Overview
Parnate is the brand name for Tranylcypromine, a Monoamine Oxidase (MAO) Inhibitor. Parnate works by increasing the concentrations of the neurotransmitters norepinephrine, epinephrine, and serotonin.

The full effects of Parnate may be felt in as little as 48 hours, or it may take up to three weeks, depending on the dosage and the patient.

Why is this drug prescribed?
Parnate is used to treat:

1. moderate to severe depression
2. depressive phases of manic-depressive psychosis (bipolar disorder)
3. involutional melancholia
4. reactive depressions
5. psychoneurotic depressions (moderate to severe)
6. headache
7. panic disorder
   

Warnings
MAO Inhibitors are a type of medication that has especially dangerous interactions with other drugs, as well as many foods. Patients are advised to carry a list of these foods as a reminder of which foods must be avoided. A partial list can be found under Interactions with Drugs and Other Substances

Studies done in animals indicate that MAO Inhibitors may slow growth in children. Little information on the use of MAO Inhibitors in children under 16 years old is available.

Dosage in both adults and children is often determined by body weight. Children under 16 years old may need especially close monitoring.

Suddenly discontinuing Parnate may cause severe withdrawal symptoms. Dosage should be gradually tapered when Parnate is discontinued.

Diabetic patients may need to check blood sugar levels more frequently than usual when taking Parnate.

For Pregnant or Nursing Mothers: Parnate may cause birth defects when taken during pregnancy, especially during the first trimester. Parnate is passed into breast milk, and is not recommended for nursing mothers.

Contraindications
Parnate should Not be used for people with the following medical conditions:

1. cerebrovascular or cardiovascular disorders
2. a history of recurrent or frequent headaches
3. liver damage
4. blood disease
5. pheochromocytoma (a tumor of the adrenal gland)
6. overactive thyroid
7. alcohol abuse

Precautions
Parnate may be used with caution in people with the following conditions:

1. cerebrovascular defect, high blood pressure (hypertension) or heart disease — Parnate can cause changes in blood pressure
2. marked psychomotor agitation
3. diabetes — insulin doses may need to be adjusted
4. epilepsy — seizures may be more frequent
5. mental illness (or a history of mental illness) or Parkinson's disease Ð Parnate may make these conditions worse
6. asthma or bronchitis — medications for these conditions may interact with Parnate
7. chest pain (angina) — Parnate may artificially mask this pain. Patients should not take this as a sign that it is safe to increase exercise or exertion

Adverse Reactions
Parnate may cause the following reactions:

1. insomnia
2. dizziness
3. low blood pressure (hypotension)
4. anorexia
5. nausea
6. drowsiness
7. high blood pressure (hypertension)
8. weakness
9. headache
10. blurred vision
11. sexual problems such as impotence
12. skin problems
13. muscle spasm and tremors
14. dry mouth
15. tinnitus (ringing in the ears)
16. constipation
17. diarrhea
18. abdominal pain
19. rash
20. chills
21. edema (excessive fluid retention)
22. mild jaundice Tachycardia
23. palpitation
24. urinary retention
25. sweating
26. paresthesia such as numbness or tingling
27. agranulocytosis (an acute deficit of certain blood cells)
28. thrombocytopenia (a reduction in the number of platelets in the blood, which results in the bleeding into the skin)

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Parnate include:

Drugs:

1. alcohol — may increase serious side effects
2. Any other MAO Inhibitors such as furazolidone (Furoxone), procarbazine (Matulane), or selegiline (Eldepryl) — may cause serious reactions including death
3. Amphetamines, high blood pressure medicines (antihypertensives), diet pills, diuretics including large amounts of caffeine, Cyclobenzaprine (Flexeril), Fluoxetine (Prozac), Levodopa (Dopar), Maprotiline (Ludiomil), asthma medicine, cold or sinus medicine, antihistamines (including nose drops and sprays), any narcotics (such as opium or heroin), Meperidine (Demerol), Methylphenidate (Ritalin), Paroxetine (Paxil), Sertraline (Zoloft), or - may lead to serious adverse reactions such as a sudden fever, extremely high blood pressure, severe convulsions, and death, when combined with Parnate. In rare circumstances, one of these medications might be used at the same time as Parnate
4. tricyclic antidepressants (TCAs) such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Pertofrane), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl), protriptyline (Vivactil), trimipramine (Surmontil) - may lead to serious adverse reactions such as a sudden fever, extremely high blood pressure, severe convulsions, and death, when combined with Parnate. Occasionally a medication from this list might be used at the same time as Parnate
5. Tryptophan or Trazodone — may cause confusion, excitement, shivering, difficulty breathing, and fever
6. cocaine — may cause a severe increase in blood pressure
8. other central nervous system (CNS) depressants Ð Parnate may increase the depressant effects
9. Dextromethorphan — combination with Parnate may lead to excitability, high blood pressure, and fever
10. carbamazepine (Tegretol) — may increase seizures when used with Parnate
11. selective serotonin reuptake inhibitors (SSRIs)
12. bupropion (Wellbutrin) — may cause serious side effects such as seizures
13. buspirone (Buspar) — may cause high blood pressure when used with Parnate
14. oral antidiabetics or insulin — the amount of these medications may need to be adjusted

Foods:
Avoid foods that are aged or fermented, including overripe fruit. The list of foods that should not be eaten when taking Parnate includes:

1. aged cheese except cream cheese and cottage cheese
2. alcohol - especially beer, red wine, and sherry, including alcohol-free versions
3. avocados, especially if overripe
4. bananas (especially the peel)
5. beef or chicken liver
6. Bovril
7. caffeinated beverages such as coffee, tea, soda, or hot chocolate
8. canned meats
9. chocolate
10. caviar
11. dry sausages
12. eggplant
13. fava bean pods
14. figs
15. preprocessed gravies
16. green bean pods
17. homemade breads
18. Italian broad beans
19. liver
20. orange pulp
21. pickled or smoked fish, poultry, or meats, and meat prepared with tenderizers
22. raisins
23. red plums
24. salami
25. packaged soup or soup cubes
26. sour cream
27. soy sauce
28. spinach
29. tomatoes
30. yeast extracts such as Marmite
31. yogurt

Sources

http://www.health-center.com/db/PageReq?SessionID=17331&TopicID=375&PageID=1499&Action=view

http://www.mentalhealth.com/drug/

http://www.healthtouch.com/bin/EContent_HT/drugShowLfts.asp?fname=use0272.htm&title=Parnate&cid=HT

http://www.rxmed.com/monographs/parnate.html