Tranylcypromine, which is also sold under the brand name Parnate, is a type of antidepressant known as a monoamine inhibitor (MAOI). It’s one of the first antidepressant medications ever produced. MAOIs like Parnate are notorious for their long list of complications and contraindications. Most doctors start new patients on other antidepressants first before placing them on an MAOI when treating for major depressive disorder.
However, for medication-resistant depression, or for other atypical presentations of depression, tranylcypromine may be prescribed. Parnate is especially effective with patients whose depression is accompanied by anxiety. Tranylcypromine is no longer present in the body after roughly 14 days following the final dose, but this can vary depending on various factors.
Side effects of tranylcypromine may include dizziness tachycardia, weight loss, dry mouth, hypertension, urinary retention, and confusion. These symptoms occur in less than ten percent of patients.
Parnate is an irreversible, non-selective MAOI. Long after the patient stops taking tranylcypromine, its effects on the breakdown of monoamine pathways in the brain remain permanent. Later generations of MAOIs are both selective and reversible, meaning that their effects on brain chemistry recede and that they target only certain types of monoamine neurotransmitters. Tranylcypromine, although technically considered a non-selective MAOI, can on occasion show slight preference to MAO-B enzymes over MAO-A enzymes.
Tranylcypromine is available via a prescription from qualified physicians and psychiatrists. It is not considered to be addictive and is therefore classified as an uncontrolled substance by the Federal Drug Administration.
Administration of Parnate, however, is done with caution due to its high rate of potentially dangerous complications. Patients taking tranylcypromine must avoid taking any substances that may further increase levels of serotonin in the brain. Combining Parnate with a selective serotonin reuptake inhibitor or a tricyclic antidepressant, both of which enhance serotonin expression, may result in a dangerous condition of serotonin overload known as serotonin syndrome. Serotonin syndrome can lead to permanent psychosis in severe cases.
Tranylcypromine is not known to be used in other drugs such as ecstasy or illegally-pressed Xanax pills. Although tranylcypromine is considered non-addictive, it can still result in addictive behaviors in patients who disregard dose protocol and take high quantities of the drug. At high doses, Parnate can induce a “buzz” like those experiences with amphetamine use. Parnate’s stimulating effects are due to its activation of the neurotransmitter norepinephrine, which influences attentiveness, motivation, and learning in addition to a variety of other functions throughout the body.
Parnate achieves its effects by inhibiting the breakdown of the neurotransmitters epinephrine, norepinephrine, serotonin, and melatonin. Serotonin and norepinephrine have been closely linked to cases of depression and anxiety, along with several other mental health disorders. Tranylcypromine also encourages the expression of the neurotransmitter GABA. Individuals with anxiety tend to be low on GABA, which is essential to calming overactive brain chemistry.
Tranylcypromine has a biological half-life of two and a half hours and a mean bioavailability of 50% in healthy patients. Maximum plasma concentrations can occur within one to two hours of taking the Parnate. The pharmacodynamic effects of Parnate can last several days because of the irreversible effects that it has on the breakdown of certain neurotransmitters.
As a rule, individuals should wait approximately 14 days after taking their final dose of Parnate before beginning other medications that are contraindicated for MAOIs. 14 days is the amount of time necessary for enzyme production to return to normal. During this time, patients should continue to follow a tyramine-free diet. Foods and alcohol that contain tyramine can trigger a hypertensive crisis in individuals who take tranylcypromine due to tyramine’s norepinephrine-enhancing effects.
Due to Paranate’s relatively short half-life, it can be present in the urine within just two hours of the initial dose. Following a 20-mg dose, plasma concentrations can reach 50 to 200 mg/ml. Tranylcypromine has three different metabolites that also inhibit the breakdown of MAO, but they’re significantly less potent than tranylcypromine itself. Parnate may continue to be excreted in the urine at testable levels for up to several weeks. As a rule, patients who have been taking tranylcypromine for long durations and at high doses will take longer to test negative than patients who’ve been taking low doses of the drug for a short period.
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