Tranylcypromine, Oral

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KEY POINTS

• This medicine is taken by mouth to treat certain types of depression. Take it exactly as directed.
• This medicine may increase suicidal thoughts or actions, or cause other behavior changes in some people.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Certain foods, drinks, and medicines can cause dangerously high blood pressure if you consume them while taking this medicine. Tell all healthcare providers who treat you about ALL the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: MAO inhibitor antidepressant

Generic and brand names: tranylcypromine, oral; Parnate

What is this medicine used for?

This medicine is an MAO inhibitor taken by mouth to treat certain types of depression.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have:

• An allergy to any medicine
• A seizure disorder (epilepsy)
• Diabetes
• Heart disease
• High blood pressure
• Kidney or liver disease
• Parkinson's disease
• Thyroid problems

Also tell your provider if you have ever had:

• A stroke or transient ischemic attack (TIA)
• Pheochromocytoma (a tumor of the adrenal gland)
• Problems with alcohol or drug abuse
• Problems with hyperactivity
• Severe or frequent headaches
• Schizophrenia, bipolar disorder, or other mental disorders

Tell your provider about all other medicines you are taking, including nonprescription or prescription medicines, supplements, or natural remedies. You may need to wait at least 14 days between using an MAO inhibitor and any other medicine.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less of it or take it longer than prescribed. Do not stop taking this medicine without your provider's approval. Take each dose with a full glass of water.

Check with your healthcare provider before using this medicine in children under age 18.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: drowsiness, dizziness, severe headache, neck pain, stiff neck, hallucinations, restlessness, nervousness, shallow breathing, fast or irregular heartbeat, fever, cold sweats, lightheadedness, seizures.

What should I watch out for?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment or at times of dose changes. Talk with your provider about this.

Behavior changes may be caused by the medicine or by depression or another mental health problem. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• More outgoing or aggressive behavior than normal
• Confusion
• Hallucinations
• Anxiety or panic attacks
• Worsening of depression
• Suicidal thoughts

Important note: Stop taking this medicine and get medical care right away if you have heavy sweating; severe chest pain; severe headache or dizziness; fast, slow, or irregular heartbeat; large pupils; sensitivity to light; stiff neck; nausea or vomiting; or any other serious effects.

This medicine may make you drowsy. Do not drive or operate machinery unless you are fully alert.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help. Also, drinking alcohol may make it worse. Do not drink alcohol unless your healthcare provider approves.

This medicine may increase the effects of alcohol and interact with many other medicines. Do not drink alcohol or take any other medicines, including nonprescription medicines or natural remedies, without your healthcare provider's approval.

If you need surgery, emergency care, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine. You may need to stop taking this medicine several days before a surgery.

Certain foods, drinks, and medicines can cause dangerously high blood pressure if you consume them while taking this medicine. Don’t drink large amounts of caffeine while you are taking this medicine. Caffeine can increase the side effects of this medicine. Get a list from your healthcare provider about which foods, drinks, and drugs you may take with this medicine. You may need to wait at least 14 days between taking this medicine and taking other medicines or other products. Talk with your provider about this.

You need to check your blood pressure regularly while taking this medicine. You may need to have blood tests to see how the medicine affects you. Keep all appointments for these tests.

If you have diabetes: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Thoughts of suicide; worsening depression; confusion; hallucinations; unusual changes in thoughts, mood, or behavior; dark urine; rash; severe diarrhea; unexplained swelling; yellowing of your skin or eyes; light-colored bowel movements; severe stomach pain; heavy sweating; chest pain; severe or frequent headache; severe dizziness or fainting; fast, slow, or irregular heartbeat, large pupils; stiff neck; severe nausea; vomiting; high fever; unusual sensitivity to light; cold, clammy skin; vision problems; changes in urination; seizures.

