Mixing Parnate with Alcohol

Parnate is a brand name of the monoamine oxidase inhibitor (MAOI) tranylcypromine. MAOIs are part of the first generation of antidepressants that came out in the 1950’s and 1960’s. Tranylcypromine is an irreversible MAOI, meaning that its effects on brain chemistry are permanent. Tranylcypromine is also indiscriminate, meaning that it affects both MAO-A AND MAO-B pathways in the brain equally.

Today, Parnate is the third line of treatment for most types of depression in favor of other more modern drugs such as selective serotonin reuptake inhibitors (SSRIs). Doctors may still prescribe MAO inhibitors like tranylcypromine for medication-resistant or atypical types of depression, especially when anxiety is involved.

Parnate should never be mixed with other medications that increase levels of serotonin in the brain. Combining tranylcypromine with an SSRI like Prozac can result in serotonin overload and the onset of serotonin syndrome. Serotonin syndrome can lead to psychosis and permanent brain damage if left untreated.

Patients taking Parnate should avoid eating foods or drinking alcohol that contains the nutrient tyramine. Tyramine is produced during fermentation and is present in dangerous quantities in fermented cheeses, aged meats, and chocolate, among others.

Tranylcypromine achieves its depression-reducing and anxiolytic (anti-anxiety) effects by inhibiting the breakdown of several monoamine pathways. The expression of the neurotransmitters serotonin, melatonin, norepinephrine, and epinephrine are enhanced by the activity of Parnate and its active metabolites. These neurotransmitters are essential to mental health and are involved in a wide variety of the body’s processes from cardiovascular function to digestion.

Parnate is thought to reduce anxiety by increasing the expression of the neurotransmitter GABA, which is responsible for calming down the activity of the excitatory neurotransmitter glutamate when it becomes overactive.

Drinking alcohol that contains tyramine while taking tranylcypromine can result in dangerously high blood pressure. Red wine is especially high in tyramine. The hypertensive crisis that may result from mixing such alcohols with Parnate can be fatal.

Tranylcypromine is known to be stimulatory for some patients due to its activity on the neurotransmitter norepinephrine. High concentrations of tyramine in the blood plasma can increase the release of norepinephrine. Typically, the body would get rid of the excess norepinephrine before it can cause a dangerous rise in blood pressure. However, under the effects of Parnate, this mechanism becomes inhibited. Blood vessels constrict, blood pressure elevates, and a severe hypertensive crisis can occur.

MAOIs like tranylcypromine are prescribed much less often than other antidepressants because of their high rate of complications with other medications, food, and alcohol. Patients should wait at least 14 days from the time of the last dose when transitioning from other antidepressants to Parnate. The combined effects of Parnate with an SSRI or tricyclic antidepressant can spike serotonin concentrations to dangerous levels.

Individuals will also need to follow a tyramine-free diet while taking tranylcypromine. The presence of tyramine in the blood along with tranylcypromine can lead to a hypertensive crisis. Parnate treatment can lead to birth defects in babies whose mothers take the drug. Mothers who are nursing should also avoid Parnate, and other MAOIs, as the drug is present in the milk during lactation.

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