Parnate (Tranylcypromine) - Oral

Warning:

Parnate comes with two serious warnings from the Food and Drug Administration (FDA). First, the FDA warns that antidepressants, including this medication, may increase the risk of suicidal thinking and behavior in young adults and children. You or your family should watch for any unusual behavior or mood changes and report them to your healthcare provider immediately. Parnate should not be used in children.

Second, the FDA warns that consuming excessive amounts of foods or beverages that contain tyramine may lead to a hypertensive crisis (sudden, severe high blood pressure). Continue reading this article for more information about foods and drinks to avoid while taking this medication.

What Is Parnate?

Parnate (tranylcypromine) is a prescription antidepressant used to treat major depressive disorder (MDD), also known as clinical depression. Parnate is used in adults when other antidepressant treatments haven’t worked well enough.

Tranylcypromine is a type of antidepressant known as a monoamine oxidase inhibitor (MAOI).

Monoamine oxidase is an enzyme that breaks down neurotransmitters (chemical messengers) in the brain. These include serotonin, norepinephrine, and dopamine, all of which help to regulate a variety of physical and psychological functions, including mood. When an MAOI drug blocks this enzyme, the levels of serotonin, norepinephrine, and dopamine rise in the brain, which is thought to improve mood and ease depression.

Parnate is available as a tablet to be taken by mouth.

Drug Facts

Generic Name: Tranylcypromine

Brand Name(s): Parnate

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antidepressant

Available Generically: Yes

Controlled Substance: N/a

Active Ingredient: Tranylcypromine

Dosage Form(s): Tablet

What Is Parnate Used For?

The Food and Drug Administration (FDA) first approved Parnate in 1961. It is FDA-approved for the treatment of major depressive disorder (MDD), also known as clinical depression, in adults.

MDD is a common mood disorder. It involves feelings of sadness, hopelessness, and loss of interest that persists for longer than two weeks. Untreated depression can affect your daily life, physical health, and relationships.

Specifically, Parnate is used when other antidepressant treatments haven’t worked well enough for MDD. It is not used as an initial treatment for MDD.

How to Take Parnate

Take tranylcypromine by mouth as directed by your healthcare provider. It is an oral tablet typically taken two times a day. Healthcare providers usually prescribe a low dose of tranylcypromine to start, then slowly increase the dose over several weeks. 

If you were taking a different antidepressant before, your healthcare provider will give you instructions to slowly reduce the dose before stopping that treatment After your last dose, they will have you wait two or more weeks to allow the previous medication to get out of your system before starting Parnate.

You may take Parnate with or without food. However, several foods and beverages interact with this medication, including foods high in an amino acid called tyramine. Some examples include:

  • Aged cheeses
  • Dried or smoked meats such as hard salami and cacciatore (an Italian tomato-based sauce)
  • Fermented foods containing yeast, such as sourdough bread, pickled herring (fish), or other pickled foods
  • Fava beans
  • Sauerkraut
  • Soy sauce
  • Tofu
  • Soybean products
  • Chocolate
  • Foods that have spoiled or gone bad
  • Aged beer, wine, and liquor

Additionally, avoid excessive caffeine consumption while taking Parnate.

Consuming these types of foods during treatment with Parnate may increase your risk for serious side effects, such as hypertensive crisis (sudden, severe high blood pressure).

Your healthcare provider can give you more information about foods or drinks you may consume in small amounts versus those you should avoid altogether. Tyramine-rich foods should generally be avoided for an additional two weeks after you stop taking Parnate.

Storage

Store Parnate tablets in a light-resistant container at room temperature, between 59 F to 86 F. Keep this medication out of the reach of children.

How Long Does Parnate Take to Work?

You typically need to take Parnate at least one to three weeks before it starts working. Full effects may take six to eight weeks. Your healthcare provider may recommend dose increases every few weeks until they find the dosage that’s right for you.

What Are the Side Effects of Parnate?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The following side effects are common while taking Parnate:

Severe Side Effects

Less commonly, serious side effects can occur while taking tranylcypromine. If you notice the symptoms described below, call your healthcare provider immediately. Call 911 for emergency medical care if your symptoms feel life-threatening. 

