(Parnate) Tranylcypromine Sulfate Uses, Dosage, Side Effects

Tranylcypromine Sulfate

(tran-ill-sip′roe-meen)

Parnate

Classification: ANTIDEPRESSANT; MONOAMINE OXIDASE INHIBITOR (MAOI)

Therapeutic: ANTIDEPRESSANT; MAOI

Prototype: Phenelzine

Pregnancy Category: C

AVAILABILITY

Tablet

ACTION & THERAPEUTIC EFFECT

Potent MAO with a antidepressant activity that arises from the increased availability of monoamines resulting from the inhibition of the enzyme MAO. This leads to increased concentration of neurotransmitters, such as epinephrine, norepinephrine, and dopamine in the CNS. Drug of last choice for severe depression unresponsive to other MAO inhibitors.

USES

Major depression.

UNLABELED USES

Orthostatic hypotension, panic disorder, social anxiety disorder.

CONTRAINDICATIONS

Confirmed or suspected cerebrovascular defect, cardiovascular disease; hepatic disease or abnormal LFT; hypertension, pheochromocytoma, history of severe or recurrent headaches; recent acute MI; angina; renal failure; suicidal ideation; anuria; lactation.

CAUTIOUS USE

Bipolar disorder; Parkinson’s disease; psychosis; schizophrenia, anxiety/agitation; CHF; DM; seizure disorders; hyperthyroidism; history of suicidal attempts; renal impairment; older adults; pregnancy (category C); children and adolescents with major depressive disorder or other psychiatric disorders.

ROUTE & DOSAGE

Major Depression

Adult: PO 30 mg/day in 2 divided doses, may increase by 10 mg/ day at 2–3 wk intervals (max: 60 mg/day)

ADMINISTRATION

Oral

• Contraindicated drugs should be discontinued 1–2 weeks before starting therapy.
• Crush tablet and give with fluid or mix with food if patient cannot swallow pill.
• Note: Doses given in the late evening may cause insomnia.

ADVERSE EFFECTS (≥1%)

CNS: Vertigo, dizziness, tremors, muscle twitching, headache, blurred vision suicidality. CV: Orthostatic hypotension, arrhythmias, hypertensive crisis. GI: Dry mouth, anorexia, constipation, diarrhea, abdominal discomfort. Skin: Rash. Urogenital: Impotence. Body as a Whole: Peripheral edema, sweating.

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INTERACTIONS

Drug: TRICYCLIC ANTIDEPRESSANTS, SSRIS, AMPHETAMINES, ephedrine, reserpine, guanethidine, buspirone, methyldopa, dopamine, levodopa, tryptophan may precipitate hypertensive crisis, and must be discontinued before tranylcypromine treatment. Alcohol and other CNS DEPRESSANTS add to CNS depressant effects; meperidine can cause fatal cardiovascular collapse; ANESTHETICS exaggerate hypotensive and CNS depressant effects; metrizamide increases risk of seizures; DIURETICS and other ANTIHYPERTENSIVE AGENTS add to hypotensive effects. Food: Tyramine-containing foods may precipitate hypertensive crisis (e.g., aged or matured cheese, air-dried or cured meats including sausages and salamis; fava or broad bean pods, tap/draft beers, sauerkraut, soy sauce, and other soybean condiments). Herbal: Ginseng, ephedra, ma huang, St. John’s wort may lead to hypertensive crisis; ginseng may lead to manic episodes.

PHARMACOKINETICS

Absorption: Completely from GI tract. Onset: 10 days. Metabolism: Rapidly in liver to active metabolite. Elimination: Primarily in urine. Half-Life: 90–190 min.

NURSING IMPLICATIONS

Black Box Warning 
Tranylcypromine sulfate has been associated with suicidal thinking and behavior in children, adolescents, and young adults.

Assessment & Drug Effects

• Monitor BP closely. Severe hypertensive reactions are known to occur with MAO inhibitors.
• Report immediately to prescriber signs of worsening mental status such as suicidal ideation, aggressiveness, agitation, anxiety, hostility, impulsivity, insomnia, irritability, panic attacks, and worsening of depression.
• Expect therapeutic response within 3 days, but full antidepressant effects may not be obtained until 2–3 wk of drug therapy.

Patient & Family Education

• Do not eat tyramine-containing foods (see FOOD–DRUG INTERACTIONS).
• Be aware that excessive use of caffeine- containing beverages (chocolate, coffee, tea, cola) can contribute to development of rapid heartbeat, arrhythmias, and hypertension.
• Report promptly emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, mania, worsening depression, suicidal ideation, or other unusual changes in behavior.
• Make position changes slowly, particularly from recumbent to upright posture.
• Avoid potentially hazardous activities until response to drug is known.
• Avoid alcohol or other CNS depressants because of their possible additive effects.

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Ditulis oleh Unknown pada tanggal Tuesday, October 27, 2015