Tranylcypromine
Pronunciation: pronunciation varies by local usage.
- Generic name
- tranylcypromine
- Brand names
- Parnate
- Drug class
- Monoamine oxidase inhibitor (MAOI) antidepressant
- Form
- Tablet
- Route
- Oral
- Legal status
- Prescription-only medicine
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What tranylcypromine is and how it works
Tranylcypromine is a monoamine oxidase inhibitor (MAOI) antidepressant used for major depressive disorder in adults who have not responded adequately to other antidepressants. It is not for initial treatment due to potential serious adverse reactions. (1)
It is not approved for pediatric patients. It requires a tyramine-restricted diet and avoidance of many medications to prevent hypertensive crisis and serotonin syndrome. Abrupt discontinuation causes withdrawal; prescriber tapers. Suicidal thoughts and behaviors risk.
What tranylcypromine is used for
Major depressive disorder in adults
Tranylcypromine is indicated for major depressive disorder in adults who have not responded adequately to other antidepressants. It is not for initial treatment of MDD. Not approved in pediatric patients. (1)
Before taking tranylcypromine
Do not take / not appropriate for
- Do not take tranylcypromine if you have pheochromocytoma or catecholamine-releasing paragangliomas. (all products) (1)
- Do not take tranylcypromine with other MAOIs, SSRIs, SNRIs, tricyclic antidepressants, or many other serotonergic drugs (e.g., buspirone, triptans) due to risk of serotonin syndrome. (all products) (1)
- Do not take tranylcypromine with sympathomimetics (e.g., pseudoephedrine, phenylephrine, ephedrine), meperidine, tramadol, dextromethorphan, levodopa, carbamazepine, or reserpine. (all products) (1)
- Do not consume tyramine-rich foods or beverages (aged/fermented meats, pickled herring, aged cheeses, broad bean pods, tap/unpasteurized beer, sauerkraut, concentrated yeast extracts, certain soy products) during treatment and for 2 weeks after stopping. (all indications) (1)
Tell your clinician about
- Any history of bipolar disorder, mania, or suicidal thoughts/behaviors.
- Diabetes (blood glucose monitoring required).
- History of postural hypotension or fainting.
- Pregnancy, plans for pregnancy, or breastfeeding.
- All current medications, including over-the-counter cold/flu remedies, antidepressants, and herbal supplements.
- Any upcoming surgery or dental procedures.
How to take tranylcypromine
- Tranylcypromine is taken orally in divided doses as prescribed.
- Typical starting dose is 30 mg per day, increased by 10 mg per day every 1–3 weeks as tolerated, up to a maximum of 60 mg per day (30 mg twice daily). Slower titration if hypotension risk.
- Do not stop the medicine abruptly; it must be tapered by the prescriber.
- Follow the tyramine-restricted diet strictly during treatment and for 2 weeks after stopping.
- Report any sudden severe headache, palpitations, or neck stiffness immediately.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
Follow the exact product instructions and do not double a dose.
Overdose
Seek urgent poison-information or emergency advice.
Side effects
Common adverse reactions may include dry mouth, dizziness, insomnia, sedation, headache, overexcitement, constipation, blurred vision, and tremor. Serious effects include hypertensive crisis, serotonin syndrome, agranulocytosis, and hepatitis.
Dry mouth
What to notice: Unusually dry or sticky feeling in the mouth.
What to do: Sip water, use sugar-free gum/candy; tell prescriber if bothersome. (1)
Dizziness or postural hypotension
What to notice: Feeling lightheaded or faint when standing up, especially at doses above 30 mg daily.
What to do: Rise slowly from sitting or lying; report to prescriber if faintness occurs. (1)
Insomnia, sedation, headache, overexcitement, constipation, blurred vision, tremor
What to notice: Trouble sleeping, drowsiness, head pain, feeling overly excited or agitated, hard stools, blurry sight, shaking.
What to do: Discuss persistent or troublesome symptoms with prescriber; do not stop abruptly. (1)
Jaundice or signs of hepatitis
What to notice: Yellowing of skin or eyes, dark urine, abdominal pain, nausea, fatigue.
What to do: Contact prescriber promptly; may indicate liver injury. (1)
Signs of agranulocytosis
What to notice: Sore throat, fever, mouth ulcers, unusual bleeding or infections.
What to do: Seek immediate medical evaluation; blood counts may be needed. (1)
Tachycardia or palpitations
What to notice: Rapid or pounding heartbeat.
What to do: Report to prescriber for cardiovascular assessment. (1)
Serious warnings
Suicidal thoughts and behaviors — emergency
Symptoms: Worsening depression, new or increased suicidal thoughts, self-harm, or unusual behavior changes.
Action: Contact prescriber immediately or go to emergency room. Family/caregivers should monitor for these changes. (1)
Hypertensive crisis — emergency
Symptoms: Occipital headache (at back of head), palpitations, neck stiffness, nausea/vomiting, sweating, dilated pupils.
Action: Seek emergency care immediately. This can occur after consuming tyramine-rich foods or interacting drugs. (1)
Serotonin syndrome — emergency
Symptoms: Agitation, confusion, hyperthermia (high fever), seizures, muscle rigidity, rapid heart rate.