Parnate may cause the following severe side effects and associated symptoms:

  • Suicidal thoughts or behavior includes depression symptoms that are more severe than usual, new or worsened anxiety, unusual behavior, or thoughts of hurting yourself.
  • Dangerously high blood pressure (hypertensive crisis) symptoms include intense headache, chest pain, nausea, vomiting, dizziness.
  • Serotonin syndrome is a group of symptoms that occur when serotonin levels become too high. Symptoms, which can range from mild to life-threatening in severity, may include rapid heartbeat, fever, muscle stiffness or twitching, sweating, confusion, nausea, vomiting, or diarrhea.
  • Orthostatic hypotension is low blood pressure that occurs when you stand or sit up, causing dizziness or syncope (fainting).
  • Liver problems, such as hepatitis can cause pain in your upper right abdomen, loss of appetite, nausea, vomiting, itching, and jaundice (yellowing of the skin).
  • Withdrawal symptoms may occur if you suddenly stop taking Parnate; anxiety, mood changes, irritability, confusion, nausea, unusual dreams, ringing in your ears, headache, delirium, and seizures may occur.

Long-Term Side Effects

If you and your healthcare provider decide that Parnate isn’t the right treatment for you, they may have to gradually reduce your dose over time before you stop it completely. This is to prevent withdrawal symptoms that can occur after you’ve stopped the medication. Parnate’s effects (including any side effects) may continue for up to 10 days after your last dose.

Report Side Effects

Parnate may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Parnate Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For depression:
      • Adults—At first, 30 milligrams (mg) per day, given in divided doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
      • Children—Use is not recommended.

Modifications

People 65 years and older may be more likely to have certain side effects from tranylcypromine, such as orthostatic hypotension. This causes a drop in blood pressure, dizziness, or possible fainting (syncope) upon standing or sitting up. Because of this risk, healthcare providers will typically prescribe a lower dose of this medication for older adults.

Missed Dose

If you miss a dose of Parnate, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and just take your next dose at your usual time. You should not take a double dose to make up for a missed dose.

Overdose: What Happens If I Take Too Much Parnate?

Taking too much Parnate may be life-threatening. The following overdose symptoms have been reported:

  • Severely high blood pressure
  • Muscle twitching or stiffness
  • Severe dizziness
  • Anxiety or restlessness
  • Confusion
  • Delirium
  • Seizures
  • Coma

What Happens If I Overdose on Parnate?

If you think you or someone else may have overdosed on Parnate, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Parnate, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to check for any unwanted effects.

You will also need to have your blood pressure measured before starting treatment with this medicine and while you are using it. If you notice any change to your recommended blood pressure, call your doctor right away. If you have questions about this, talk to your doctor.

Do not use this medicine if you have used another MAO inhibitor within the past 14 days. Do not take an MAO inhibitor for at least 7 days after you stop this medicine.

Do not use this medicine if you are taking buspirone (Buspar®), carbamazepine (Tegretol®), cyclobenzaprine (Flexeril®), methyldopa (Aldomet®), milnacipran (Savella®), rasagiline (Azilect®), reserpine (Serpasil®), tapentadol (Nucynta®, Palexia®, Tapal®), or tetrabenazine (Nitoman®, Xenazine®).

When taken with certain foods, drinks, or other medicines, tranylcypromine can cause very dangerous reactions, such as sudden high blood pressure (also called hypertensive crisis). To avoid such reactions, follow these rules of caution:

  • Do not eat foods that have a high tyramine content (most common in foods that are aged or fermented to increase their flavor), such as cheese (especially strong or aged kinds), caviar, sour cream, liver, canned figs, soy sauce, sauerkraut, fava beans, yeasts, and yogurt. Avoid smoked or pickled meat, poultry, or fish, such as sausage, pepperoni, salami, anchovies, or herring. Do not eat dried fruit (such as raisins), bananas, avocados, raspberries, or very ripe fruit.
  • Do not drink alcoholic beverages. This includes Chianti wine, sherry, beer, non-alcohol or low alcohol beer and wine, and liqueurs.
  • Do not eat or drink too much caffeine. Caffeine can be found in coffee, cola, chocolate, tea, and many other foods and drinks. Ask your doctor how much caffeine is safe to use.

Tranylcypromine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.

Call your doctor or hospital emergency room right away if you have a severe headache, stiff or sore neck, chest pains, fast heartbeat, sweating, dizziness, or nausea and vomiting while you are taking this medicine. These may be symptoms of a serious side effect called hypertensive crisis.

Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

This medicine may cause blurred vision, drowsiness, or make some people less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes, then stand up slowly. If the problem continues or gets worse, check with your doctor.

Do not stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine or have used it within the past 10 days. Taking tranylcypromine together with medicines that are used during surgery, dental, or emergency treatments may increase the risk of serious side effects.

