Parnate (Tranylcypromine): Uses, Side Effects, Warnings, & More

What Is Parnate (Tranylcypromine)?

Parnate is an antidepressant that is used to treat a type of depression called major depressive disorder (MDD) in adults. It is part of a medication class called monoamine oxidase inhibitors (MAOIs). Parnate is not used as a first-line medication to treat MDD. It is used after other antidepressants have been tried and failed due to ineffectiveness or were not tolerated due to side effects. There are diet restrictions for patients who take Parnate and other MAOIs. Parnate is not approved for use in children.¹

How Does Parnate Work?

Parnate is a monoamine oxidase inhibitor (MAOI). This medication helps the brain’s feel-good chemicals stay active for longer. They do this by stopping a molecule called monoamine oxidase from removing these chemicals too quickly. By increasing the active time of the feel-good chemicals, Parnate can help improve mood and depression symptoms for people who have a diagnosis of depression.¹

What Is Parnate Used to Treat?

Parnate is FDA-approved to treat major depressive disorder (MDD). A medication that is FDA-approved has undergone a rigorous evaluation process by the U.S. Food and Drug Administration (FDA) and has been deemed safe and effective for its intended use. Parnate is not approved to be used for the initial treatment of MDD because of the potential side effects, drug interactions, and restricted diet. Parnate is used to treat MDD after other medications have been tried and failed. Parnate is not approved for use in children or adolescents.¹

An off-label use of a medication is a use that is not FDA-approved. The off-label uses for this medication include treatment-resistant depression, treatment-resistant social anxiety disorder, treatment-resistant panic disorder, and atypical depression. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.

Parnate Warnings & Precautions

Parnate may worsen depression symptoms and increase suicidal thoughts or actions, especially in young adults. This may happen within the first few months of treatment and when the Parnate dose is changed. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have or have a family history of bipolar disorder or suicidal thoughts or actions. If you experience any changes in mood, behavior, or feelings, or if you experience thoughts of self-harm, tell your healthcare provider right away.¹

Taking Parnate while eating certain foods or drinking certain beverages can cause a sudden, severe increase in blood pressure (hypertensive crisis). A hypertensive crisis can lead to stroke and death. People who have thyroid problems (hyperthyroidism) may have a higher chance of having a hypertensive crisis. Symptoms of a hypertensive crisis may include sudden, severe headache, vomiting, a fast heartbeat (palpitations), excessive sweating, and more.¹

Precautions for taking Parnate include:

• Use during pregnancy and breastfeeding: Parnate may harm your unborn baby and should be avoided in pregnant patients. Parnate passes through breast milk and should not be taken if you are breastfeeding.¹
• Low blood pressure (hypotension): Hypotension is more common when there is a dosage change. Postural hypotension is when your blood pressure drops when you stand or sit up. It may cause you to feel dizzy and faint.¹
• Mania or hypomania (manic episodes): Parnate may activate mania in patients who have been diagnosed with bipolar disorder.¹
• Changes in your blood pressure with anesthesia: Taking Parnate with certain medicines used for anesthesia can cause low or high blood pressure. If you plan to have surgery, tell your surgeon or the healthcare provider who will give you anesthesia that you take Parnate. Your healthcare provider should stop Parnate at least 10 days before you have surgery.¹
• Liver problems: Parnate may cause a decrease in liver function or infection.¹
• Withdrawal symptoms: Do not suddenly stop taking Parnate, as it can cause withdrawal symptoms such as confusion, dizziness, headache, nausea, and more.¹
• Low blood sugar (hypoglycemia): Hypoglycemia may occur in people with diabetes who take medicines to lower blood sugar.¹
• Seizures: Seizures have occurred in patients who take too much Parnate.¹

Interactions With Parnate

Patients taking Parnate should avoid foods and drinks that contain tyramine. Consuming tyramine while taking Parnate can cause a sudden, severe increase in blood pressure (hypertensive crisis). A hypertensive crisis can lead to stroke and death. Examples of some foods and drinks that should be avoided include:

• Air-dried, aged, and fermented meats, sausages, and salamis
• Pickled herring
• Any spoiled or improperly stored meat, poultry, and fish
• Spoiled or improperly stored animal livers
• Broad bean pods (fava bean pods)
• Aged cheeses
• All tap beers and other beers that have not been pasteurized
• Concentrated yeast extract (such as Marmite)
• Most soybean products (including soy sauce and tofu)
• Sauerkraut
• Over-the-counter supplements containing tyramine

Parnate interacts with many medications, substances, herbs, foods, and drinks. Most of these interactions can cause either serotonin syndrome or a hypertensive crisis. Serotonin syndrome happens when there is too much serotonin in the brain and can potentially be deadly. Symptoms of serotonin syndrome include fast heartbeat, shakiness, confusion, or even coma. Check with your provider or pharmacist before taking any over-the-counter medications or dietary supplements, as they may interact with Parnate.¹