Action: Seek emergency care immediately. Often caused by interaction with serotonergic drugs. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Tyramine-rich foods and beverages | Can cause sudden severe hypertensive crisis. | Strictly avoid: aged/fermented meats, pickled herring, aged cheeses, broad bean pods, tap/unpasteurized beer, sauerkraut, concentrated yeast extracts, certain soy products. Safe alternatives: fresh meats, mozzarella/ricotta/cottage cheese, pasteurized bottled beer. Continue for 2 weeks after stopping tranylcypromine. (1) |
| Other antidepressants (SSRIs, SNRIs, tricyclics, other MAOIs, St. John's Wort) | Risk of serotonin syndrome or hypertensive crisis. | Prescriber-managed washout periods required: wait at least 4–5 half-lives of previous antidepressant before starting tranylcypromine; wait at least 1 week after stopping tranylcypromine before starting another MAOI. MAO inhibition can last up to 10 days. (1) |
| Serotonergic drugs (triptans, buspirone, tramadol, meperidine, dextromethorphan) | Can precipitate serotonin syndrome. | Avoid combination; check all medications with prescriber and pharmacist. (1) |
| Sympathomimetics (pseudoephedrine, phenylephrine, ephedrine) and stimulants | Can cause hypertensive crisis. | Avoid over-the-counter decongestants and stimulants; always check labels. (1) |
| Carbamazepine, levodopa, reserpine | Variable interactions. | Contraindicated; prescriber must ensure no concomitant use. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pediatric patients
Not approved for pediatric patients. Safety and effectiveness not established. (1)
Pregnancy
Limited human data; placental infarction risk reported. Clinician-guided risk/benefit decision. Do not stop treatment without prescriber discussion. (1)
Lactation
Present in human milk. The label advises discontinuing breastfeeding during treatment. Discuss alternatives with prescriber. (1)
Patients with diabetes
Blood glucose should be monitored due to potential hypoglycemia risk. (1)
Patients at risk of bipolar disorder
Screen for bipolar disorder before starting; tranylcypromine can precipitate mania. (1)
Monitoring
Before starting
- Screen for bipolar disorder and suicide risk.
- Assess current medications for contraindicated drugs; enforce washout periods.
- Evaluate baseline blood pressure and orthostatic changes.
- Educate patient on tyramine-restricted diet and recognition of hypertensive crisis/serotonin syndrome.
During treatment
- Monitor for worsening depression, suicidal thoughts, or behavioral changes.
- Regularly check blood pressure, especially after dose increases.
- Monitor blood glucose in diabetic patients.
- Reinforce dietary and drug interaction precautions at each visit.
Storage
Follow the exact product label and keep medicines away from children.
Study the drug class: SNRIs and other antidepressants
Professional information
Clinician-facing context only. Use the current US prescribing information, especially boxed warnings, contraindications, and dietary/drug interaction precautions.
United States
Indication: Major depressive disorder in adults
Dose summary: Initial 30 mg/day in divided doses; titrate by 10 mg/day every 1–3 weeks as needed; maximum 60 mg/day (30 mg twice daily). Slower titration if hypotension risk.
Renal context: The US prescribing information gives no renal-impairment dose adjustment and does not list renal disease as a contraindication. Its geriatric guidance advises starting at the low end of the dosing range, noting that elderly patients more often have decreased hepatic, renal or cardiac function. Apply current prescribing references and clinical judgement for any patient with impaired renal function. (1)
Frequently asked questions
Why do I need a special diet while taking tranylcypromine?
Tyramine in aged or fermented foods can trigger a sudden, dangerous rise in blood pressure (hypertensive crisis) when you are on an MAOI like tranylcypromine. This diet must be followed during treatment and for 2 weeks after stopping. (1)
Can I take over-the-counter cold or flu remedies?
No. Avoid sympathomimetic decongestants (pseudoephedrine, phenylephrine) and dextromethorphan. Check every medicine with the pharmacist; use only those approved by your prescriber. (1)
What if I get a sudden severe headache?
An occipital headache (at the back of the head) with palpitations or neck stiffness can signal a hypertensive crisis. Seek emergency care immediately. (1)
Can I stop tranylcypromine once I feel better?
No. Abruptly stopping can cause withdrawal symptoms such as dizziness, nausea, headache, irritability, and insomnia. The prescriber will taper the dose gradually. (1)
Why can't tranylcypromine be combined with other antidepressants?
Combining it with serotonergic drugs can cause life-threatening serotonin syndrome. Washout periods are required when switching between antidepressants to avoid this risk. (1)
What is the generic name of Tranylcypromine?
The generic name is tranylcypromine. It is sold under brand names including Parnate. (1)
What class of drug is tranylcypromine?
Tranylcypromine is classed as: Monoamine oxidase inhibitor (MAOI) antidepressant. (1)
References
- PARNATE (tranylcypromine sulfate) tablets — prescribing informationU.S. Food and Drug Administration · United States · accessed 2026-08-08 · source 1
- TRANYLCYPROMINE TABLET [REMEDYREPACK INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 2
- Tranylcypromine — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 3
- Tranylcypromine — FDA approval record (Drugs@FDA ANDA213503)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- tranylcypromine — RxNorm normalized drug concept (RXCUI 10734)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient tranylcypromine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- PARNATE10 mg · advanz pharma (us) corp.
Canada
- PARNATE