Tranylcypromine: What You Need to Know

What Is Tranylcypromine?

Tranylcypromine is an FDA (Food and Drug Administration) approved drug. It is most importantly used to treat severe forms of depression, like major depressive disorder. It is effective in people without melancholia. And what is melancholia? It is a severe form of depression.

Tranylcypromine is used when other depression treatments fail to show any improvement. And it belongs to the monoamine oxidase inhibitors (MAOIs). Which means it belongs to a class of drugs that treat depression, and it works by boosting the brain chemicals that keep your mood balanced. Tranylcypromine, an MAO inhibitor, received its initial FDA approval for managing mood and anxiety disorders in 1961.

What Are the Uses of Tranylcypromine?

The primary FDA-approved use of Tranylcypromine involves treating major depressive disorder lacking melancholia. Also, it is used in people who suffer from panic disorders and other neurological issues, such as some kind of social phobia, for example like if you or someone you know is affected, you may feel anxious about big gatherings or interactions. And also in atypical depression, this medicine is used. Atypical depression is nothing but depression, only with opposite signs. For example, in depression, people will not eat, they will always be sad, and all that, but in atypical depression, you will feel better if someone makes you happy or surprises you with something you like, etc.

How Should I Take Tranylcypromine?

Take this drug orally. Follow the instructions on the medication label. The recommended dose is 30 mg daily, distributed across separate administrations. Suppose the patients do not exhibit a satisfactory response. Increase the dose by 10 mg daily at intervals of one to three weeks to reach a peak of 30 mg administered twice daily (60 mg daily) for maximum effect.

What Should I Know About Tranylcypromine Before Using It?

Dosage Forms: This medication is a 10 mg (milligram) oral tablet with an accessible generic formulation.

• The recommended therapeutic amount stands at 30 mg per day, administered in separate doses.

• Initially, the typical commencement dose of Tranylcypromine is 10 mg daily.

• You can adjust the dosage gradually up to 30 mg daily.

• In scenarios requiring further adjustment, a 10 mg increment every one to three weeks can be implemented following a two-week interval until the maximum prescribed dosage of 60 mg per day is reached.

Missed Dose:

When you or someone close to you misses the dose, it should be taken when recalled, but if the next dose is near, it is better to skip the forgotten dose and stick to the usual dosing plan. Do not take two doses at once to compensate for the missed dose.

Overdose:

An overdose of Tranylcypromine can lead to adverse reactions typically associated with Tranylcypromine administration. However, these reactions may be more severe, potentially resulting in fatal outcomes. Below are the effects reported with Tranylcypromine and other MAOIs overdosing.

• Initial symptoms may include insomnia, restlessness, and anxiety, which can progress to severe agitation, mental confusion, and incoherence. In some cases, it may lead to delirium and seizures.

• Hypotension, dizziness, weakness, and drowsiness may occur initially, progressing to extreme dizziness and potentially leading to shock.

• Some individuals may experience hypertension accompanied by severe headaches and other related symptoms and complications.

• An overdose may also manifest as twitching or myoclonic fibrillation of skeletal muscles, often associated with hyperpyrexia (elevated body temperature). In severe cases, this can progress to generalized rigidity and coma.

What Are the Side Effects of Tranylcypromine?

Below are a few side effects that you can experience when you are taking Tranylcypromine:

• Headache.

• Variations in heartbeat speed (slow, fast, or pounding).

• The sensation of chest pain or tightness.

• Constriction in the throat.

• Nausea.

• Sweating.

• Fever.

• Cold and clammy skin sensation.

• Dizziness.

• Stiffness or soreness in the neck.

• Sensitivity to light.

• Dilated pupils (enlarged black circles in the eye centers).

• Swelling in the arms, hands, feet, ankles, or lower legs.

• Unusual bleeding or bruising.

• Upper right abdominal pain.

• Yellowing of the skin or eyes.

What Are the Contraindications to Tranylcypromine?

