Phenelzine (Nardil) - Uses, Dose, MOA, Brands, Side effects

Monoamine oxidase inhibitors are a group of drugs that includes phenelzine (Nardil). It is used to treat people with anxiety and depression and permanently suppresses MOA.

Phenelzine Uses:

Depression:
- Treatment of atypical, nonendogenous, or neurotic depression.

Phenelzine (Nardil) Dose in Adults

Phenelzine (Nardil) Dose in the treatment of Depression:

Oral: Preliminary: 15 mg 3 times daily
Early phase:
- Increase gradually to 60 to 90 mg/day, depending on the patient's tolerance; it could take 4 or more weeks of 60 mg/day treatment before there is a clinical response.
Maintenance:
- Once the greatest benefit has been attained, the dose should be gradually decreased over a number of weeks; it may be as low as 15 mg once daily or 15 mg every other day.
Discontinuation of therapy:
- When ending antidepressant therapy, lower the dosage gradually to reduce withdrawal symptoms and make it possible to spot any re-emerging symptoms.
- There is insufficient evidence to support appropriate taper rates. The APA and NICE guidelines recommend tapering therapy over at least a few weeks while taking the antidepressant's half-life into account; MAO inhibitors and antidepressants with a shorter half-life may require more cautious tapering.
- Furthermore, WFSBP standards advise tapering over 4-6 months for those receiving long-term treatment.
- If severe withdrawal symptoms arise following a dose reduction, think about going back to the original dose recommendation and/or reducing the dose much more gradually.
MAO inhibitor recommendations:
- Switching to or from an MAO inhibitor intended to treat psychiatric disorders:
  - Before starting phenelzine, wait two weeks after terminating another antidepressant (such as TCAs, paroxetine, fluvoxamine, or venlafaxine) or MAO inhibitor used to treat psychiatric illnesses.
  - Starting phenelzine after stopping fluoxetine (which has metabolites with lengthy half-lives) used to treat psychiatric illnesses should wait 5 weeks.
  - When switching from phenelzine to another antidepressant or MAO inhibitor intended to treat psychiatric problems, give yourself two weeks in between.
- Use with other MAO inhibitors (such as linezolid or IV methylene blue):
  - Avoid administering phenelzine to patients receiving IV methylene blue or linezolid; instead, consider other treatments for their psychiatric illness (Zyvox prescribing information; methylene blue prescribing information).
    Immediately stop taking phenelzine and start giving linezolid or IV methylene blue to a patient who was previously receiving it if urgent therapy is required and the possible benefits exceed the dangers.
  - For two weeks or until 24 hours after the final dosage of linezolid or IV methylene blue, whichever comes first, keep an eye out for serotonin syndrome.
  - 24 hours after the previous dosage of linezolid or intravenous methylene blue, phenelzine may be continued.

Use in Children:

Not indicated.

Pregnancy Risk Category: C

Studies on animal reproduction have yielded poor outcomes. There is little information available on the usage of phenelzine during pregnancy (Frayne 2014, Gracious 1997; Pavy 1996).
Women who are expecting should register with the National Pregnancy Registry for Antidepressants if they have been exposed to antidepressants while pregnant.
The registry can be contacted by women aged 18-45 years or their healthcare providers by calling 844-405-6185. It is important to enroll in pregnancy as soon as possible.

Use of phenelzine while breastfeeding

It is unknown if breast milk contains phenelzine.
The decision to breastfeed while receiving therapy should take into account both the advantages for the mother and the hazards to the baby, according to the product's maker.

Dose in Kidney Disease:

Mild to moderate impairment:
- There are no dosage modifications given in the manufacturer’s labeling.
Severe impairment:
- Use is contraindicated.

Dose in Liver disease:

Use is contraindicated.

