Tranylcypromine adverse effects

Preliminary studies suggest that MAOIs are effective in juvenile and adult ADHD. In a controlled trial of clorygline (MAOI-A) and tranylcypromine sulfate (mixed), Zametkin et al. (1985) reported a significant reduction in ADHD symptoms with minimal adverse effects. Eeigin et al. (1996) conducted a controlled trial of 10 mg of selegiline (which at low doses is a specific MAOI-B) in children with ADHD and Tourette s syndrome. Selegiline was well tolerated and was associated... 

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). 

The monoamine oxidase inhibitors epitomize cyclical fashions in drug use and the impact of adverse effects. They were the first psychotropic drugs for which a clear biochemical action was defined. Early excitement was quickly tempered by reports of liver toxicity with the hydrazine derivatives, leading to synthesis of the cyclopropylamine drug, tranylcypromine, which in turn elicited the food and drug interactions that led to an overall decline in popularity. 

Because of the concern expressed about the use of tricyclic antidepressants in elderly people, MAO inhibitors have been studied in this population (39). Patients with dementia benefited in mood (but not cognition), and some non-demented patients also improved. Adverse effects were considered less frequent or troublesome than those due to tricyclic compounds, although one patient taking tranylcypromine became paranoid and... 

Four cases of addiction to tranylcypromine have been described, in addition to the three reported since 1965 (2). The dosage was 150-300 mg/day. The mild euphoriant properties of tranylcypromine reflect its structural resemblance to amfetamine, and probably account for tolerance and addiction in predisposed individuals. Tranylcypromine abuse in 18 patients has been reviewed (3), and two further reports have appeared (SEDA-17,17) (4). In one case (5), the patient took 440 mg/day without any adverse effects. The patient reported that she was longing for the energizing effect of the drug and for the feeling of freedom and power. Withdrawal resulted in repeated generalized seizures and status epilepticus. 

The most common adverse effect of MAOIs is postural hypotension this is more likely to occur with phenelzine than with tranylcypromine. Hypotensive reactions may be minimized through divided dosage scheduling. Anticholinergic side effects, especially dry mouth and constipation, are common but are milder in severity compared with those associated with the TCAs. 

Fewer adverse effects were reported among moclobemide-treated patients compared with selective serotonin reuptake inhibitor (SSRI)-treated patients. Since moclobemide does not induce orthostatic hypotension, does not possess anticholinergic properties, and is not cardiotoxic, it is very well suited among the MAOIs for the treatment of depression. Moclobemide has limited potential to elicit a hypertensive crisis, because the pressor effect of tyramine from food is only marginally potentiated compared with tranylcypromine. The pressor effect of tyramine is normalized within 3 days of cessation of treatment with moclobemide. The combination of SSRIs and moclobemide has good efficacy in cases of refractory depression, but there is controversy as to whether toxic side-effects such as serotonin syndrome can result from this combination. Currently, more studies are needed before this combination can be recommended. Acute overdose with MAOIs causes agitation, hallucinations, hyperpyrexia, hyperreflexia, convulsions, and death. The most dangerous MAOIs in overdose are the irreversible non-selective MAOIs. T2s-27... 

Many reports, including well-controlled studies, have found no averse interaction with phenothiazines, except rare reports of fatal adverse effects when an MAOI (pargyline or tranylcypromine) was given with methotrimeprazine. 

Many cases of serious (some fatal) adverse effects have been reported when meperidine is added to an MAOi (phenelzine or tranylcypromine). 

In contrast, one woman was switched directly from phenelzine 60 mg daily to tranylcypromine 20 mg daily without any obvious problems (blood pressure was on the high side, but within the usual range for this patient). She was abruptly switched directly back to phenelzine, again without any adverse effect. " Similarly, a review of 8 cases of patients who were switched rapidly from tranylcypromine to phenelzine (3 cases) or vice versa (5 cases) found that 7 patients tolerated the switch well with minimal or no adverse effects. However the eighth patient experienced anxiety, nausea, hyperventilation, flushing, sense of doom, and increased insomnia, which may have been a mild form of the serotonin syndrome. ... 

Patients taking the non-seiective MAOIs (e.g. tranylcypromine, phenelzine) can suffer a serious hypertensive reaction if they drink tyramine-rich drinks (some beers or iagers, including low-aicohoi brands, or wines), but no serious interaction is likely with the RIMAs (e.g. mociobemide). The hypotensive adverse effects of the MAOIs may be exaggerated in a few patients by aicohoi, and they may experience dizziness and faintness after drinking reia-tiveiy modest amounts. Mociobemide does not appear to aiter the psychomotor effects of aicohoi to a ciinicaiiy reievant extent. 

Inhibition of liver MAO leaves the patient vulnerable to the so-called wine-and-cheese syndrome, with adverse cardiovascular effects caused by absorption of such vasoactive amines as tyramine into the general circulation [for review, see Blackwell et al. (23)], The syndrome can include severe headache and hypertension and may lead to cerebral hemorrhage and death. Although this is a real risk, it seems likely that fears of MAOfood interactions may have been grossly exaggerated. Pare (24) reviewed the evidence in 1985 and noted that despite the widespread use of MAO inhibitors in the previous decade there had only been 17 reports of food interactions with phenelzine (19) and none of these proved fatal. With tranylcypromine (23) seven deaths had been reported, but in only two of these could a definite relationship with diet be established. 

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