Tranylcypromine is highly effective, but it does come with a few restrictions to keep in mind when you are asked to take it. Here are specific contraindications and precautions of Tranylcypromine, which you should be aware of due to its mechanism of action and interactions.

• Tranylcypromine should not be used in individuals with a known hypersensitivity or allergy to the medication or its components.

• Tranylcypromine should not be used concurrently with other monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing another MAOI. Combining MAOIs can lead to a potentially life-threatening condition known as serotonin syndrome.

• It is not to be given in individuals with pheochromocytoma, which is a rare tumor of the adrenal glands, as it can lead to a severe increase in blood pressure.

• Tranylcypromine should be used with caution, if at all, in individuals with cardiovascular conditions, including heart disease, hypertension (high blood pressure), and a history of stroke.

• Tranylcypromine should be used cautiously in individuals with severe liver impairment.

• Patients with severe kidney (renal) impairment may also require dose adjustments or extra caution when using Tranylcypromine.

• Patients with a history of drug abuse or substance dependence should be monitored carefully, as Tranylcypromine has the potential for abuse.

• Tranylcypromine interacts with various medications, over-the-counter drugs, and substances. It is always important to inform your healthcare provider about all medications you take, including prescription, non-prescription, herbal supplements, and dietary changes.

• Tranylcypromine requires dietary restrictions, particularly avoiding foods high in tyramine, as it can lead to dangerous increases in blood pressure. Foods to avoid while on Tranylcypromine include aged cheeses, fermented or pickled products, certain meats, and some alcoholic beverages.

• Tranylcypromine is generally not recommended for children as there is no sufficient safety and efficacy data in this population.

• The use of Tranylcypromine during pregnancy and breastfeeding should be discussed with a doctor.

Drug Interactions:

If you are taking Tranylcypromine, it is recommended to avoid foods that have tyramine because of Tranylcypromine interactions. Because tranylcypromine increases tyramine sensitivity. Some of the tyramine-rich foods are processed meat, fermented vegetables, aged cheese, tropical and citrus fruits, beer, and red wine. So, avoid drinking these drinks too.

Always inform your treating doctor if you take over-the-counter medicines too often, or any supplements like herbal products or multivitamins.

Also, let the doctor know that you have taken or are taking other types of antidepressants like tricyclic antidepressants (TCAs), SSRIs (selective serotonin reuptake inhibitors), and SNRIs (serotonin norepinephrine reuptake inhibitors). Not just this, if you have taken any other monoamine oxidase inhibitors, the doctors must know that because these MOIs are used to treat other conditions.

Antihistamines, decongestants, and Ephedrine, which are used in allergies and asthma, can interact with Tranylcypromine. So informed consent is advised.

Muscle relaxants, hypertensive drugs, opioids, diabetic medications, drugs used for sleep disorders, anxiety, neurological problems, liver and bone problems, can also interact with Tranylcypromine. You should not take coffee or caffeine if you are taking this medicine.

Warnings and Precautions:

Serotonin Syndrome:

Also, one important thing you should keep in mind is that Tranylcypromine can lead to serotonin syndrome, which causes changes in mental status like agitation, hallucinations, delirium, or even coma. It involves autonomic instability, such as rapid fluctuations in vital signs like tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, and hyperthermia.

Neuromuscular symptoms like tremors, rigidity, myoclonus, hyperreflexia, and incoordination, as well as seizures and gastrointestinal symptoms. Fatal outcomes due to serotonin syndrome have been reported, even in patients treated with Tranylcypromine.

Activation of Mania or Hypomania:

Treating a depressive episode with Tranylcypromine or another antidepressant in patients with bipolar disorder can trigger mixed or manic episodes. Patients should be screened for any mental health history before starting Tranylcypromine.

