Parnate

Generic name: tranylcypromine sulfate

What is Parnate?

Parnate is a prescription medicine used to treat adults with a certain type of depression called major depressive disorder (MDD) who have not responded well to treatment with other medicines used to treat depression (antidepressants). Parnate belongs to a class of medicines called monoamine oxidase inhibitors (MAOIs).

• It is important to talk with your healthcare provider about the risks of treating depression and the risk of not treating it. Talk with your healthcare provider about all your treatment choices.
• Parnate is not for use as the first medicine to treat MDD.
• It is not known if Parnate is safe and effective for use in children.

Description

Tranylcypromine sulfate, the active ingredient of PARNATE, is a non-hydrazine MAOI. The chemical name is (±)‑trans‑2‑phenylcyclopropylamine sulfate (2:1). The molecular formula is (C9H11N)2•H2SO4 and its molecular weight is 364.46. The structural formula is:

PARNATE film-coated tablets are intended for oral administration. Each round, rose‑red tablet is debossed on one side with the product name “PARNATE” and “SB” and contains tranylcypromine sulfate equivalent to 10 mg of tranylcypromine.

Inactive ingredients consist of microcrystalline cellulose, anhydrous citric acid, croscarmellose sodium, D&C Red No. 7, FD&C Blue No. 2, FD&C Yellow No. 6, gelatin, lactose, magnesium stearate, talc, titanium dioxide, carnauba wax, polyethylene glycol 400 and 8000, and hypromellose.

Mechanism of Action

The mechanism of action of PARNATE as an antidepressant is not fully understood, but is presumed to be linked to potentiation of monoamine neurotransmitter activity in the central nervous system (CNS) resulting from its irreversible inhibition of the enzyme monoamine oxidase (MAO).

What is the most important information I should know about Parnate?

Parnate can cause serious side effects including:

• Increase in suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment and when the Parnate dose is changed. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions.These include people who have, or have a family history of, bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions. Parnate is not for use in children.How can I watch for and try to prevent suicidal thoughts and actions?
  • Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
  • Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms​​​​​​​​​​​​​​Call a healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
    • thoughts about suicide or dying
    • attempts to commit suicide
    • new or worse depression
    • new or worse anxiety
    • feeling agitated, restless, angry or irritable
    • panic attacks
    • trouble sleeping
    • new or worse irritability
    • acting aggressive, being angry or violent
    • acting on dangerous impulses
    • an extreme increase in activity or talking (mania)
    • other unusual changes in behavior or mood
• A sudden, severe increase in blood pressure (hypertensive crisis). A hypertensive crisis can happen when you eat certain foods and drinks certain beverages during or after Parnate treatment. A hypertensive crisis can lead to stroke and death. People who have thyroid problems (hyperthyroidism) may have a higher chance of having a hypertensive crisis. Symptoms of a hypertensive crisis may include:
  • sudden, severe headache
  • nausea
  • vomiting
  • stiff or sore neck
  • a fast heartbeat (palpitations) or a change in the way your heart beats
  • excessive sweating, sometimes with fever or cold, clammy skin
  • the pupils in your eyes increase in size
  • light bothers your eyes
  • fast or slow heart beat with chest pain
  • bleeding in your brainA hypertensive crisis can also happen if you take Parnate with certain other medicines. See, “Who should not take Parnate?”
    Avoid foods and drinks with a lot of tyramine while taking Parnate and for 2 weeks after you stop taking it. For a list of some of the foods and drinks you should avoid during treatment with Parnate see, “What should I avoid while taking Parnate?”

Who should not take Parnate?

Taking Parnate with certain antidepressants and certain pain, allergy symptom, and cold and cough symptom medicines may cause a potentially life-threatening hypertensive crisis or a problem called serotonin syndrome. See, “What is the most important information I should know about Parnate?” and “What are the possible side effects of Parnate?”