Side effects of Phenelzine (Nardil):

Cardiovascular:
- Edema
- Orthostatic Hypotension
Central Nervous System:
- Anxiety (Acute)
- Ataxia
- Cardiac Insufficiency (Following ECT; Transient)
- Coma
- Delirium
- Dizziness
- Drowsiness
- Euphoria
- Fatigue
- Headache
- Hyperreflexia
- Hypersomnia
- Insomnia
- Mania
- Myoclonus
- Paresthesia
- Schizophrenia
- Seizure
- Twitching
- Withdrawal Syndrome (Nausea
- Vomiting
- Malaise)
Dermatologic:
- Diaphoresis
- Pruritus
- Skin Rash
Endocrine & Metabolic:
- Hypernatremia
- Weight Gain
Gastrointestinal:
- Constipation
- Glottis Edema
- Xerostomia
Genitourinary:
- Sexual Disorder (Anorgasmia, Ejaculatory Disorder, Impotence)
- Urinary Retention
Hematologic & Oncologic:
- Leukopenia
Hepatic:
- Increased Serum Transaminases
- Jaundice
Neuromuscular & Skeletal:
- Lupus-Like Syndrome
- Tremor
- Weakness
Ophthalmic:
- Blurred Vision
- Glaucoma
- Nystagmus
Respiratory:
- Respiratory Depression (Following ECT; Transient)
Miscellaneous:
- Fever

Contraindications to Phenelzine (Nardil):

Allergic reaction to phenelzine, or any component of the formulation
congestive heart failure
pheochromocytoma
Tests of irregular liver function or history of liver disease
Kidney disease or severe renal damage
Use parallel
- bupropion
- buspirone
- Excessive use of caffeine
- Alcohol and CNS depressants
- Cocaine
- Dextromethorphan and sympathomimetic vasoconstrictors are both components of local anaesthesia.
- Elective surgery requires general anaesthesia. Before any elective operation, stop taking phenelzine at least 10 days beforehand.
- Guanethidine
- meperidine
- MAO inhibitors and derivatives of dibenzazepine (eg, amitriptyline or clomipramine; nortriptyline or protriptyline; doxepine, carbamazepine. cyclobenzaprine. amoxapine. maprotiline. perphenazine. trimipramine).
- Ophthalmic agents (eg apraclonidine)
- SSRIs and SNRIs
- Spinal anesthesia
- Examples of sympathomimetics include meals high in tyramine, levodopa, methyldopa, dopamine, norepinephrine, and related compounds (levodopa, phenylalanine, or tryptophan) (or within two weeks after stopping treatment).
- BupropionThere should be at least two weeks between the time phenelzine is stopped and the time bupropion is started.
- Buspirone
- It should take at least two weeks between the start of buspirone and the end of phenelzine.
- Both SSRIs and SNRIs
- It should be at least two weeks before starting phenelzine after stopping SNRIs or SSRIs.
- It should take at least five weeks to transition off of both SSRIs and SNRIs.
- Fluoxetine at the beginning of the phenelzine
- At least two weeks should pass between starting or stopping phenelzine and starting or continuing SNRIs or SSRIs.
- It should take at least two weeks between the end of the phenelzine treatment and the introduction of the next medication..
  - Serotoninergic drugs (including SNRIs and SSRIs), bupropion and buspirone and other antidepressants.
- Exaggerated spinal anaesthesia, hypotension (hypotension), and general anaesthesia may occur.
- Phenelzine shouldn't be administered to patients who are using local anaesthetics that contain sympathomimetic medications.
- Phenelzine shouldn't be administered to people having elective surgery.
- Edibles containing high levels of tyramine and dopamine; foods or supplements containing tyrosine or phenylalanine or tryptophan.
- It is difficult to cite any evidence of allergenic cross-reactivity with monoamine oxidase inhibiters.
- Cross-sensitivity can be difficult to rule out because of similar chemical compositions and/or pharmacologic reactions.

Canadian labeling: Additional contraindications not in US labeling

Simultaneous Use with Reserpine.

