An MAOI antidepressant
Tranylcypromine
An older MAOI antidepressant, somewhat stimulating, that needs a strict low-tyramine diet for safety.
What is Tranylcypromine?
Tranylcypromine is a monoamine oxidase inhibitor (MAOI), an older antidepressant usually reserved by specialists for depression that has not responded to other treatments. Compared with some MAOIs it can be a little stimulating. Like other irreversible MAOIs it needs a strict low-tyramine diet — avoiding mature cheese, cured meats and yeast extracts — to prevent a dangerous rise in blood pressure, signalled by a sudden severe throbbing headache. It also interacts dangerously with many other medicines.
Education and reference only. This is a plain-language guide to Tranylcypromine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Tranylcypromine is one of the original antidepressants, a monoamine oxidase inhibitor (MAOI). It is usually started by a specialist and reserved for depression that has not responded to newer antidepressants. It tends to be a little more stimulating than some other MAOIs, which some people find helpful. It needs the same strict attention to diet and to interacting medicines as other irreversible MAOIs.
How it works
Tranylcypromine blocks monoamine oxidase, the enzyme that breaks down mood-related brain chemicals such as serotonin, noradrenaline and dopamine, so more of these are available to lift mood over weeks. The same enzyme normally breaks down tyramine from food and the active parts of some medicines, which is why these must be restricted to avoid a dangerous build-up and a surge in blood pressure.
Company & origin
Originated / developed by: Generic (long-established).
An older MAOI antidepressant used in the UK for depression that has not responded to other treatments, with some stimulating effect.
What it treats
Conditions Tranylcypromine is used for
Practical use
How to take Tranylcypromine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Follow the low-tyramine diet carefully, avoiding mature cheese, cured or aged meats, yeast extracts and other listed foods.
- Take it as prescribed, often earlier in the day, as it can be stimulating and disturb sleep if taken late.
- Do not take other medicines, including over-the-counter cold, flu or decongestant remedies, without checking they are safe with an MAOI.
- Carry an MAOI warning card and tell any doctor, dentist or pharmacist that you take tranylcypromine; precautions continue for weeks after stopping.
- If you miss a dose, take it when you remember unless it is nearly time for the next, then skip it — do not double up, and do not stop suddenly.
Weighing it up
Advantages & disadvantages of Tranylcypromine
Advantages
- Can be effective for depression that has not responded to other antidepressants.
- Its mildly stimulating effect suits some people with low energy.
- An established specialist option when other treatments have failed.
Disadvantages
- Requires a strict low-tyramine diet to avoid dangerous blood-pressure surges.
- Interacts dangerously with many medicines, including other antidepressants and decongestants.
- Can be over-stimulating, and precautions continue for weeks after stopping.
Practical use
Good to know
As with other irreversible MAOIs, a strict low-tyramine diet is essential: avoid mature and aged cheeses, cured, smoked or aged meats, yeast and meat extracts (such as Marmite, Bovril and OXO), some fermented foods and certain drinks. Eating these can cause a dangerous rise in blood pressure (a hypertensive crisis); a sudden, severe, throbbing headache, often with a stiff neck, sweating or palpitations, is an emergency. Because tranylcypromine can be stimulating, it is often taken earlier in the day to avoid disturbing sleep. It interacts dangerously with many medicines, including other antidepressants, some painkillers (especially pethidine), and decongestants and stimulants in cold and flu remedies. The precautions continue for a couple of weeks after stopping, a washout is needed before switching antidepressants, and it should never be stopped abruptly. Carry an MAOI warning card.
Who should not take it / use with caution
- It must not be combined with other antidepressants, certain painkillers such as pethidine, or decongestants and similar stimulant medicines.
- People with phaeochromocytoma, significant liver disease, or certain heart and circulation problems should not take it.
- Anyone unable to follow the dietary and medicine restrictions, or with a history of serious MAOI reactions, should avoid it.
Monitoring
- Blood pressure is checked, and you are taught to recognise the warning signs of a hypertensive crisis.
- Mood and any thoughts of self-harm are reviewed, especially early in treatment.
- Adherence to the diet and medicine restrictions is reviewed at appointments.
Side effects
- Insomnia (especially if taken late), restlessness, dizziness on standing and dry mouth.
- Headache, tremor and difficulty passing urine.
- Dangerously, a hypertensive crisis from tyramine — a sudden severe throbbing headache needs emergency care.
Key interactions
- Other antidepressants (including SSRIs and tricyclics) must be avoided, with a washout when switching.
- Some painkillers, especially pethidine, and decongestants or stimulants can cause severe reactions.
- Many cold and flu remedies and certain foods interact, so always check before taking anything new.
Available as: Tablets taken by mouth.
Answers
Tranylcypromine: frequently asked questions
Why is the diet so important?
Tranylcypromine blocks the enzyme that breaks down tyramine, so high-tyramine foods like mature cheese and cured meats can cause a dangerous rise in blood pressure.
Why might I take it earlier in the day?
It can be stimulating, so taking it earlier helps avoid difficulty sleeping; follow the timing your prescriber advises.
What are the emergency warning signs?
A sudden, severe throbbing headache, often with a stiff neck, sweating or palpitations, can signal a hypertensive crisis and needs emergency help.
Can I take painkillers with it?
Some painkillers, especially pethidine, are dangerous with it; always check with a pharmacist before taking any new painkiller.
How long do the precautions last after stopping?
The effect lingers for a couple of weeks, so the diet and medicine precautions, and a washout before switching, are still needed after you stop.
The wider class
About MAOI antidepressants
Tranylcypromine belongs to the maoi antidepressants class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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