Class: MAOI FDA Indications: Depressed Patients Characterized As "atypical," "nonendogenous," Or "neurotic" Off-Label Use: Bulimia Nervosa, Treatment-resistant Depression, Treatment-resistant Panic Disorder
Forms: 15mg tablet Dose Range: 30-90 mg/day Starting: 45 mg/day in 3 divided doses; increase to 60-90 mg/day; after desired therapeutic effect is achieved lower dose as far as possible Once dosing is stabilized, some patients may tolerate qd or bid dosing rather than tid. Stopping: Generally no need to taper, as the drug wears off slowly over 2-3 weeks. Monitoring: Monitor blood pressure and BMI. Hepatic function should be monitored periodically in patients receiving high doses.
Contraindications: all known antidepressants, including St. John's Wort and other MAOIs; certain pain medications: meperidine, methadone, Darvon (caution advised with Ultram); the triptans Imitrex and Maxalt; dextromethorphan; Sudafed
Serious Side Effects: Hypertensive crisis (especially when MAOIs are used with certain tyramine-containing foods or prohibited drugs), induction of mania, seizures, hepatotoxicity
Contraindicated in patients with congestive heart failure or hypertension.
Side Effects: sedation/somnolence, dizziness, visual changes, weakness/asthenia, increased appetite, weight gain, weight gain, xerostomia, hyperhidrosis, tremor, insomnia, sexual dysfunction, orthostatic hypotension
1° MOA: Non-selective irreversible monoamine oxidase inhibitor 2° MOA: One of phenelzine's 2° metabolites, PEH, inhibits GABA-T, which ↑'s GABA levels (in brain and body). Another 2° metabolite is the stimulant, phenethylamine, which ↑'s presynaptic DA & NE release. Target: MAO-A, MAO-B
- Do not coadminister with any serotonergic medications (especially SSRIs, SNRIs, TCAs), which can cause serotonin syndrome
- Don't start phenelzine into 5-half lives of any stopped antidepressant, and wait ~2 weeks after stopping selegiline before starting any antidepressant. Do not use patient is taking meperidine, any sympathomimetic agent or guanethidine, non-subcutaneous sumatriptan, tramadol, chlorpheniramine, methamphetamine, methadone, mrompheniramine, St. John's wort, amphetamine, fentanyl, dextromethorphan, or another MAOI.
- Use with caution with coprescribed noradrenergic agents, e.g. phenylephrine, phentermine, pseudoephedrine, local anesthetics containing vasoconstrictors, NDRIs, modafinil, tapentadol, armodafinil.
- foods to generally avoid, as they are usually high in tyramine content: dry sausage, pickled herring, liver, broad bean pods, sauerkraut, cheese, yogurt, alcoholic beverages, nonalcoholic beer and wine, chocolate, caffeine, meat, and fish
Category C—The human pregnancy experience is too limited to assess the embryo-fetal risk. It is not known if phenelzine crosses the human placenta. The molecular weight of the sulfate form (about 234) and elimination half-life suggest that exposure of the embryo-fetus should be expected. The Collaborative Perinatal Project monitored 21 mother-child pairs exposed to MAO inhibitors during the 1st trimester, 3 of which were exposed to phenelzine. Three of the 21 infants had malformations (RR 2.26). Details of the three cases with phenelzine exposure were not specified.
No reports describing the use of phenelzine during breastfeeding have been located. Its molecular weight and moderately long t½ suggest that it will be excreted into breast milk.
Initial dose 7.5 mg/day; increase every few days by 7.5-15 mg/day Elderly patients may have greater sensitivity to adverse effects.
No dose adjustment necessary
No dose adjustment necessary. The serum aminotransferase elevations that occur on phenelzine therapy are usually self-limited and mild and do not require dose modification or discontinuation of therapy.
Developed & Designed by Kevin M. Nasky, D.O. • Built with Bootstrap, PHP & MySQL • Hosted by SiteGround
Last updated August 27 2018 18:45:06. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
Think before you use this website!
Psychopharmacopeia.com includes clinical information intended for use by healthcare professionals. This does not constitute as clinical or professional advice. Physicians and other healthcare professionals should always use their own clinical judgment first and follow laws and guidelines in their own practice jurisdiction. Psychopharmacopeia.com does not give medical advice or diagnostic services. Neither we nor our content providers can guarantee that the content covers all possible uses, directions, precautions, drug interactions, or adverse effects that may be associated with any therapeutic treatments.
Non-health care providers who use this website, please do so at your own risk, and always seek professional medical advice. I have done my best to ensure that the information on this website is reliable, but neither we nor our content providers guarantee the accuracy of the information contained on this site.
Use this site at your own risk. Psychopharmacopeia.com and its hosting provider do not assume any liability or responsibility for damage, injury, or death to you, other persons or property from any use of any ideas, information, or instruction in this website.