Warnings and precautions

Depression in the CNS:
- CNS depression can cause mental or physical impairments. Patients should be aware that driving or operating machinery requires mental attention.
Hypertension crisis:
- There have been cases of hypertensive crises (sometimes very serious). Symptoms include an occipital headache radiating frontally, nausea/vomiting and neck stiffness/soreness.
- Bradycardia and Tachycardia can be present. These conditions may cause constricting chest pain or dilated pupils.
- All patients should be monitored for blood pressure. Stop therapy immediately if there are tremors and frequent headaches.
- This may occur when you consume edibles/supplements that are high in tyramine or tryptophan, dopamine and phenylalanine.
- Hypertensive crises may be treated with phentolamine.
Hypotension
- It can cause hypotension postural and syncope.
- Patients who are at high risk for this effect should be used cautiously, especially if they have high blood pressure already or have conditions that make it difficult for them to tolerate transient hypotensive episodes (cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent use of medications that can cause hypotension or bradycardia).
- Patients with hypotension tend to increase their dosages more slowly.
Intracranial bleeding
- Increased blood pressure has been associated with intracranial bleeding.
Diabetes:
- Diabetes mellitus patients need to be cautious. There may be a sensitivity to the effects of insulin. keep an eye on your blood sugar levels.
Glaucoma
- Glaucoma: Use with caution in patients with angle-closure.
Hypomania/mania:
- Hysteria and hypomania may vary in the course of bipolar disorder patients.
- Monotherapy is not advised for those with bipolar disorder.
- Patients who display depressed symptoms should be evaluated for bipolar disorder.
- The FDA has not approved phenelzine for the treatment of bipolar disorder.
Seizure disorder
- Patients at high risk of seizures should be used with caution, especially those who have had seizures or are currently being treated with medication that can reduce seizure tolerance.
Thyroid dysfunction
- Patients with hyperthyroidism should be cautious.

