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Brand name:

Parnate

Pronounced: PAR-nate
Generic name: Tranylcypromine sulfate

Why is this drug prescribed?

Parnate is prescribed for the treatment of major depression--that is, a depressed mood that lasts for at least 2 weeks and interferes with daily functioning. Major depression is marked by at least 4 of the following 8 symptoms: changes in appetite, changes in sleep patterns, agitation or listlessness, loss of interest in usual activities or a decrease in sex drive, fatigue, feelings of guilt or worthlessness, slowed thinking or difficulty concentrating, and thoughts of suicide.

Parnate is a member of the class of drugs known as monoamine oxidase (MAO) inhibitors. It works by increasing concentrations of the brain chemicals epinephrine, norepinephrine, and serotonin.

Most important fact about this drug

Parnate is a potent drug with the capability of producing serious side effects. It is typically prescribed only if other antidepressants fail, and then only for adults who are under close medical supervision. It is considered especially risky because it can interact with a long list of drugs and foods to produce life-threatening side effects (see "Possible food and drug interactions when taking this medication").

How should you take this medication?

Your doctor will adjust the dosage of Parnate according to your individual needs and response. The drug usually produces improvement within 48 hours to 3 weeks after starting therapy.

--If you miss a dose...

Take it as soon as you remember. If it is within 2 hours of your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Parnate.

• Side effects may include:
  Abdominal pain, agitation, altered touch sensation, anxiety, appetite loss, blood disorders, blurred vision, chills, constipation, diarrhea, dizziness, drowsiness, dry mouth, hair loss, headaches, hepatitis, impotence, insomnia, irregular or rapid heartbeat, mania, muscle spasms and jerks, nausea, numbness, overstimulation, restlessness, retarded ejaculation, ringing in ears, reduced urination, skin rashes, tremors, swelling, water retention, weakness

Why should this drug not be prescribed?

Do not take Parnate if you are in danger of a stroke, if you have heart or liver disease, high blood pressure, or a history of headaches, if you have a type of tumor known as pheochromocytoma, or if you will be undergoing elective surgery requiring general anesthesia.

Special warnings about this medication

The most dangerous reaction to Parnate is a surge in blood pressure, which has sometimes been fatal. For this reason, report promptly to your doctor any of the following symptoms: constriction or pain in the throat or chest, dizziness, fever, headache, irregular heartbeat, light sensitivity, nausea, neck stiffness or soreness, palpitations, pupil dilation, sweating, or vomiting.

A number of people who take Parnate experience low blood pressure, faintness, or drowsiness, so exercise great care when performing potentially hazardous tasks, such as driving a car or operating machinery.

Some people become physically dependent on Parnate and experience withdrawal symptoms when the drug is stopped, including restlessness, anxiety, depression, confusion, hallucinations, headache, weakness, and diarrhea.

If you have kidney problems, make sure the doctor is aware of this. The doctor may need to reduce your dosage of Parnate to avoid a buildup of the drug. Parnate should also be used with caution if you have an overactive thyroid gland.

MAO inhibitors can suppress heart pain that would otherwise serve as a warning sign of a heart attack. For this reason and others, it should be used with caution by older adults. Also, it should be used with caution by diabetics and people with epilepsy or other convulsive disorders because it can alter the level of drugs used to treat these conditions. Tell every doctor or dentist who you see that you are taking Parnate.

Possible food and drug interactions when taking this medication

Never take Parnate with the following drugs; the combination can trigger seizures or a dangerous spike in blood pressure:

Other MAO inhibitors such as Nardil
Antidepressant drugs classified as "tricyclics," such as Anafranil, Elavil, and Tofranil
Carbamazepine (Tegretol)
Cyclobenzaprine (Flexeril)

When switching from one of these drugs to Parnate, or vice versa, allow an interval of at least 1 week between medications.

Also avoid combining Parnate with any of the following:

Antidepressant drugs classified as "selective serotonin reuptake inhibitors," such as Paxil, Prozac, and Zoloft
Amphetamines such as Adderall and Dexedrine
Anesthetics
Antihistamines such as Allegra, Benadryl, and Clarinex
Blood pressure medications such as Accupril, Lotensin, and Prinivil
Bupropion (Wellbutrin)
Buspirone (BuSpar)
Cold and hay fever remedies that constrict blood vessels
Cough remedies containing dextromethorphan
Demerol and other narcotic painkillers such as Percodan, OxyContin, and Vicodin
Disulfiram (Antabuse)
Guanethidine
Methyldopa
Over-the-counter weight reduction aids
Parkinson's disease medications such as Parlodel, Requip, and Sinemet
Reserpine
Sedatives such as Halcion, Nembutal, and Seconal
Tryptophan
Water pills such as HydroDIURIL

While taking Parnate, you should also avoid foods that contain a high amount of a substance called tyramine, including:

Anchovies
Avocados
Bananas
Beer (including nonalcoholic beer)
Caviar
Cheese (especially strong and aged varieties)
Chianti wine
Chocolate
Dried fruits (including raisins, prunes, and figs)
Liqueurs
Liver
Meat extracts or meat prepared with tenderizers
Overripe fruit
Pickled herring
Pods of broad beans like fava beans
Raspberries
Sauerkraut
Sherry
Sour cream
Soy sauce
Yeast extracts
Yogurt

Likewise, avoid alcohol and large amounts of caffeine.

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately. Parnate should be used during pregnancy only if its benefits outweigh potential risks.

Parnate makes its way into breast milk. If the drug is essential to your health, your doctor may advise you to stop nursing until your treatment is finished.

Recommended dosage

ADULTS

Overdosage

If you suspect an overdose of Parnate, seek medical help immediately.

• Symptoms of Parnate overdose may include:
  Agitation, confusion, coma, dizziness, drowsiness, high fever, incoherence, rigid muscles, severe headache, twitching, weakness