21 substances you should avoid while taking Parnate include:

• Antidepressant: Using any antidepressant with Parnate may cause serotonin syndrome. If taking another MAOI with Parnate, there is an increased risk of side effects, serotonin syndrome, and hypertensive crisis.
• Amphetamines and methylphenidates: When taken with Parnate, there is an increased risk of hypertensive crisis.
• Medicines that can raise blood pressure: When taken with Parnate, there is an increased risk of hypertensive crisis, including the risk of a brain bleed.
• Sympathomimetic herbal medicines or dietary supplements:, When Ephedra sinica or Ma Huang are taken with Parnate, there is an increased risk of hypertensive crisis, including the risk of a brain bleed.
• Antihistamines (allergy medicines): When taken with Parnate, there is a risk of effects such as dry mouth, blurry vision, trouble urinating, and even some memory problems.
• Triptans: When taken with Parnate, there is an increased risk of serotonin syndrome.
• Buspirone: When taken with Parnate, there is an increased risk of hypertensive crisis.
• Carbamazepine: When taken with Parnate, there is an increased risk of serotonin syndrome.
• Dextromethorphan: When taken with Parnate, there is an increased risk of serotonin syndrome and psychosis.
• Dopamine: When taken with Parnate, there is an increased risk of hypertensive crisis.
• Hydroxytryptophan and tryptophan: When taken with Parnate, there is an increased risk of serotonin syndrome.
• Levodopa and methyldopa: When taken with Parnate, there is an increased risk of hypertensive crisis.
• Meperidine: When taken with Parnate, there is an increased risk of serotonin syndrome.
• Rasagiline: When taken with Parnate, there is an increased risk of hypertensive crisis.
• Resperine: When taken with Parnate, there is an increased risk of hypertensive crisis.
• S-adenosyl-L-methionine (SAM-e): When taken with Parnate, there is an increased risk of serotonin syndrome.
• Tapentadol: When taken with Parnate, there is an increased risk of hypertensive crisis and serotonin syndrome.
• Tetrabenazine: When taken with Parnate, there is an increased risk of hypertensive crisis.

Side Effects of Parnate

When starting on Parnate, be aware of any potential side effects. All medications have side effects; however, not all patients experience side effects or may only experience minor side effects. Tell your healthcare provider or pharmacist if you start experiencing any side effects or if you are unsure if you are experiencing a potential side effect.¹

Common Side Effects of Parnate

Parnate may affect every patient differently. There are several side effects that are more common than others, including dry mouth, dizziness, and headache. If any of these side effects or any other side effects bother you or do not go away, contact your provider or pharmacist or seek medical help.¹

Common side effects of Parnate include:*

• Dry mouth
• Dizziness or sleepiness
• Headache
• Trouble sleeping
• Constipation
• Shakiness
• Blurred vision

Serious Side Effects of Parnate

There are some potentially serious side effects associated with Parnate. Though rare, some patients may have very bad and sometimes deadly side effects when taking medication. Parnate can cause some serious side effects, including serotonin syndrome, very low or very high blood pressure, and a change or increase in suicidal thoughts and actions. If you experience any of these side effects, seek medical care immediately.¹

Serious side effects of Parnate may include:*

• Serotonin syndrome
• Signs of very high or low blood pressure (severe headache, dizziness, passing out, or change in vision)
• Increase in suicidal thoughts and actions
• Low blood sugar (hypoglycemia)
• Liver problems (hepatotoxicity)

*All medications, including Parnate, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Antidepressant Discontinuation

When starting or stopping Parnate, there needs to be a washout period between antidepressants to allow time for the medication to get out of your system. Washout periods are important to avoid drug interactions between antidepressants and Parnate. For most antidepressants, this period should be about 14 days between stopping your previous antidepressant and starting Parnate. Talk to your provider or pharmacist about switching antidepressants before stopping or starting any medications.¹

Do not abruptly stop taking Parnate, as this may cause antidepressant withdrawal symptoms to occur. Some antidepressant withdrawal symptoms include dizziness, headache, irritability, changes in mood, abnormal dreams, anxiety, and more. Your provider may slowly decrease your Parnate dose to help prevent antidepressant discontinuation syndrome. If you are experiencing any antidepressant withdrawal symptoms, seek immediate medical care.¹

Allergic Reactions to Parnate

Be sure to watch for signs of an allergic reaction when starting Parnate. Common signs of an allergic reaction include hives, rash, and/or itching. Do not take Parnate if you have an allergy to other MAOIs. If you are unsure, contact your healthcare provider or pharmacist.

