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Tranylcypromine Dosage

Applies to the following strength(s): 10 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Depression

Usual effective dose: 30 mg per day, orally, in divided doses
-If no improvement in a reasonable period (up to 2 weeks), increase by 10 mg per day at 1 to 3 week intervals
Maximum dose: 60 mg per day

Comments:
-Adjust dosage to the requirements of the individual patient.
-Improvement occurs within 48 hours to 3 weeks after starting therapy.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Contraindicated

Dose Adjustments

Switching to/from tranylcypromine from another MAOI or from a dibenzazepine-related entity:
-Allow a medication free interval of at least a week.
-Initiate tranylcypromine at half the normal starting dose for at least the first week of therapy.

Allow at least 14 days between stopping tranylcypromine and starting bupropion.

Do not use SSRIs or SNRIs within 14 days of discontinuing an MAOI

Allow at least 5 weeks between stopping fluoxetine and starting an MAOI

Increase doses more gradually in patients showing a tendency toward hypotension at the beginning of therapy.

Precautions

US BOXED WARNINGS:
SUICIDALITY AND ANTIDEPRESSANT DRUGS
-Antidepressants increased the risk (compared to placebo) of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short term studies of major depressive disorder (MDD) and other psychiatric disorders.
-Balance this risk with the clinical need for treatment.
-Short term studies did not show increased suicidality in adults beyond the age of 24; there was a reduction of risk in patients 65 years and older.
-Depression and certain other psychiatric disorders are themselves associated with increased risk of suicidality.
-Monitor all patients starting antidepressants closely for clinical worsening, suicidality, or unusual behavior changes.
-Advise families and caregivers of the need for close observation and communication with the prescriber.
-This drug is not approved for use in pediatric patients.


Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Monitoring:
-Monitor for clinical worsening, suicidality, or unusual changes in behavior, especially during the first few months of therapy and during dose changes.
-Hypertensive crisis is the most important adverse reaction with this drug, watch for some or all of the following symptoms: occipital headache with may radiate frontally, palpitation, neck stiffness or soreness, nausea, vomiting, sweating (sometimes with fever and sometimes with cold, clammy skin), dilated pupils, and photophobia. Either tachycardia or bradycardia may be present, and can be associated with constricting chest pain.
-Observe blood pressure frequently.
-Discontinue therapy immediately for palpitation or frequent headaches.

Patient advice:
-Patients should not take sympathomimetic drugs (including amphetamines, cocaine, methylphenidate, dopamine, epinephrine, and norepinephrine) or related compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine, and phenylalanine).
-Patients should avoid high protein foods that have undergone protein breakdown by aging, fermentation, pickling, smoking, or bacterial contamination.
-Patients should avoid cheeses (especially aged varieties), pickled herring, beer, wine, alcohol-free or reduced-alcohol beer or wine, liver, yeast extract (including large quantities of brewer's yeast), dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna), pods of broad beans (fava beans), sauerkraut, meat extract, and yogurt.
-Tyramine levels in foods vary brand to brand and batch to batch; having no reaction to a prohibited food on one occasion does not mean they will not react on a different occasion.
-Excessive amounts of caffeine and chocolate may cause hypertensive reactions.
-Patients should avoid the following over-the-counter medications: cold and cough preparations (including those with dextromethorphan), nasal decongestants (tablets, drops, or spray), hay fever medications, sinus medications, anti-appetite medicines, weight reducing preparations, "pep" pills, L-tryptophan containing preparations.

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