Parnate

The recommended starting dose of Parnate (Tranylcypromine) is 10 mg taken twice daily: once in the morning and once in the afternoon. After 2 to 3 weeks, your doctor may increase the dose to 30 mg daily (20 mg in the morning and 10 mg in the afternoon) depending on how effective the medication has been and how you are affected by side effects. After your symptoms of depression have been reduced, your doctor may decrease the dose that you continue with.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Parnate (Tranylcypromine) exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Parnate (Tranylcypromine) at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause dryness of the mouth; it may cause diarrhea or constipation, depending on the person; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause sleep disturbances or insomnia. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Each biconvex, rose-red, film-coated tablet, with "PARNATE" and "SB" monogram printed in black on one side, contains Parnate (Tranylcypromine) 10 mg. Nonmedicinal ingredients: carnauba wax, citric acid, croscarmellose sodium, D&C Red No. 7, edible black printing ink, FD&C Blue No. 2, FD&C Yellow No. 6, gelatin, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, talc, propylene glycol 400, purified water, and titanium dioxide.

Do not take Parnate (Tranylcypromine) if you:

• are allergic to Parnate (Tranylcypromine) or any ingredients of the medication
• are also taking (or have taken within the last 2 weeks) certain medications, including:
  • Buspirone
  • Dextromethorphan
  • dibenzazepine derivatives (e.g., Amitriptyline, Nortriptyline, Desipramine, Imipramine, Doxepin, Perphenazine, Carbamazepine, Cyclobenzaprine, amoxapine, Maprotiline, and Trimipramine)
  • dopamine
  • levodopa
  • methyldopa
  • other MAO inhibitors (e.g., Phenelzine)
  • selective serotonin reuptake inhibitors (SSRIs) other than Fluoxetine (e.g., Citalopram, Escitalopram, Fluvoxamine, Paroxetine, or Sertraline)
  • serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Venlafaxine
  • sympathomimetics (e.g., amphetamines, ephedrine, Pseudoephedrine; over-the-counter preparations for colds, hay Fever, and weight reduction)
  • "triptan" migraine medications (e.g., Sumatriptan, Rizatriptan)
  • Tryptophan
• have a disorder of the brain caused by blood flow problems
• have high blood pressure, heart disease, or a history of Stroke
• have a history of recurrent or frequent Headaches
• have a pheochromocytoma tumour (a tumour of the adrenal gland)
• have eaten any foods with high tyramine content (see "Are there other precautions or warnings for Parnate (Tranylcypromine)?") in the last 2 weeks
• have liver damage or blood disorders
• have taken fluoxetine within the last 5 weeks

There may be an interaction between Parnate (Tranylcypromine) and any of the following:

• aclidinium
• alcohol
• Aldesleukin
• Aliskiren
• alpha-agonists (e.g., Clonidine, methyldopa)
• alpha/beta-agonists (e.g., Epinephrine, norepinephrine)
• alpha-blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• amantadine
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine, methamphetamine)
• angiotensin-converting enzyme inhibitors (ACEIs; e.g., Captopril, Lisinopril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Atomoxetine
• atropine
• azelastine
• barbiturates (e.g., Phenobarbital, secobarbital)
• belladonna
• Benztropine
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• beta-2 agonists (e.g., salbutamol, formoterol, terbutaline)
• Bezafibrate
• botulinum toxin
• brimonidine
• Bromocriptine
• Buprenorphine
• Bupropion
• buspirone
• Cabergoline
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• cannabis
• carbamazepine
• cyclobenzaprine
• Darifenacin
• decongestant cold medications (e.g., phenylephrine, pseudoephedrine)
• decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
• dexmethylphenidate
• dextromethorphan
• diabetes medications (e.g., chlorpropamide, Glyburide, insulin, Metformin, Rosiglitazone)
• Disopyramide
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, Amiloride)
• Domperidone
• Donepezil
• Eluxadoline
• Entacapone
• ephedrine
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• Flavoxate
• Galantamine
• Glucagon
• glycopyrrolate
• Guanfacine
• ipratropium
• levodopa
• Linezolid
• lithium
• Methadone
• methylene blue
• Methylphenidate
• Metoclopramide
• Midodrine
• mifepristone
• Minoxidil
• Mirabegron
• Mirtazapine
• other monoamine oxidase inhibitors (MAOIs; e.g., Moclobemide, phenelzine, Selegiline)
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nitrates (e.g., isosorbide dinitrate, isosorbide mononitrate, nitroglycerine)
• Obinutuzumab
• Octreotide
• orphenadrine
• Oxybutynin
• Pentoxifylline
• phosphodiesterase 5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pizotifen
• potassium chloride
• quinidine
• quinine
• Rivastigmine
• Ropinirole
• St. John's wort
• scopolamine
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin antagonists (e.g., antiemetics; Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, venlafaxine)
• Tapentadol
• Tetrabenazine
• tiotropium
• Tizanidine
• tolcapone
• Tolterodine
• Topiramate
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., amitriptyline, Clomipramine, desipramine, trimipramine)
• "triptan" migraine medications (e.g., Eletriptan, sumatriptan)
• tryptophan
• umeclidinium

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Parnate (Tranylcypromine). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Parnate (Tranylcypromine).

Angina: Parnate (Tranylcypromine) can mask the pain of angina that might warn of a Heart Attack. If you have heart disease or are at risk for developing heart disease, discuss with your doctor how Parnate (Tranylcypromine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Parnate (Tranylcypromine), and whether any special monitoring is needed.