Allergic reactions to Parnate may include:

• Red, swollen, blistered, or peeling skin with or without fever
• Wheezing
• Tightness in the chest or throat
• Trouble breathing, swallowing, or talking
• Unusual hoarseness
• Swelling of the mouth, face, lips, tongue or throat

If you experience any of these symptoms, immediately seek medical care or go to the emergency room. If you experience an allergic reaction to Parnate, your healthcare provider will help determine different medication options for the treatment of major depressive disorder (MDD).¹

Parnate Dosages for FDA-Approved Treatment

Parnate doses can vary for each individual. The recommended starting dosage is 30 milligrams per day split into multiple doses. Elderly patients may be started on a lower dose of Parnate. The typical dosage range is 30-60 mg per day split into multiple doses. Your prescriber may increase your dose by 10 milligrams every one to three weeks for maximum effectiveness. Your prescriber will adjust your Parnate dosage until it is the right dose for you.¹

Parnate Form & Strength

Parnate is available as an oral tablet. The right strength for an individual is determined by their age, their medical conditions, and the disorder being treated. This medication is available only in an immediate-release tablet. Parnate starts working within two hours of taking it. It may take one to two weeks to start feeling the initial effects of Parnate and four to six weeks to see full or improved effects.^1,3,4

Parnate is available in the following form and strength:

• 10 milligrams (mg) oral tablet

It is important to take Parnate as prescribed by your healthcare provider. Take the tablet by mouth at the same time(s) each day. Keep taking this medication as directed, even if you start to feel better. Talk to your provider or pharmacist before changing how you take your medication.

How Should I Take Parnate?

Take the Parnate tablet by mouth at the same time(s) each day. Parnate can be taken with or without food as long as you are avoiding foods high in tyramine. There are many possible side effects and interactions with Parnate. Therefore, it is important to take this medication exactly how it was prescribed. Continue taking this medication as directed, even if you start to feel better. Talk to your provider or pharmacist before changing how you take your medication.¹

What Should I Do If I Miss a Dose of Parnate?

If you miss a dose of Parnate, take that dose as soon as you remember. If it is almost time for your next dose, skip the missed one and return to your regular schedule. Avoid taking two doses together or extra doses. Do not abruptly stop taking Parnate, as this may cause antidepressant withdrawal symptoms to occur. If you are unsure if you should take your missed dose, contact your pharmacist or provider.¹

Can You Overdose on Parnate?

Yes, you can overdose on Parnate. Taking too much Parnate can cause the general side effects to occur, but they may be more severe reactions and even fatal. Some signs and symptoms of an overdose on Parnate include trouble sleeping, anxiety, low blood pressure, seizures, delirium, dizziness, very high blood pressure with severe headaches, and twitching.¹

What Should You Do If You Take Too Much Parnate?

If you take too much Parnate, call your provider or poison control (1-800-222-1222), or go to the closest emergency room immediately. Be ready to explain or show what was taken, how much, and when it happened. There are no antidotes for Parnate.¹

Questions to Ask Your Healthcare Provider About Parnate (Tranylcypromine)

Parnate is an antidepressant that is in the MAOI drug class. Parnate is not typically the first antidepressant tried to treat major depressive disorder (MDD). Talk to your healthcare provider or pharmacist if you are unsure if Parnate is right for you. Do not drive, operate heavy machinery or do other dangerous activities until you know how Parnate affects you. Do not drink alcohol while taking Parnate. Be sure to talk to your provider, psychiatrist, pharmacist, and/or therapist before starting this medication. If you need to change prescribers or are looking for different provider options, online psychiatry services may be a good option.

Questions to ask your care team about Parnate include:

• How long will it take for me to adjust to taking Parnate?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• When should I reach out to you if I am experiencing sexual side effects?
• Is there anything I should tell my therapist about this new medication?
• How soon might I notice side effects while on Parnate?
• What if my symptoms get worse while taking Parnate?
• What should I avoid while taking Parnate?
• How many antidepressants should be tried before taking Parnate?

In My Experience

In my experience, Parnate can be useful in patients experiencing treatment-resistant depression. If other antidepressants have not worked to treat your depression, Parnate may be a good option to be the next antidepressant you try. Parnate can cause a variety of side effects and may be severe in some patients. Strict diet restrictions must be followed while taking Parnate. It is important to talk with your healthcare provider about any side effects you may be experiencing and follow their guidance. There are many drug, herbal, and substance interactions that exist with Parnate. Tell your provider about all medications, supplements, and over-the-counter (OTC) medications you are taking before starting Parnate.

For Further Reading

• How to Get Antidepressants: Everything You Need to Know – Choosing Therapy
• How Do Antidepressants Make You Feel? Possible Side Effects & Changes
• What are MAOI Antidepressants and How Do They Work?
• Depression Resources For Everyone