Non-selective irreversible MAOI
Tranylcypromine
Brand names: Parnate
Adult dose
Dose: Initial 10mg PO BD, increase to max 30mg/day
Route: PO
Frequency: BD
Clinical pearls
- Treatment-resistant depression — specialist psychiatry
- Strict tyramine-restricted diet
Contraindications
- Concurrent SSRIs/SNRIs/TCAs (washout)
- Concurrent sympathomimetics
- Phaeochromocytoma
- Severe hepatic impairment
- Hypertension
- Tyramine-rich foods
Side effects
- Hypertensive crisis (with tyramine)
- Postural hypotension
- Insomnia
- Hepatotoxicity
- Serotonin syndrome (with serotonergic drugs)
Interactions
- Many — SSRIs (avoid; 2 weeks washout, 5 weeks for fluoxetine)
- Pethidine (avoid)
- Sympathomimetics
- Tyramine-rich foods (cheese reaction)
Monitoring
- BP
- LFTs
- Mood
Reference: BNF; NICE NG222; https://bnf.nice.org.uk/drugs/tranylcypromine/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185 / BNF