Phenelzine: Drug Interaction

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Alfuzosin	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Altretamine	Could make monoamine oxidase inhibitors' orthostatic hypotensive action stronger.
Amantadine	May strengthen an anticholinergic agent's anticholinergic action.
Amifampridine	Amifampridine may have a stronger neuroexcitatory and/or seizure-potentiating impact when combined with substances with seizure threshold lowering potential.
Anticholinergic Agents	Other anticholinergic agents' negative or hazardous effects might be amplified.
Antiemetics (5HT3 Antagonists)	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Antipsychotic Agents	Serotonin modulators might make antipsychotic drugs more harmful or toxic. Serotonin modulators, in particular, may enhance dopamine blockade, potentially raising the risk for neuroleptic malignant syndrome. Serotonin modulators' serotonergic effects may be strengthened by antipsychotic drugs. Serotonin syndrome might occur from this.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Beta2-Agonists	Beta2Agonists may have a more negative or toxic effect when combined with monoamine oxidase inhibitors.
Betahistine	The serum concentration of betahistine may rise in response to monoamine oxidase inhibitors.
Blood Glucose Lowering Agents	Blood Glucose Lowering Agents' hypoglycemic effects may be strengthened by monoamine oxidase inhibitors.
Blood Pressure Lowering Agents	May increase the hypotensive effects of agents associated with hypotension.
Botulinum Toxin-Containing Products	May strengthen an anticholinergic agent's anticholinergic action.
Brexanolone	Brexanolone's CNS depressive impact may be strengthened by phenelzine.
Brimonidine (Ophthalmic)	Monoamine Oxidase Inhibitors might make brimonidine more harmful or poisonous (Ophthalmic). Brimonidine serum levels may rise in response to monoamine oxidase inhibitors (Ophthalmic).
Brimonidine (Topical)	Monoamine Oxidase Inhibitors might make brimonidine more harmful or poisonous (Topical). Brimonidine serum levels may rise in response to monoamine oxidase inhibitors (Topical).
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Cannabinoid-Containing Products	Cannabinoid-containing products' tachycardic impact may be enhanced by anticholinergic agents. Exceptions: Cannabidiol.
Cerebrolysin	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Chloral Betaine	May worsen anticholinergic agents' harmful or hazardous effects.
Chlorphenesin Carbamate	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Clemastine	Monoamine oxidase inhibitors might boost clemastine's anticholinergic effects.
Codeine	Monoamine Oxidase Inhibitors might make codeine more harmful or poisonous.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dihydrocodeine	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Domperidone	Monoamine Oxidase Inhibitors may intensify Domperidone's negative/toxic effects. Monoamine Oxidase Inhibitors may lessen Domperidone's therapeutic efficacy. Monoamine Oxidase Inhibitors' therapeutic effects may be lessened by dolperidone.
Doxapram	Doxapram's hypertensive effect may be strengthened by monoamine oxidase inhibitors.
Doxylamine	Doxylamine's anticholinergic effects may be strengthened by monoamine oxidase inhibitors. Management: Use with monoamine oxidase inhibitors is particularly contraindicated by the US manufacturer of Diclegis (doxylamine/pyridoxine) and the makers of Canadian doxylamine products.
EPINEPHrine (Nasal)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Nasal).
Epinephrine (Racemic)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Racemic).
EPINEPHrine (Systemic)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Systemic).
Esketamine	The hypertensive effects of monoamine oxidase inhibitors might be enhanced.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Herbs (Hypotensive Properties)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Hypotension-Associated Agents	Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Itopride	Anticholinergic Agents may diminish the therapeutic effect of Itopride.
Lormetazepam	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Metaraminol	Monoamine Oxidase Inhibitors may enhance the hypertensive effect of Metaraminol.
Metaxalone	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Methadone	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Metoclopramide	Serotonin modulators may intensify Metoclopramide's harmful or hazardous effects. This could appear as signs of neuroleptic malignant syndrome or serotonin syndrome.
Mirabegron	Anticholinergic drugs may make Mirabegron's harmful or hazardous effects worse.
Mivacurium	The serum concentration of Mivacurium could rise as a result of phenelzine.
Molsidomine	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicergoline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicorandil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nitroglycerin	Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.
Nitroprusside	Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.
Norepinephrine	Monoamine Oxidase Inhibitors may increase Norepinephrine's ability to raise blood pressure.
Opioid Agonists	Anticholinergic drugs may make opioid agonists more harmful or toxic. In particular, this combination may raise the risk for constipation and bladder retention.
Opioid Agonists	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Pentoxifylline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Phosphodiesterase 5 Inhibitors	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
Serotonin Modulators	May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
TraMADol	Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Risk Factor D (Consider therapy modification)
Amifostine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Benzhydrocodone	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this. Treatment: Patients on monoamine oxidase inhibitors (MAOIs) or those who have stopped taking MAOIs within 14 days shouldn't use benzhydrocodone.
COMT Inhibitors	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
DOPamine	DOPamine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors. Treatment: Patients who are taking (or have recently taken) monoamine oxidase inhibitors should start dopamine at no more than one-tenth (1/10) of the typical dose. Keep an eye out for a heightened hypertensive reaction to dopamine.