Other: Dry mouth, trembling, mild headache, weakness, drowsiness, mild nausea, mild dizziness, constipation, mild diarrhea, trouble sleeping, change in sexual ability or desire.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• Alosetron (Lotronex)
• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin
• Altretamine (Hexalen)
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antianxiety medicines such as alprazolam (Xanax), chlordiazepoxide, clonazepam (Klonopin), clorazepate (Gen-Xene, Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
• Antidepressants such as amitriptyline, amoxapine, citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), maprotiline, mirtazapine (Remeron), nefazodone, nortriptyline (Pamelor), protriptyline (Vivactil), sertraline (Zoloft), trazodone, trimipramine (Surmontil), venlafaxine (Effexor), and vilazodone (Viibryd)
• Antihistamines such as brompheniramine, chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Dramamine)
• Antipsychotic medicines such as aripiprazole (Abilify), asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), perphenazine, pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, trifluoperazine and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), phenytoin (Dilantin, Phenytek), and valproic acid (Depacon, Depakene, Depakote)
• Atomoxetine (Strattera)
• Barbiturates such as butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital, and secobarbital (Seconal)
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), and pindolol
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Buspirone
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), nisoldipine (Sular), and verapamil (Calan, Covera, Verelan)
• Clonidine (Catapres, Kapvay)
• Cough, cold, or allergy medicines such as cyproheptadine, dextromethorphan (Robitussin DM), ephedrine, naphazoline, oxymetazoline (Afrin, Dristan), phenylephrine (Neo-Synephrine, Sudafed PE), and pseudoephedrine (Sudafed)
• Diabetes medicines such as glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Glynase), and metformin (Fortamet, Glucophage, Riomet)
• Disulfiram (Antabuse)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Eliglustat (Cerdelga)
• Eluxadoline (Viberzi)
• Epinephrine (Adrenalin, Asthmanefrin, Auvi-Q, EpiPen)
• Erectile dysfunction medicines such as avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn)
• Heart medicines such as amiodarone (Cordarone, Pacerone), flecainide, mexiletine, procainamide, and propafenone (Rythmol)
• Hydralazine
• Linezolid (Zyvox)
• Lithium (Lithobid)
• Lorcaserin (Belviq)
• Malaria medicines such as chloroquine and primaquine
• Medicines to treat breathing or lung problems such as albuterol (ProAir, Proventil, Ventolin), arformoterol (Brovana), formoterol (Perforomist), levalbuterol (Xopenex), metaproterenol, pirbuterol (Maxair), and theophylline
• Medicines to treat high pressure in the eye such as apraclonidine (Iopidine) and brimonidine (Alphagan P)
• Medicines to treat or prevent blood clots such as cilostazol (Pletal) and clopidogrel (Plavix)
• Methyldopa
• Metoclopramide (Metozolv, Reglan)
• Midodrine
• Migraine medicines such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Sumavel), and zolmitriptan (Zomig)
• Milnacipran (Savella)
• Mirabegron (Myrbetriq)
• Muscle relaxants such as carisoprodol (Soma), cyclobenzaprine (Amrix), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as ephedra, guarana, kava, ma huang, SAMe, St. John's wort, tryptophan, tyrosine, and yohimbe
• Nausea medicines such as dolasetron (Anzemet), ondansetron (Zofran), prochlorperazine (Compro), and promethazine
• Other MAO inhibitors
• Pain medicines such as codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone (Hysingla, Zohydro), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), pentazocine (Talwin), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Parkinson’s disease medicines such as bromocriptine (Cycloset, Parlodel), entacapone (Comtan), levodopa/carbidopa (Duopa, Rytary, Sinemet), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tolcapone (Tasmar)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Phenylalanine, an ingredient that may be in products sweetened with aspartame
• Procarbazine (Matulane)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Reserpine
• Sleeping pills such as eszopiclone (Lunesta), flurazepam, ramelteon (Rozerem), tasimelteon (Hetlioz), temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo)
• Stimulants and diet pills such as armodafinil (Nuvigil), benzphetamine (Regimex), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), diethylpropion (Tenuate), lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), methylphenidate (Concerta, Daytrana, Metadate, Ritalin), modafinil (Provigil), phendimetrazine, and phentermine (Adipex-P, Suprenza)
• Tetrabenazine (Xenazine)
• Voriconazole (Vfend)

When taken with certain foods or drinks, this medicine can cause an increase in blood pressure. To avoid this, do not eat large amounts of foods or drink beverages that have a high tyramine content. This includes foods that are aged, fermented, pickled, or smoked, such as aged cheeses; yogurt, sour cream, bananas, avocados, dried fruits, smoked fish, meat, or poultry; sauerkraut; soy sauce; red wine; or beer. Avoid caffeine and chocolate. Talk with your healthcare provider about this.

Do not drink alcohol while taking this medicine.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.