Your doctor may want you to carry an identification card stating that you are using this medicine.

This medicine may affect blood sugar levels. If you are diabetic, be especially careful in testing for sugar in your blood or urine. If you have any questions about this, check with your doctor.

After you stop using this medicine, you must continue to exercise caution for at least 2 weeks with your foods, drinks, and other medicines, since these items may continue to react with tranylcypromine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Parnate?

Tranylcypromine is not safe for everyone. You should not take Parnate if:

  • You have a type of adrenal gland tumor called pheochromocytoma.
  • You take (or recently took within a specific period) certain other medications, including other antidepressants.

See the section directly below for a list of medications that should not be taken with Parnate.

What Other Medications Interact With Parnate?

Many medications can interact with Parnate and potentially lead to dangerous side effects, such as hypertensive crisis or serotonin syndrome.

For your safety, tell your healthcare provider and pharmacist about all medications you currently take. Also, mention anything you took in the last few weeks. Be sure to include prescription and over-the-counter (OTC) medications, vitamins, dietary supplements, and herbs.

You should not take Parnate if you currently take (or recently took) the following medications:

If you are switching to Parnate from another antidepressant, your healthcare provider may wait at least two weeks after stopping the other medication before switching your prescription. Conversely, if you are switching to another antidepressant from Parnate, you will also need to wait at least two weeks between drugs.

Other drug interactions are possible. It is very important not to take any new medications without consulting a healthcare provider. Ask your healthcare provider or pharmacist for a complete list of medications that can interact with Parnate.

What Medications Are Similar?

Parnate belongs to a class of drugs called monoamine oxidase inhibitors (MAOIs).

Other MAOIs that are used to treat depression include:

  • Eldepryl, Zelapar (selegiline)
  • Marplan (isocarboxazid)
  • Nardil (phenelzine)

Note that these medications should not be taken with Parnate. Talk to your healthcare provider if you have questions about other treatment options for depression. 

Frequently Asked Questions

  • Are there any OTC medications that I should not take with Parnate?

    Yes, several OTC medications, such as cold and allergy remedies, should not be taken with Parnate. A few examples include diphenhydramine, dextromethorphan, pseudoephedrine, and phenylephrine.

    Dietary supplements, such as SAM-e and 5-HTP, should also be avoided. However, this is not a complete list. To be safe, read all labels and check with your pharmacist or healthcare provider before taking any medications with Parnate.

  • What is Parnate used for?

    Parnate is an antidepressant. It belongs to an older class of drugs called MAOIs. This medication is used in adults with depression (major depressive disorder, or MDD) for which other treatments haven’t been effective.

  • Does Parnate cause sexual side effects?

    It’s possible for sexual dysfunction to occur as a side effect of some antidepressants. However, sexual side effects, such as erectile dysfunction and ejaculation problems have been less commonly reported in people taking tranylcypromine. Talk to your healthcare provider if you’re having sexual side effects.

  • Is it safe to drink alcohol with Parnate?

    You should not drink any alcohol while you’re taking Parnate. Doing so can raise your risk for severe side effects. Not only can the combination cause excessive drowsiness, but the fermented ingredients in certain types of alcohol can cause a sudden and severe spike in blood pressure called hypertensive crisis.

How Can I Stay Healthy While Taking Parnate?

Parnate may be an effective treatment option for depression when other antidepressant treatments haven’t worked well enough. However, taking medication is only one part of managing depression.

You may also benefit from therapy and working with a mental health provider on ways to cope with stress and manage your symptoms. Additionally, it can be helpful to take part in regular self-care, such as:

Remember that getting better takes time, so be patient with yourself and how you're feeling.

It's important to remember that MAOIs, like Parnate, interact with several foods, beverages, and medications. Ask your healthcare provider about which foods you should avoid. Always tell them about all medications you take, including prescription and OTC drugs, vitamins, and herbal supplements.

If you are experiencing any bothersome or concerning side effects, reach out to your healthcare provider. They may be able to offer strategies for managing side effects or work with you to find a better treatment option.

When to Seek Emergency Help

If you think you may be in a position to harm yourself or someone else, call 911 or your local emergency number ASAP. There are also several treatment resources and support groups that can be sought through the Substance Abuse and Mental Health Service Administration (SAMHSA) National Hotline at 1-800-662-HELP (4357).

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Patricia Weiser, PharmD
Patricia Weiser, PharmD, is a licensed pharmacist and freelance medical writer. She has more than 14 years of professional experience.