HYDROcodone	Monoamine Oxidase Inhibitors may intensify Hydrocodone's harmful or hazardous effects. Management: When possible, look into alternatives to this pairing.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Levodopa-Containing Products	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. The emergence of hypertensive responses when levodopa is combined with nonselective MAOI is of special concern. Treatment: It is not advised to take levodopa and nonselective MAO inhibitors (MAOIs) together. Levodopa should be started at least two weeks after stopping the nonselective MAOI. Observe patients who are on levodopa with a selective MAOI.
Lithium	Monoamine Oxidase Inhibitors might make lithium's harmful/toxic effects worse. Management: Use extreme caution when using this combo. When combination treatment is therapeutically necessary, keep a vigilant eye out for any symptoms of serotonin syndrome or toxicity.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs starting 12 hours before the start of the obinutuzumab infusion and lasting until 1 hour after it.
OxyCODONE	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this. Management: When possible, look for alternatives. Use of oxycodone/naltrexone should be avoided during and for 14 days following monoamine oxidase inhibitor therapy. Some oxycodone products' non-US labels suggest that such use is not advised.
Pindolol	Pindolol's hypotensive impact may be strengthened by monoamine oxidase inhibitors. Management: Pindolol's Canadian labelling warns against using a monoamine oxidase inhibitor at the same time.
Pramlintide	May strengthen an anticholinergic agent's anticholinergic action. The GI tract alone is the target of these effects.
Reserpine	Monoamine Oxidase Inhibitors may enhance the adverse/toxic effect of Reserpine. Existing MAOI therapy can result in paradoxical effects of added reserpine (e.g., excitation, hypertension). Management: Monoamine oxidase inhibitors (MAOIs) should be avoided or used with great caution in patients who are also receiving reserpine.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Succinylcholine	Phenelzine may enhance the neuromuscular-blocking effect of Succinylcholine.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Alcohol (Ethyl)	May enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors.
Alpha-/Beta-Agonists (Indirect-Acting)	Alpha-/Beta-Agonists may have a stronger hypertensive effect when combined with monoamine oxidase inhibitors (Indirect-Acting). Although this is the expected mode of action for linezolid, management guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs.
Alpha1-Agonists	Alpha1Agonists may have a stronger hypertensive effect when combined with monoamine oxidase inhibitors. Although this is the expected mode of action for linezolid, management guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs.
Amphetamines	Amphetamines' tendency to cause hypertension may be increased by monoamine oxidase inhibitors. However, unlike other monoamine oxidase inhibitors, linezolid and tedizolid have different management recommendations. For more information, consult the monographs for those agents.
Apraclonidine	Monoamine Oxidase Inhibitors might make acrolonidine more harmful or poisonous. The concentration of araclonidine in the serum may rise after using monoamine oxidase inhibitors.
AtoMOXetine	Monoamine Oxidase Inhibitors may intensify AtoMOXetine's neurotoxic (central) impact.
Atropine (Ophthalmic)	Atropine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Ophthalmic).
Bezafibrate	Monoamine Oxidase Inhibitors may intensify Bezafibrate's harmful or hazardous effects.
Bromperidol	The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.
Buprenorphine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
BuPROPion	BuPROPion's ability to raise blood pressure may be enhanced by monoamine oxidase inhibitors.
BusPIRone	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. Increases in blood pressure have specifically been recorded.
CarBAMazepine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. Management: Refrain from using carbamazepine concurrently with monoamine oxidase inhibitor therapy or within 14 days of stopping it.
Cimetropium	The anticholinergic activity of cimetropium may be strengthened by anticholinergic agents.
Cyclobenzaprine	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Cyproheptadine	Monoamine oxidase inhibitors may boost Cyproheptadine's anticholinergic effects. The serotonergic impact of monoamine oxidase inhibitors may be lessened by cyproheptadine.
Dapoxetine	Serotonin modulators' harmful or toxic effects could be exacerbated.
Deutetrabenazine	Monoamine Oxidase Inhibitors may make deutetrabenazine's harmful or hazardous effects worse.
Dexmethylphenidate	Dexmethylphenidate may have a stronger hypertensive effect when used with monoamine oxidase inhibitors.
Dextromethorphan	Monoamine oxidase inhibitors might improve dextromethorphan's serotonergic effects. It might result in serotonin syndrome.
Diethylpropion	Diethylpropion may have a stronger hypertensive effect when used with monoamine oxidase inhibitors.
Diphenoxylate	The hypertensive effects of monoamine oxidase inhibitors might be enhanced.
Droxidopa	Droxidopa's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors.
Eluxadoline	Eluxadoline's constipating effects may be enhanced by anticholinergic drugs.
EPINEPHrine (Oral Inhalation)	Epinephrine's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors (Oral Inhalation).
FentaNYL	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Glycopyrrolate (Oral Inhalation)	The anticholinergic effect of glycopyrrolate may be enhanced by anticholinergic agents (Oral Inhalation).
Glycopyrronium (Topical)	May strengthen an anticholinergic agent's anticholinergic action.
Guanethidine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Heroin	Monoamine Oxidase Inhibitors might make heroin more harmful or poisonous.
HYDROmorphone	Monoamine Oxidase Inhibitors may intensify HYDROmorphone's harmful or hazardous effects.
Indoramin	Indoramin's hypotensive impact may be strengthened by monoamine oxidase inhibitors.
Iobenguane Radiopharmaceutical Products	Iobenguane radiopharmaceutical products' therapeutic effects may be reduced by monoamine oxidase inhibitors. Treatment: Before administering iobenguane, stop taking any medications that could impede or interfere with catecholamine transport or uptake for at least five biological half-lives. After each dose of iobenguane, wait at least 7 days before administering these medications.
Ipratropium (Oral Inhalation)	May strengthen an anticholinergic agent's anticholinergic action.
