Phenelzine indications

Examples of monoamine oxidase inhibitors are phenelzine, tranylcypromine, isocarboxazid and mo-clobemide. They are indicated for atypical depression. Changes in the neurotransmitter levels are seen in several days but the clinical effect may lag by several weeks. Phenelzine is a non-selective hydrazine-type monoamine oxidase inhibitor while the also non-selective inhibitor tranylcypromine is of the non-hydrazine-type. Phenelzine, tranylcypromine and isocarboxazid are irreversible inhibitors. Phenelzine is partly metabolized by acetylation and slow acetylators are more prone to toxicity. It has anxiolytic properties and superior efficiacy in treating severe anxiety. 

In the United States, the three MAOIS available for the treatment of psychiatric conditions are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). All three agents have indications for adult major depression (>16 years old) and, more specifically, atypical depression (anergia, hypersomnia, hy-perphagia, somatization, and anxiety symptoms). Although not indicated for anxiety, the MAOIs can also be particularly helpful in treatment of these disorders. Selegiline or L-deprenyl (Eldepryl) is also available in the United States and indicated for symptoms of Parkinson s disease and depression. 

Those patients presenting with atypical symptoms of depression (i.e., rejection-sensitivity, hypersomnia, hyperphagia, and hysteroid personality types] were confirmed as a unique subgroup responsive to MAOls including phenelzine (Liebowitz et al. 1988]. There are indications that atypical symptomatology may also be responsive to the RlMAs such as moclobemide (Lonnqvist et al. 1994 Paykel 1995] however, results are preliminary. 

The efficacy of phenelzine and tranylcypromine has now been well established by several large, double-blind studies, which found them equal to tertiary amine TCAs and clearly superior to placebo (Table 7-11 and Table 7-12) (185). Other studies indicate that atypical depressions may respond better to MAOIs and typical depressions to TCAs however, most find that their similarities are more obvious than their differences ( 186). One research group has suggested that anergic, bipolar patients respond particularly well to tranylcypromine and other MAOIs ( 187). Extensive clinical experience indicates the MAOIs are often effective when TCAs have failed. 

One British study found amphetamine to be no different than placebo in the treatment of depressed outpatients (188) a second study found amphetamine less effective than phenelzine and no better than placebo (189) and a Veteran s Administration (VA) study found dextroamphetamine no more effective than placebo in hospitalized depressed patients (1,90). Uncontrolled clinical evidence indicates that amphetamine may occasionally be of value, but, except for a mild, early, transient benefit, there is no evidence that amphetamine can ameliorate moderate-to-severe depressive episodes. 

Phenelzine has been studied for the treatment of anxiety, phobic and obsessive-compulsive disorders, as well as typical and atypical depressions. Its antidepressant efficacy has been correlated with an 80% to 85% inhibition of the MAO enzyme. Studies by Ravaris, replicated by this text s authors, indicate that 60 mg per day are usually needed to inhibit MAO by at least 80% (353, 354). Although monitoring of platelet MAO inhibition during treatment may permit more optimal dosing, the assay is not readily available commercially. This, coupled with the infrequent use of MAOIs, has hampered the widespread application of this specialized form of TDM. 

Although most physicians avoid the combination of an MAOl with most other antidepressants, a number of reports indicate that MAOIs combined with a TCA can be effective and safe in treatment-resistant patients. This combination should be used only by a physician skilled in their use and familiar with their potential adverse effects and drug interactions. Generally, tertiary amine TCAs have been used in combination with MAOIs. Once the dose of the TCA is established, the MAOl should be slowly added. Never attempt the reverse order without a 2-week delay. It may also be prudent to lower the TCA dose slightly before starting the MAOl. An example might be the addition of phenelzine to amitriptyline, starting with an initial dose of 15 mg and subsequent dose increments weekly as needed. The total dose of an MAOl, used in combination with TCA, is usually lower than when used alone (e.g., 30 to 60 mg per day). When the combination is discontinued, the MAOl should be stopped first. 

Although behavioral treatments for social phobia have been well studied, there are very limited data on its pharmacological management, b- Blockers (propranolol, atenolol) have been recommended, but available evidence indicates their effect may be no different than that of placebo ( 78). In a controlled study, the monoamine oxidase inhibitor (MAOl) phenelzine has been shown to be more effective than placebo (78, 79). Anecdotal reports have also described efficacy with alprazolam, clonidine, and fluoxetine, but systematic data are lacking (80, 81, 82 and 83). 

Although clinical experience indicates tranylcypromine may be an effective antipanic agent, there are no controlled trials confirming this observation. Phenelzine, however, has been found to be very effective in both open and controlled designs ( 21, 116, 117). Onset of action is similar to that of other antidepressants, and although adverse effects tend to be less troublesome than with tricyclics, dietary restrictions may limit the usefulness of MAOIs in some patients. Unfortunately, the relapse rate may be comparable to that seen with BZDs and TCAs. For example, Kelly et al., in a follow-up of 246 patients, found that 50% who had discontinued MAOIs relapsed within 1 year (118). 

Direct Tests on Stomach Contents. Odour, colour, and pH. Characteristic smells may indicate the presence of substances such as camphor, cresol, cyanide, etiianol and otiier organic solvents, ethchlorvynol, methyl salicyl-ate, paraldehyde, and phenelzine. A high pH may indicate ingestion of alkali. Undegraded tablets or capsules should be retrieved and examined separately. A green or blue colour suggests the presence of iron salts. 2.Salicylates—Trinder s test To 2ml of tiie sample add 2ml of O.IM hydrochloric acid, boil for 10 minutes, filter if necessary, neutralise the filtrate with... 

A few (hugs have distinctive odours md this can provide a clue to the compoimd or at least to the type of preparation. A yeast-like or meaty smell may indicate a harmless vitamin preparation, an odour of peppermint may indicate a non-toxic indigestion remedy. Antibiotics, especially of the penicillin group, sometimes have a rather unpleasant sulphide-type smell. Other drugs with characteristic odours are chlormethiazole, phenelzine, ethchlorvynol, chloral hydrate, and methylpentynol. 

Phenelzine, a monoamine oxidase (MAO) A inhibitor (15 mg t.i.d.), is indicated in treatment of depressed patients clinically characterized as atypical, nonendogenous, or neurotic. These patients often have mixed anxiety and depression and phobic or hypochondriacal features (see also Tables 5 through 7). 

The MAOIs are indicated in patients with atypical (exogenous) depression and in some patients who are unresponsive to other antidepressive therapy. They rarely are a drug of first choice. Unlabeled uses have included bulimia (having characteristics of atypical depression), treatment of cocaine addiction (phenelzine)... 

N methanolic hydrochloric acid. Absorbance of the yellow solution is read at 400 nm. Since phenelzine degrades by oxidative destruction of the hydrazine function, this method is stability indicating. 

Radecka and Nigam (17) have reported the direct titration of phenelzine with N-bromosuccinimide in acidic solution employing methyl red as the indicator. However, their results show a 5% positive bias. This bias is attributed to allylie bromination by N-bromosuccinimide. 

The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective ... 

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