Blood pressure: The most serious reaction to Parnate (Tranylcypromine) is severe high blood pressure (hypertensive crises), which can be fatal. This reaction includes some or all of the following symptoms:

• dilated pupils
• extremely fast or slow heart rate, possibly associated with constricting chest pain
• eyes sensitive to light
• nausea
• neck stiffness or soreness
• palpitation
• severe headache at the back of the head that may travel to the front
• sweating (sometimes with fever and sometimes with cold, clammy skin)
• vomiting

If you notice these symptoms, stop taking the medication and get immediate medical attention.

Diabetes: Parnate (Tranylcypromine) may cause decreased blood glucose for people with diabetes. If you have diabetes, you may find it necessary to monitor your blood sugar more frequently while using Parnate (Tranylcypromine). Make sure you keep a "rescue" source of sugar with you to prevent episodes of severely low blood glucose.

Drowsiness/reduced alertness: Parnate (Tranylcypromine) may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how Parnate (Tranylcypromine) affects you.

Food reactions: Parnate (Tranylcypromine) should not be taken in combination with C.E.S. or other foods with a high tyramine content. In general, those taking Parnate (Tranylcypromine) should avoid protein foods in which aging or protein breakdown is used to increase flavour. In particular, avoid foods such as:

• alcohol-free and reduced-alcohol beer and wine products
• avocados (especially if overripe)
• bananas (if used with the peel)
• beer and wine
• broad bean pods (fava beans)
• canned figs
• caviar
• cheese (exceptions: cream cheese and cottage cheese)
• dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna)
• excessive amounts of chocolate or caffeine
• fermented meat (e.g., bologna, pepperoni, salami)
• fermented tofu
• liver
• meat extracts (such as Bovril)
• miso
• pickled herring
• sauerkraut
• soy sauce
• yeast extracts (such as Marmite)

These foods should be avoided while taking the medication and for at least 2 weeks after stopping the medication. There are other foods that you should limit the amount you are consuming, such as raisins and yogurt.

Alcoholic beverages have been known to trigger a severe reaction with Parnate (Tranylcypromine). Therefore those taking Parnate (Tranylcypromine) should avoid alcoholic drinks, especially red wines (such as Chianti), sherry, beer (including nonalcoholic beer), etc.

People taking Parnate (Tranylcypromine) should also avoid consuming too much caffeine in any form (coffee, tea, cola drinks, etc.) because of possible increased effects of caffeine.

People taking Parnate (Tranylcypromine) should also avoid any spoiled or improperly refrigerated, handled, or stored protein-rich foods such as meats, fish, and dairy products, including foods that may have undergone protein breakdown by aging, pickling, fermentation, or smoking to improve flavour.

Glaucoma: Parnate (Tranylcypromine) may cause the symptoms of glaucoma (increased pressure in the eye) to become worse, causing an acute attack of symptoms. If you have glaucoma, discuss with your doctor how Parnate (Tranylcypromine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Parnate (Tranylcypromine), and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking Parnate (Tranylcypromine).

Headache: People taking Parnate (Tranylcypromine) should immediately report headaches or other unusual symptoms to their doctor. If you have recurring or frequent headaches, discuss with your doctor how Parnate (Tranylcypromine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Parnate (Tranylcypromine), and whether any special monitoring is needed.

Identification: People taking Parnate (Tranylcypromine) are encouraged to carry a card or other notification of the fact that they are taking Parnate (Tranylcypromine).

Kidney function: Kidney Disease or reduced kidney function may cause Parnate (Tranylcypromine) to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Parnate (Tranylcypromine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Parnate (Tranylcypromine), and whether any special monitoring is needed.

Mental health issues: Parnate (Tranylcypromine) can worsen mental health issues such as psychosis or bipolar disorder or cause some symptoms of depression, such as anxiety or agitation, to become worse. If you experiences hallucinations (seeing, hearing, or feeling things that are not there), distorted thoughts, or mania (racing thoughts, rapid talking, impulsiveness, extremely elevated mood, extremely high energy), contact your doctor immediately.

Seizures: Parnate (Tranylcypromine) may cause an increase in seizure frequency. If you have a history of Epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how Parnate (Tranylcypromine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Parnate (Tranylcypromine), and whether any special monitoring is needed.

Stopping the medication: Stopping Parnate (Tranylcypromine) suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: People taking Parnate (Tranylcypromine) may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting Parnate (Tranylcypromine). If you experience these side effects or notice them in a family member who is taking Parnate (Tranylcypromine), contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking Parnate (Tranylcypromine).

Surgery: If you are scheduled for surgery, let your health professionals know that you are taking Parnate (Tranylcypromine). Ask your doctor when you should stop the medication before surgery - it should usually be stopped at least 7 days before surgery.

Thyroid disease: Hyperthyroidism (having an overactive thyroid) may make you more sensitive to the effects of Parnate (Tranylcypromine). If you have an overactive thyroid gland, discuss with your doctor how Parnate (Tranylcypromine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Parnate (Tranylcypromine), and whether any special monitoring is needed.

Pregnancy: The safety and effectiveness of using Parnate (Tranylcypromine) have not been established for pregnant women. Parnate (Tranylcypromine) should not be taken during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Parnate (Tranylcypromine), contact your doctor immediately.

Breast-feeding: It is not known if Parnate (Tranylcypromine) passes into breast milk. If you are a breast-feeding mother and are taking Parnate (Tranylcypromine), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children The safety and effectiveness of using Parnate (Tranylcypromine) have not been established for children.

Seniors: People over the age of 60 may be at an increased risk of severe side effects from Parnate (Tranylcypromine). Talk to your doctor about the risks and benefits of using Parnate (Tranylcypromine).

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Take it regularly and continuously to maintain its beneficial effects. This medication may be taken with or without food. A severe reaction may occur if this medication is taken with certain foods, such as: fermented cheese, cold cuts, beer, shrimp, organ meats and red wine. Avoid these foods during your treatment.