Isometheptene	Monoamine Oxidase Inhibitors might make isotheptene more harmful or poisonous.
Levomethadone	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Levonordefrin	Levonordefrin's ability to increase blood pressure may be enhanced by monoamine oxidase inhibitors.
Levosulpiride	Levosulpiride's therapeutic impact may be diminished by anticholinergic medications.
Linezolid	Monoamine Oxidase Inhibitors may intensify Linezolid's negative/toxic effects.
Maprotiline	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Meperidine	Meperidine's serotonergic action may be enhanced by monoamine oxidase inhibitors. It might result in serotonin syndrome.
Meptazinol	Monoamine Oxidase Inhibitors may intensify Meptazinol's harmful or hazardous effects.
Mequitazine	Mequitazine's anticholinergic effects may be enhanced by monoamine oxidase inhibitors.
Methyldopa	Monoamine Oxidase Inhibitors may intensify Methyldopa's harmful or hazardous effects.
Methylene Blue	Methylene Blue may have a stronger serotonergic impact when taken with monoamine oxidase inhibitors. Serotonin syndrome might occur from this.
Methylene Blue	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Methylphenidate	Methylphenidate's ability to raise blood pressure may be enhanced by monoamine oxidase inhibitors.
Mianserin	The neurotoxic effect of Mianserin may be increased by monoamine oxidase inhibitors.
Mirtazapine	Monoamine Oxidase Inhibitors may intensify Mirtazapine's neurotoxic (central) impact. While interactions between methylene blue and linezolid are anticipated, their usage is not advised in the same way as other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Moclobemide	Monoamine Oxidase Inhibitors may intensify Moclobemide's harmful or hazardous effects.
Monoamine Oxidase Inhibitors	Some monoamine oxidase inhibitors have the potential to increase their hypertensive effects. Other monoamine oxidase inhibitors' serotonergic effects may be enhanced by monoamine oxidase inhibitors. Serotonin syndrome might occur from this.
Morphine (Systemic	Monoamine Oxidase Inhibitors might make morphine more harmful or poisonous (Systemic).
Nefopam	Monoamine Oxidase Inhibitors may intensify Nefopam's harmful or hazardous effects.
Opium	Monoamine Oxidase Inhibitors might make opium more harmful or poisonous.
Oxatomide	May strengthen an anticholinergic agent's anticholinergic action.
OxyMORphone	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Pheniramine	Monoamine oxidase inhibitors' anticholinergic effects might be strengthened.
Pholcodine	The serotonergic effects of monoamine oxidase inhibitors may be enhanced. Serotonin syndrome might occur from this.
Pizotifen	Monoamine Oxidase Inhibitors may strengthen Pizotifen's anticholinergic effects.
Potassium Chloride	Potassium chloride may have a stronger ulcerogenic effect when used with anticholinergic drugs. Treatment: Patients taking medications with strong anticholinergic effects should refrain from taking potassium chloride in any solid oral dosage form.
Potassium Citrate	Potassium Citrate has an ulcerogenic action that may be enhanced by anticholinergic drugs.
Reboxetine	Monoamine Oxidase Inhibitors may intensify Reboxetine's harmful or hazardous effects.
Revefenacin	Revefenacin's anticholinergic action may be strengthened by anticholinergic agents.
Selective Serotonin Reuptake Inhibitors	Selective Serotonin Reuptake Inhibitors' serotonergic effects may be enhanced by monoamine oxidase inhibitors. It might result in serotonin syndrome. Although this interaction between methylene blue and linezolid is anticipated, management guidelines for this drug are different from those for other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Serotonin 5-HT1D Receptor Agonists	Serotonin 5-HT1D Receptor Agonists' metabolism may be slowed down by monoamine oxidase inhibitors. Management: Naratriptan, eletriptan, or frovatriptan may be suitable 5-HT1D agonists to use if MAO inhibitor medication is necessary. Eletriptan, Frovatriptan, and Naratriptan are exceptions.
Serotonin Reuptake Inhibitor/Antagonists	Serotonin Reuptake Inhibitor/Antagonists' harmful or toxic effects may be increased by monoamine oxidase inhibitors. While interactions between methylene blue and linezolid are anticipated, their usage is not advised in the same way as other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Serotonin/Norepinephrine Reuptake Inhibitors	Serotonin/Norepinephrine Reuptake Inhibitors' serotonergic effects may be enhanced by monoamine oxidase inhibitors. It might result in serotonin syndrome. Although this interaction between methylene blue and linezolid is anticipated, management guidelines for this drug are different from those for other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Solriamfetol	Solriamfetol's ability to raise blood pressure may be enhanced by monoamine oxidase inhibitors.
SUFentanil	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. Particularly, there may be an elevated risk for serotonin syndrome or opioid toxicities (such as respiratory depression or coma). Management: Due to the risk of serotonin syndrome and/or severe CNS depression, fentanyl should not be administered in conjunction with monoamine oxidase (MAO) inhibitors (or within 14 days of discontinuing an MAO inhibitor).
Tapentadol	The negative or hazardous effects of monoamine oxidase inhibitors can be increased. In particular, norepinephrine's cumulative actions could have harmful cardiovascular repercussions. The serotonergic action of monoamine oxidase inhibitors may be enhanced by tapentadol. Serotonin syndrome might occur from this.
Tetrabenazine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Tetrahydrozoline (Nasal)	Monoamine Oxidase Inhibitors may increase Tetrahydrozoline's hypertensive impact (Nasal).
Tianeptine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Tiotropium	Tiotropium's anticholinergic action may be strengthened by anticholinergic drugs.
Tricyclic Antidepressants	Tricyclic antidepressants' serotonergic action may be strengthened by monoamine oxidase inhibitors. It might result in serotonin syndrome. Although this interaction between methylene blue and linezolid is anticipated, management guidelines for this drug are different from those for other monoamine oxidase inhibitors. For more information, consult the monographs for those agents.
Tryptophan	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.
Umeclidinium	May strengthen an anticholinergic agent's anticholinergic action.
Valbenazine	The negative or hazardous effects of monoamine oxidase inhibitors can be increased.

