Adult: In patients who have failed to respond to other antidepressants: Initially, 10 mg in the morning and afternoon. If response is insufficient after the initial week, an additional 10 mg may be given at midday and continued for at least 1 week. May reduce to maintenance dose of 10 mg daily once a satisfactory response has been achieved. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Initiate at a lower dose with more gradual dose increases.
Hepatic Impairment
Contraindicated.
Contraindications
Phaeochromocytoma or other catecholamine-releasing paragangliomas, porphyria, actual or suspected cerebrovascular disease, severe CV disease, hyperthyroidism, blood dyscrasias. Hepatic impairment. Concomitant use with or within 2 weeks of discontinuing other MAOIs. Concomitant use with other antidepressants (e.g. TCAs, tetracyclic antidepressants, SSRIs, SNRIs, bupropion, nefazodone, trazodone, vilazodone, vortioxetine), sympathomimetic agents (e.g. amphetamine, fenfluramine, ephedrine, pseudoephedrine, phenylephrine), triptans, carbamazepine, cyclobenzaprine, tryptophan, methyldopa, tapentadol, tetrabenazine, reserpine, levodopa, dopamine, pethidine, dextromethorphan and buspirone.
Special Precautions
Patient with CV disease or preexisting hypertension, hypovolaemia, epilepsy, diabetes mellitus, history of dependence on drugs or alcohol; history of headaches; history of suicide-related events or exhibiting a significant degree of suicidal ideation. Not indicated for use in bipolar depression. Avoid abrupt withdrawal. Discontinue use at least 10 days before elective surgery, if possible. Renal impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Suicidal ideation or behaviour, CNS depression; withdrawal symptoms (upon abrupt discontinuation); postural hypotension (particularly at >30 mg/day doses), which may result in syncope; hepatitis, elevated aminotransferases. Cardiac disorders: Palpitations. Eye disorders: Blurred vision. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, dry mouth. General disorders and administration site conditions: Fatigue, fluid retention. Investigations: Weight gain. Nervous system disorders: Headache or throbbing headache, dizziness, somnolence. Psychiatric disorders: Insomnia, anxiety, agitation, restlessness. Skin and subcutaneous tissue disorders: Rash. Potentially Fatal: Hypertensive crisis.
Patient Counseling Information
This drug may cause drowsiness or dizziness, if affected, do not drive or operate machinery. Avoid foods and beverages with high tyramine content (e.g. aged or matured cheese, air-dried or cured meat, tap/draft beers, sauerkraut, soy sauce, fava or broad bean pods, Marmite concentrate) during treatment and within 2 weeks of stopping tranylcypromine.
Monitoring Parameters
Screen patients for bipolar disorder before starting treatment. Closely monitor for any clinical worsening, suicidal behaviour or thoughts and unusual behavioural changes, particularly during the initial few months (1-2 months) of treatment or during dose adjustments. Monitor blood pressure, heart rate, renal and hepatic function; blood glucose (in diabetic patients).
Overdosage
Symptoms: Tremor, seizures, insomnia, restlessness, anxiety progressing to agitation, mental confusion and incoherence; delirium, hypotension, dizziness, weakness, drowsiness progressing to shock and severe dizziness; hypertension with severe headache; twitching or myoclonic fibrillation of skeletal muscles with hyperpyrexia that may progress to generalised rigidity and coma.
Management: Supportive and symptomatic treatment. Perform gastric lavage and induce vomiting. For hyperpyrexia, external cooling is recommended. Provide fluid replacement for hypotension; norepinephrine may be considered for severe or persistent cases. If marked refractory hypotension occurs, metaraminol may be required. In case of hypertension, slow IV inj of phentolamine may be administered. Administer pancuronium bromide with mechanical ventilation to reverse muscle spasm and pyrexia. Barbiturates may be given with caution to treat myoclonic reactions.
Drug Interactions
May increase the hypertensive effect with metoclopramide. May increase the risk of serotonin syndrome with fentanyl, lithium, tramadol and methadone. May enhance the effects of hypotensive agents. Increased risk of CNS depression with CNS depressants (e.g. opioids, sedatives, hypnotics). Concomitant use with reserpine may result in hyperactivity. May potentiate the effects of oral hypoglycaemic agents and insulin. May antagonise the effect of guanethidine. May enhance the antimuscarinic and sedative effects of antihistamines. Potentially Fatal: Concomitant use with other MAOIs may increase the risk of hypertensive crisis or serotonin syndrome. Increased risk of serotonin syndrome with TCAs, tetracyclic antidepressants (e.g. mirtazapine), SSRIs (e.g. fluoxetine, paroxetine, sertraline), SNRIs (e.g. milnacipran), bupropion, nefazodone, trazodone, vilazodone, vortioxetine, triptans, dextromethorphan, tryptophan, carbamazepine, cyclobenzaprine, tapentadol and pethidine. Increased risk of severe hypertensive reactions with sympathomimetic agents (e.g. amphetamine, fenfluramine, ephedrine, pseudoephedrine, phenylephrine), buspirone, levodopa, dopamine, methyldopa, reserpine and tetrabenazine.
Food Interaction
Increased risk of hypertensive crisis or serotonin syndrome with tyramine-containing foods (e.g. aged or matured cheese, air-dried or cured meat, tap/draft beers, sauerkraut, soy sauce, fava or broad bean pods, Marmite concentrate). May increase the risk of serotonin syndrome with St. John's wort.
Action
Description: Overview: Tranylcypromine is a cyclopropylamine derivative monoamine oxidase inhibitor. Mechanism of Action: Tranylcypromine irreversibly inhibits the monoamine oxidase (MAO) enzyme, which is responsible for the breakdown of neurotransmitters (norepinephrine, epinephrine, serotonin), thus potentiating neurotransmitter activity in the CNS. Onset: Antidepressant: Within 1-2 weeks. Duration: MAO inhibition: Up to 10 days following discontinuation. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: Approx 1-3 hours. Distribution: Enters breast milk. Excretion: Via urine (mainly as metabolites). Elimination half-life: Approx 2.5 hours.
Chemical Structure
Tranylcypromine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5530, Tranylcypromine. https://pubchem.ncbi.nlm.nih.gov/compound/Tranylcypromine. Accessed Oct. 27, 2025.
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