Tranylcypromine

Registered South African indications:

• Depression

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Pregnancy
• Breastfeeding
• Hepatic impairment or known liver damage
• Porphyria
• Cerebrovascular disease
• Severe cardiovascular disease
• Phaeochromocytoma
• Hyperthyroidism
• Blood dyscrasias
• Coadministration with other monoamine oxidase inhibitors or within 14 days of their use
• Coadministration with tricyclic or tetracyclic antidepressants or within 21 days of their use
• Coadministration with sympathomimetic amines
• Coadministration with levodopa, dopamine, pethidine, nefopam, dextromethorphan, buspirone, bupropion

Cautions

• Renal impairment
• Elderly
• Cardiovascular disease
• Epilepsy
• Elective surgery
• Dependence disorders
• Abrupt withdrawal
• History of suicide-related events
• Significant suicidal ideation
• Fructose intolerance
• Glucose-galactose malabsorption
• Sucrase-isomaltase insufficiency
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: tab

Depression

• Oral (tab): Initial: 10mg, 12hrly; Maintenance: 10-20mg, dly

An additional 10mg tab can be added at midday if response is inadequate after 1-2 weeks

Not established for use in children below 18 years

Pregnancy

• Contraindicated
• Limited human data. No relevant animal data
• There is no data from the use of tranylcypromine in pregnant woment
• Animal studies are insufficient with respect to reproduction toxicity
• It is not known if tranylcypromine crosses the human placenta. The molecular weight (about 365) is low enough that exposure of the embryo-foetus should be expected
• Tranylcypromine should not be used in pregnancy unless considered essential by the physician

Breastfeeding

• Contraindicated
• No human data with potential toxicity
• The drug is excreted in human milk and has been also found to pass into the milk in lactating dogs
• A risk to the suckling child cannot be excluded
• A decision should be made whether to discontinue breastfeeding or to discontinue/abstain from tranylcypromine therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman

Fertility

• No fertility data is available

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Contraindicated

Elderly

• Caution; dose adjustment recommended
  Use with great caution and at a lower dosage

Porphyria Information

• Not classified (NC)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Insomnia
• Dizziness
• Drowsiness
• Fatigue
• Headache
• Sleep disturbances
• Hallucinations
• Anxiety
• Agitation
• Hypomania
• Tolerance
• Dependance
• Suicidal ideation
• Suicidal behaviours

Cardiovascular Disorders

• Hypertension
• Multiple extrasystoles
• Substernal pain
• Postural hypertension

Gastrointestinal Disorders

• Dry mouth
• Diarrhoea
• Nausea and vomiting

Hepatobiliary Disorders

• Hepatocellular damage
• Jaundice

Musculoskeletal Disorders

• Neck pain and stiffness

 Skin and Subcutaneous Tissue Disorders

• Rash
• Sweating
• Pallor
• Flushing

Immune, Blood and Lymphatic System Disorders

• Blood dyscrasias

Sensory Disorders

• Blurred vision
• Mydriasis
• Photophobia

• Monoamine oxidase inhibitors
• Furazolidone
• Isocarboxazid
• Pargyline HCl
• Procarbazine HCl
• Selective serotonin reuptake inhibitors
• Fluoxetine
• Paroxetine
• Sertraline
• Tricyclic antidepressants
• Amitriptyline
• Carbamazepine
• Trimipramine
• Clomipramine
• Imipramine
• Other antidepressants
• Buspirone
• Sympathomimetics
• Amphetamine
• Ephedrine
• Phenylpropanolamine
• Over-the-counter cough & cold, hay fever, or weight loss preparations
• Antimuscarinic agents
• Anaesthetic agents
• Opioid analgesics
• Antiepileptics
• Antihistamines
• Barbiturates
• Hypnotics
• Bupropion
• Guanethidine
• Reserpine
• Methyldopa
• Levodopa
• Dopamine
• Tryptophan
• Antihypertensives
• Oral hypoglycaemic agents
• Insulin
• Anticholinergic antiparkinsonism agents
• Narcotic analgesics
• Metrizamide
• Tyramine-rich foods

• Blood glucose
• Renal function
• Hepatic function
• Blood pressure

Dietary precautions

• High levels of tyramine in certain foods have been the cause of severe hypertensive reactions in patients on MAO inhibitor therapy. Patients must be warned to avoid the following:
  - Matured cheeses,
  - Hydrolysed protein extracts such as Marmite or Bovril,
  - Alcoholic drinks, particularly red wines such as chianti,
  - Non-alcoholic beer,
  - Lager, and protein-rich food that are not fresh or whose preparation involved hydrolysis, fermentation, pickling or hanging,
  - Broad bean pods which contain levodopa
  - Banana skins

Tranylcypromine is a rapid-onset, non-hydrazine monoamine oxidase inhibitor (MAOI). Monoamine oxidase is an enzyme that catalyzes the oxidative deamination of serotonin, norepinephrine, epinephrine, and dopamine. The mechanism of action of MAOIs is not well understood, but it is postulated that their antidepressant effects are due to increased concentrations of free serotonin and norepinephrine, and changed concentrations of other amines in the brain.

Tablet 10mg

• Parnate (Litha)