Tranylcypromine

Irreversible MAOI·Psychiatry - Antidepressants

Severe Treatment-Resistant Depression (especially melancholic, psychomotor-retarded depression)

Authority requiredPBSMAOIParnate10 mg tablet+2

Max Dose

60 mg/day

Half-life

2 h

Diet Restrictions

CRITICAL

Activation

HIGH

Rapid Summary

Overview

Irreversible Monoamine Oxidase Inhibitor (MAOI). Structurally related to amphetamine. Exceptionally potent, highly stimulating, and fast-acting, but carries the same lethal dietary and drug interactions as Phenelzine.

Maximum Dose

Max 30 mg/day in the current Australian Parnate source; any higher specialist dosing should be explicitly source-checked before display.

Clinical Focus

Highly activating. Must be taken in the morning to prevent severe insomnia. Strict Tyramine-free diet is mandatory.

Bottom Line

Tranylcypromine is an irreversible MAOI for treatment-resistant depression, but has the most stimulant-like profile and requires the same strict tyramine dietary restrictions as phenelzine.

Formulation & Access

Brand Names

Parnate

Oral Routes

Tablets (10 mg).

Prescribing & PBS

Authority Required (PBS). Initiated by Psychiatrists only.

Indications & Use

Primary

PBSTGA

Severe Treatment-Resistant Depression (especially melancholic, psychomotor-retarded depression).

Clinical Place

Used when the patient needs the immense power of an MAOI but also requires the stimulating, 'amphetamine-like' kick to get out of bed.

Quick reference

Class & Role

Irreversible MAOI — Irreversible Monoamine Oxidase Inhibitor (MAOI).

Route / Formulation

Tablets (10 mg). (Parnate)

Usual Dose & Max

Start PO 10 mg BD (morning and midday). Titrate to 30-60 mg/day. Max 60 mg/day.

Key Indication Doses

Treatment Resistant Depression: Start PO 10 mg BD (morning and midday). Titrate to 30-60 mg/day. Washout Period: Must wait 14 days after stopping an SSRI (or 5 weeks after Fluoxetine) before starting Tranylcypromine.

Best Uses

Tranylcypromine is an irreversible MAOI for treatment-resistant depression, but has the most stimulant-like profile and requires the same strict tyramine dietary restrictions as phenelzine.

Avoid / Cautions

Non-compliance with diet. Pheochromocytoma, cardiovascular disease, concurrent SSRIs/SNRIs. Pregnancy Category B3.

Key Risks

Cardiovascular: Hypertensive Crisis (if tyramine is ingested or sympathomimetics are given). HIGH — Orthostatic hypotension (can be severe). Neurological: Insomnia, severe agitation, hypomania, tremor. CRITICAL — Serotonin Syndrome (with SSRIs). Metabolic: Unlike Phenelzine, Tranylcypromine causes very little weight gain and less sexual dysfunction.

Key Interactions

Aged cheeses, cured meats, tap beer, Vegemite/Marmite, fermented soy (Tyramine). Cold and flu tablets containing Pseudoephedrine/Phenylephrine will cause a fatal stroke. SSRIs and Tramadol cause fatal Serotonin Syndrome.

Monitoring

Check BP sitting and standing. Orthostatic hypotension is the most common reason for ceasing the drug. Provide an 'MAOI Alert Card'.

Clinical Pearl

Never prescribe Tranylcypromine after 3 PM. Its amphetamine-like structure will guarantee the patient does not sleep for 24 hours.

Access

Authority requiredParnate10 mg tablet

Brand: Parnate
PBS status: Authority required
Formulation: Tablets (10 mg)

Tranylcypromine

Irreversible MAOI·Psychiatry - Antidepressants

Severe Treatment-Resistant Depression (especially melancholic, psychomotor-retarded depression)

Authority requiredPBSMAOIParnate10 mg tablet+2

Max Dose

60 mg/day

Half-life

2 h

Diet Restrictions

CRITICAL

Activation

HIGH

Rapid Summary

Overview

Maximum Dose

Max 30 mg/day in the current Australian Parnate source; any higher specialist dosing should be explicitly source-checked before display.

Clinical Focus

Highly activating. Must be taken in the morning to prevent severe insomnia. Strict Tyramine-free diet is mandatory.

Bottom Line

Tranylcypromine is an irreversible MAOI for treatment-resistant depression, but has the most stimulant-like profile and requires the same strict tyramine dietary restrictions as phenelzine.

Formulation & Access

Brand Names

Parnate

Oral Routes

Tablets (10 mg).

Prescribing & PBS

Authority Required (PBS). Initiated by Psychiatrists only.

Indications & Use

Primary

PBSTGA

Severe Treatment-Resistant Depression (especially melancholic, psychomotor-retarded depression).

Clinical Place

Used when the patient needs the immense power of an MAOI but also requires the stimulating, 'amphetamine-like' kick to get out of bed.

Quick reference

Class & Role

Irreversible MAOI — Irreversible Monoamine Oxidase Inhibitor (MAOI).

Route / Formulation

Tablets (10 mg). (Parnate)

Usual Dose & Max

Start PO 10 mg BD (morning and midday). Titrate to 30-60 mg/day. Max 60 mg/day.

Key Indication Doses

Best Uses

Tranylcypromine is an irreversible MAOI for treatment-resistant depression, but has the most stimulant-like profile and requires the same strict tyramine dietary restrictions as phenelzine.

Avoid / Cautions

Non-compliance with diet. Pheochromocytoma, cardiovascular disease, concurrent SSRIs/SNRIs. Pregnancy Category B3.

Key Risks

Key Interactions

Monitoring

Check BP sitting and standing. Orthostatic hypotension is the most common reason for ceasing the drug. Provide an 'MAOI Alert Card'.

Clinical Pearl

Never prescribe Tranylcypromine after 3 PM. Its amphetamine-like structure will guarantee the patient does not sleep for 24 hours.

Access

Authority requiredParnate10 mg tablet

Brand: Parnate
PBS status: Authority required
Formulation: Tablets (10 mg)