Hypotension:

Tranylcypromine therapy may lead to hypotension, which means a reduction in the blood pressure, including postural hypotension, especially at doses above 30 mg daily. Symptoms of postural hypotension are commonly seen, particularly in patients with pre-existing hypertension. Blood pressure typically returns to pretreatment levels upon discontinuation of Tranylcypromine.

Emergency Treatment With Contraindicated Drugs: Close monitoring for adverse reactions is essential in such cases.

Discontinuation Syndrome: If you abruptly discontinue or if you reduce the dosage of Tranylcypromine can lead to new symptoms like irritability. Such discontinuation events occurred more frequently with longer therapy durations.

Hepatotoxicity:

Hepatitis and elevated aminotransferases are associated with Tranylcypromine use.

It is mandatory that patients should be closely observed for signs and symptoms of hepatotoxicity, and Tranylcypromine should be discontinued if necessary. Sedation has been reported in Tranylcypromine-treated patients with cirrhosis, requiring monitoring for central nervous system adverse reactions in such cases.

Seizures:

Seizures have been reported with Tranylcypromine withdrawal after abuse and overdose.

Patients at risk for seizures should be closely monitored.

Hypoglycemia in Diabetic Patients:

Also, in patients who have diabetes, the blood glucose levels should be closely watched if they are using Tranylcypromine and blood-glucose-lowering agents, and reducing the dosage of such agents may be necessary.

Where Should I Keep My Medication?

Keep your medicine in its original container, securely sealed, and away from children so they cannot reach it. Keep it at room temperature to avoid excessive heat and moisture (do not store it in the bathroom).

Dispose of any unused medication safely to prevent accidental ingestion by pets, kids, or others. Never flush this medication down the toilet; the recommended method for disposal is participating in a medicine take-back program.

How Is Tranylcypromine Different From Other Antidepressants?

Tranylcypromine vs. Other Antidepressants like SSRIs and SNRIs:

Tranylcypromine is different from other antidepressants in both its mechanism of action and clinical use. Common antidepressants are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Tranylcypromine works by permanently blocking the enzyme monoamine oxidase, particularly MAO-A, which prevents the breakdown of neurotransmitters like serotonin, norepinephrine, and dopamine. This broad-spectrum increase in neurotransmitter levels can make it especially effective for treatment-resistant or atypical forms of depression. In contrast, SSRIs work by selectively blocking the reuptake of serotonin, thus increasing its availability in the synaptic cleft, while SNRIs inhibit the reuptake of both serotonin and norepinephrine, offering a dual-action approach.

SSRIs such as Fluoxetine, Sertraline, and Escitalopram are first-line drugs for their favorable safety profiles and tolerability. SNRIs like Venlafaxine and Duloxetine are often chosen when SSRIs are not effective or when additional noradrenergic activity is desired. Tranylcypromine is effective, mostly in patients who do not respond to SSRIs or SNRIs. Tranylcypromine is generally kept as a later option due to its dietary restrictions and severe drug interactions.

Conclusion

Tranylcypromine is usually reserved for people who have not responded to other antidepressants. It's effective, but it does come with some risks, like a sudden spike in blood pressure. It also has possible serious reactions when combined with certain medications, known as serotonin syndrome and other drug interactions. That is why extra care is needed when your doctor is prescribing medicines.

Before starting, your medical team will make sure it is the right fit for you. They will go through your medical history, current medications, and any risks. They will also monitor how you are feeling, watch for any warning signs, and guide you on what foods to avoid. If anything feels off or if you have concerns, do not hesitate to reach out to your doctor immediately.

Key Takeaway/ Note From iCliniq:

Tranylcypromine is a powerful antidepressant, and it is used in the treatment-resistant depression and atypical depression. It needs careful observation due to serious risks like hypertensive crisis and food and drug interactions. With proper guidance and dietary precautions, it can be a safe and effective option for those who have not found relief with other treatments.

At icliniq, our doctors will help you know the details of Tranylcypromine, their benefits, and risks. In case you have questions about what to eat or avoid, you can contact the icliniq doctors. We are happy to help you.