Antidepressant, irreversible non-selective monoamine oxidase inhibitor (MAO-A and MAO-B), amphetamine derivative
ATC code: N06AF04 (Tranylcypromine)
Brand names
Parnate
Irreversibly inhibits MAO-A and MAO-B, raising synaptic serotonin, noradrenaline and dopamine. Unlike phenelzine, tranylcypromine has an amphetamine-like backbone that adds catecholamine-releasing activity. Onset is faster (1–3 weeks), but the risk of tyramine-induced hypertensive crisis is higher.
Third line
Tranylcypromine is a third-line antidepressant for treatment-resistant depression. In Spain it is preferred over phenelzine in apathetic or anergic presentations because the amphetamine-like effect adds activation. SEPB restricts prescribing to inpatient or specialist outpatient settings after SSRI/SNRI washout. A tyramine-free diet and blood pressure checks every 2 weeks for the first 2 months are mandatory.
8 pairs found. Sorted from critical to minor.
Mechanism
MAO-A inhibition + triptan – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Mechanism
Tranylcypromine is an irreversible MAOI. Combined with fluoxetine causes serotonin syndrome. AEMPS Parnate Section 4.3.
Symptoms
Hyperthermia, myoclonus, tachycardia, hypertension.
Management
Combination contraindicated. 5-week washout from fluoxetine.
Mechanism
Cumulative MAO inhibition (irreversible tranylcypromine + reversible linezolid). Severe serotonin syndrome with tyramine load.
Symptoms
Hypertensive crisis, hyperthermia.
Management
Combination contraindicated.
Mechanism
Same pharmacodynamics – fatal serotonin syndrome.
Symptoms
Hyperthermia, myoclonus, coma.
Management
Combination contraindicated.
Mechanism
MAO-A inhibition by tranylcypromine + rizatriptan – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Mechanism
Tranylcypromine irreversibly inhibits MAO-A. Sumatriptan accumulates – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Mechanism
Tranylcypromine irreversibly inhibits MAO. Tramadol inhibits serotonin reuptake. Combination causes fatal serotonin syndrome.
Symptoms
Hyperthermia, myoclonus, agitation, seizures.
Management
Combination contraindicated. Alternative analgesic: paracetamol.
Mechanism
MAO-A inhibition + zolmitriptan – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Pregnancy data are limited. Switch to an antidepressant with a better profile when planning pregnancy.
Breastfeeding during treatment is not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Tranylcypromine is evaluated for the following indications with varying evidence strength: Treatment-resistant depression (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Tranylcypromine (≥ 1 in 100): Orthostatic hypotension, Insomnia, Anxiety, Tachycardia, Decreased libido, Dizziness. See the Safety section for uncommon and serious reactions.
FDA category C. Pregnancy data are limited. Switch to an antidepressant with a better profile when planning pregnancy.
Breastfeeding during treatment is not recommended.
Tranylcypromine is contraindicated in: Any serotonergic drug (SSRI, SNRI, TCA, clomipramine, mirtazapine, triptans, tramadol, pethidine, dextromethorphan, methadone, linezolid); Sympathomimetics (pseudoephedrine, ephedrine, phenylephrine), levodopa, dopamine agonists; Phaeochromocytoma, thyrotoxicosis; Severe hepatic impairment, cerebrovascular disease; Prior tyramine-induced hypertensive crisis. Full list in the Safety section.