Monitoring parameters:

Blood glucose;
renal and hepatic function;
blood pressure, heart rate;
mental status;
worsening of depression, suicidality, or unusual changes in behavior (especially at the beginning of treatment or when doses are increased or reduced)

How to administer Phenelzine (Nardil)?

It is administered with or without meals.

Mechanism of action of Phenelzine (Nardil):

It increases the endogenous levels of serotonin, dopamine and norepinephrine by inhibiting the enzyme (monoamineoxidase), which is responsible for their breakdown.

The onset of action:

Therapeutic: 4 weeks or more

Duration:

Two weeks after the end of therapy, it may still have therapeutic effects and interactions.

Absorption:

Well absorbed

Metabolism:

oxidised by acetylation and the monoamine oxidase (primary route) (minor pathway)

Time to peak:

43 minutes

Half-life elimination:

11.6 hours

Excretion:

Urine (73% as metabolites)

International Brand Names of Phenelzine:

Nardil
Margyl
Nardelzine

Phenelzine Brand Names in Pakistan:

No Brands Available in Pakistan.

Phenelzine (Nardil) - Uses, Dose, MOA, Brands, Side effects

Phenelzine Uses:

Depression:

Phenelzine (Nardil) Dose in Adults

Phenelzine (Nardil) Dose in the treatment of Depression:

MAO inhibitor recommendations:

Use in Children:

Pregnancy Risk Category: C

Dose in Kidney Disease:

Mild to moderate impairment:

Severe impairment:

Dose in Liver disease:

Side effects of Phenelzine (Nardil):

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Hematologic & Oncologic:

Hepatic:

Neuromuscular & Skeletal:

Ophthalmic:

Respiratory:

Miscellaneous:

Contraindications to Phenelzine (Nardil):

Warnings and precautions

Depression in the CNS:

Hypertension crisis:

Hypotension

Intracranial bleeding

Diabetes:

Glaucoma

Hypomania/mania:

Seizure disorder

Thyroid dysfunction

Monitoring parameters:

How to administer Phenelzine (Nardil)?

Mechanism of action of Phenelzine (Nardil):

International Brand Names of Phenelzine:

Phenelzine Brand Names in Pakistan:

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