Tranylcypromineinteractions

See Full Prescribing Information for a list of products, foods and beverages that can interact with tranylcypromine tablets

7.1 Clinically-Significant

Drug Interactions Tables 3 and 4 lists drug classes and individual products, respectively, with a potential for interaction with tranylcypromine tablets, describes the predominant observed or anticipated risks, and provides advice on concomitant use. Given serious adverse reactions with multiple agents, patients should avoid taking over-the-counter medications or dietary supplements without prior consultation with a healthcare provider able to provide advice on the potential for interactions. Time to Start Tranylcypromine Tablets after Discontinuation of a Contraindicated Drug For products that are contraindicated with tranylcypromine tablets, a time period of 4 to 5 half-lives of the other product or any active metabolite should elapse before starting treatment with tranylcypromine tablets. After stopping treatment with an MAO inhibitor antidepressant, a time period of at least 1 week or 4 to 5 half-lives of the other MAO inhibitor (whichever is longer) should elapse before starting treatment with tranylcypromine tablets because of the risk for clinically significant adverse reactions after discontinuation due to persistent MAO inhibition. This period can be several weeks long (e.g., a minimum of 5 weeks for fluoxetine given fluoxetine's long half-life). Refer to the prescribing information of the contraindicated product for relevant information. Time to Start Contraindicated Drug after Discontinuation of Tranylcypromine Tablets The potential for interactions persists after discontinuation of tranylcypromine tablets until MAO activity has sufficiently recovered. Inhibition of MAO may persist up to 10 days following discontinuation. After stopping tranylcypromine tablets, at least 1 week should elapse before starting another MAOI (intended to treat MDD) or other contraindicated antidepressants. Refer to the prescribing information of any agent considered for subsequent use for recommendations on the duration of a waiting period after discontinuation of a MAO inhibitor. If in the absence of therapeutic alternatives and emergency treatment with a contraindicated drug (e.g., linezolid, intravenous methylene blue, direct-acting sympathomimetic drugs such as epinephrine) becomes necessary and cannot be delayed, discontinue tranylcypromine tablets as soon as possible before initiating treatment with the other agent, and monitor closely for adverse reactions. Table 3: Clinically Significant Drug Interactions with Drug Classes Some drugs in these groups may also be listed in Table 4 below. Product Clinical Comment on Concomitant Use; Predominant Effect/Risk [Hypertensive Reaction (HR); or Serotonin Syndrome (SS) ] Agents with blood pressure-reducing effects Use with caution If not otherwise specified in this table, consider avoiding concomitant use (see also information on medication-free intervals, use agent at the lowest appropriate dosage, monitor for effects of the interaction, advise the patient to report potential effects). Hypotension; Non-selective H1 receptor antagonists Contraindicated Increased anticholinergic effects Beta-adrenergic blockers (see also agents or procedures with blood pressure-reducing effects) Use with caution More pronounced bradycardia, postural hypotension Blood glucose-lowering agents Dosage reduction of such agents may be necessary. Monitor blood glucose. Excessive reduction of blood glucose (additive effect); CNS depressant agents (including opioids, alcohol, sedatives, hypnotics) Use with caution Increased CNS depression Dietary supplements containing sympathomimetics Contraindicated Antidepressants including but not limited to:

Other MAOIs (e.g., linezolid, intravenous methylene blue, selective MAOIs)

Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)

Tricyclic antidepressants

Amoxapine, bupropion, maprotiline, nefazodone, trazodone, vilazodone, vortioxetine Contraindicated SS for all antidepressants For MAOIs, increased MAO inhibition and risk of adverse reactions, SS, and HR Amphetamines and methylphenidates and derivatives Contraindicated HR Sympathomimetic drugs Sympathomimetic drugs include amphetamines as well as cold, hay fever or weight-reducing products that contain vasoconstrictors such as pseudoephedrine, phenylephrine, and ephedrine) Contraindicated HR; Including risk of intracerebral hemorrhage Triptans Contraindicated SS Table 4: Clinically Significant Drug Interactions with Individual Products Some drugs in this table may also belong to groups listed in Table 3 above, and may be associated with additional interactions. Product Clinical Comment on Concomitant Use; Predominant Effect/Risk [Hypertensive Reaction (HR); or Serotonin Syndrome (SS) ] Altretamine Use with caution If not otherwise specified in this table, consider avoiding concomitant use (see also information on medication-free intervals, use agent at the lowest appropriate dose, monitor for effects of the interaction, advise the patient to report potential effects, and be prepared to discontinue the agent and treat effects of the interaction Orthostatic hypotension Buspirone Contraindicated HR Carbamazepine Contraindicated SS Chlorpromazine Use with caution Hypotensive effects Cyclobenzaprine Contraindicated SS Dextromethorphan Contraindicated SS; Psychosis, bizarre behavior Dopamine Contraindicated HR Droperidol Use with caution QT interval prolongation Entacapone Use with caution HR Fentanyl Use with caution SS Hydroxytryptophan Contraindicated SS Levodopa Contraindicated HR Lithium Use with caution SS Meperidine Contraindicated SS Methadone Use with caution SS Methyldopa Contraindicated HR Metoclopramide Use with caution HR/SS Mirtazapine Contraindicated SS Oxcarbazepine Use with caution because of close structural relationship with tricyclic antidepressants SS Rasagiline Contraindicated HR Reserpine Contraindicated HR S-adenosyl-L-methionine (SAM-e) Contraindicated SS Tapentadol Contraindicated HR/SS Tetrabenazine Contraindicated HR Tolcapone Use with caution HR Tramadol Use with caution SS; Increased seizure risk Tryptophan Contraindicated SS

7.2 Tyramine-Containing

Foods and Beverages Tranylcypromine tablets inhibits intestinal MAO, which is responsible for the catabolism of tyramine in food and beverages. As a result of this inhibition, large amounts of tyramine may enter the systemic circulation and precipitate a sudden elevation in blood pressure or hypertensive crisis. Instruct tranylcypromine tablets-treated patients to avoid foods and beverages with significant tyramine content during treatment with tranylcypromine tablets or within 2 weeks of stopping treatment (see Table 5 for a list of food and beverages containing significant amounts of tyramine).

Table 5: Foods and Beverages with and without Significant Amounts of Tyramine Class of Food or Beverage Tyramine-Rich Foods and Beverages to Avoid Acceptable Foods and Drinks, Containing No or Little Tyramine Meat, Poultry, and Fish Air dried, aged and fermented meats, sausages and salamis (including cacciatore, hard salami and mortadella); pickled herring; and any spoiled or improperly stored meat, poultry, and fish (e.g., foods that have undergone changes in coloration, odor, or become moldy); spoiled or improperly stored animal livers Fresh meat, poultry, and fish, including fresh processed meats (e.g., lunch meats, hot dogs, breakfast sausage, and cooked sliced ham) Vegetables Broad bean pods (fava bean pods) All other vegetables Dairy Aged cheeses Processed cheeses, mozzarella, ricotta cheese, cottage cheese, and yogurt Beverages All varieties of tap beer and beers that have not been pasteurized so as to allow for ongoing fermentation and excessive amounts of caffeine. Concomitant use of alcohol with tranylcypromine tablets is not recommended. (Bottled and canned beers and wines contain little or no tyramine.) Other Concentrated yeast extract (e.g., Marmite), sauerkraut, most soybean products (including soy sauce and tofu), OTC supplements containing tyramine, and chocolate Brewer's yeast, baker's yeast, soy milk, commercial chain restaurant pizzas prepared with cheeses low in tyramine