Parnate is a brand name of the antidepressant tranylcypromine. Tranylcypromine is an irreversible, non-selective monoamine oxidase inhibitor (MAOI). Today, MAOIs like tranylcypromine are only occasionally prescribed for cases of major depressive disorder. Doctors typically start patients out on other more modern antidepressants first. If the patient proves to be resistant to these medications, then an MAOI like Parnate may be prescribed. Depression that presents along with anxiety tends to be more likely to respond well to treatment with tranylcypromine.
Parnate is notorious for its long list of contraindications, complications, and potentially fatal drug interactions. Individuals taking tranylcypromine will need to avoid foods and beverages containing tyramine. Tyramine is a nutrient found in many foods and alcoholic drinks. Red wine is particularly high in tyramine. Foods that contain high levels of tyramine include fermented cheese and meats. Tyramine is produced as a byproduct of the fermentation process.
Patients will also need to avoid medications that increase the expression of serotonin. Combining the effects of drugs like selective serotonin reuptake inhibitors (SSRIs) can result in a dangerous condition known as serotonin syndrome and lead to permanent psychosis if left untreated.
MAOI inhibitors achieve their function in the brain by inhibiting the breakdown of several key neurotransmitters. These neurotransmitters include serotonin, melatonin, epinephrine, and norepinephrine. To say that tranylcypromine is non-selective means that it targets these neurotransmitters equally. Parnate also increases the expression of GABA and thereby achieves its anxiety-reducing effects.
Tranylcypromine is one of the few MAOIs that comes with the occasional occurrence of addiction and misuse. Parnate has mildly stimulating effects at normal doses thanks to its activity on the neurotransmitter norepinephrine. At high daily doses, Parnate can induce a “buzz” similar to the effects experienced on amphetamines or similar stimulants. Most patients who engage in such behavior have a history of misusing other substances.
Several instances have been reported of patients taking up to 30 ten mg tablets of tranylcypromine daily. These individuals obtained prescriptions from multiple doctors to supply their habit. Some of these patients ended up in the emergency room with symptoms of agitation, confusion, and hallucinations. A condition called thrombocytopenic purpura, in which blood platelet counts become low was also noted in some cases.
Parnate is safe to take under the guidance of a single prescribing doctor so long as dose recommendations are followed. The changes that tranylcypromine induces in brain chemistry are irreversible, meaning that even after the patient stops taking the drug, the breakdown of serotonin, melatonin, epinephrine, and norepinephrine will continue to be inhibited. Later generations of MAOIs are designed to have greater selectivity, and the effects are reversible upon cessation of treatment.
When transitioning off tranylcypromine, patients may experience increased irritability, restlessness, diarrhea, muscle twitches, fatigue, and weakness. These symptoms can be mitigated by gradually reducing the dose over the course of weeks, months, or years depending. The length of the discontinuation phase depends on the current dose strength and duration of treatment. Patients who have been taking Parnate for several years will need to allow for a longer and more gradual discontinuation period.
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