Do not take Parnate if you:

• take certain medicines, including:
  • antidepressants, such as:
    • other monoamine oxidase inhibitors (MAOIs)
    • selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
    • tricyclic antidepressants
    • other antidepressants, such as amoxapine, bupropion, maprotiline, nefazodone, trazodone, vilazodone, vortioxetine
    • amphetamines and methylphenidates
  • medicines that can raise blood pressure (sympathomimetic medicine), such as pseudoephedrine, phenylephrine and ephedrine. These medicines are in some cold, hay fever or weight-loss medicines.
  • sympathomimetic herbal medicines or dietary supplements
  • antihistamines (allergy medicines)
  • triptans
  • buspirone
  • carbamazepine
  • dextromethorphan
  • dopamine
  • hydroxytryptophan and tryptophan
  • levodopa and methyldopa
  • meperidine
  • rasagline
  • resperine
  • s-adenosyl-L-methionine (SAM-e)
  • tapentadol
  • tetrabenazine

Ask your healthcare provider or pharmacist if you are not sure if you take any of these medicines.

• have a tumor on your adrenal gland called a pheochromocytoma or a type of tumor called a paraganglioma.

What should I tell my healthcare provider before taking Parnate?

Before taking Parnate, tell your healthcare provider about all your medical conditions, including if you:

• have high or low blood pressure
• have heart problems
• have cerebrovascular problems or have had a stroke
• have headaches
• have, or have a family history of, bipolar disorder, mania, or hypomania
• plan to have surgery
• have liver or thyroid problems
• have or have had seizures or convulsions
• have diabetes
• are pregnant or plan to become pregnant. Parnate may harm your unborn baby.
• are breastfeeding or plan to breastfeed. Parnate passes into your breast milk. Do not breastfeed during treatment with Parnate. Talk to your healthcare provider about the best way to feed your baby while taking Parnate.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Parnate and some other medicines may affect each other causing serious side effects. Parnate may affect the way other medicines work, and other medicines may affect how Parnate works.

Some medicines need to be stopped for a period of time before you can start taking Parnate and for a period of time after you stop taking Parnate.

Know the medicines you take. Keep a list of them to show your healthcare providers, pharmacist, and dentist when you get a new medicine.

How should I take Parnate?

• Take Parnate exactly as your healthcare provider tells you to take it.
• Your healthcare provider may need to change your dose of Parnate until it is the right dose for you.
• Do not stop taking Parnate without first talking to your healthcare provider. Stopping Parnate suddenly may cause withdrawal symptoms. See, “What are the possible side effects of Parnate?”
• Tell your healthcare provider if you think your condition has gotten worse during treatment with Parnate.
• If you take too much Parnate (overdose) call your healthcare provider or poison control, or go to the nearest hospital emergency room right away.

What should I avoid while taking Parnate?

• Do not eat foods or have drinks that have high amounts of tyramine while taking Parnate or for 2 weeks after you stop taking Parnate.
  • All foods you eat should be fresh or properly frozen.
  • Avoid foods when you do not know how those foods should be stored.
  • Ask your healthcare provider if you are not sure if certain foods and drinks contain tyramine.

The table below lists some of the foods and drinks you should avoid while you take Parnate.

• Do not drive, operate heavy machinery, or do other dangerous activities until you know how Parnate affects you.
• Do not drink alcohol while taking Parnate.

What are the possible side effects of Parnate?

Parnate may cause serious side effects, including:

• See “What is the most important information I should know about Parnate?”
• Serotonin Syndrome. A potentially life-threatening problem called serotonin syndrome can happen when you take Parnate with certain other medicines. See, “Who should not take Parnate?” Symptoms of serotonin syndrome may include:
  • agitation, confusion
  • seeing or hearing things that are not real (hallucinations)
  • coma
  • rapid pulse
  • changes in blood pressure
  • dizziness
  • sweating
  • flushing
  • high body temperature (hyperthermia)
  • fever
  • seizures
  • tremors, stiff muscles, or muscle twitching
  • becoming unstable
  • nausea, vomiting, diarrhea
    If you have any of these symptoms, call your healthcare provider or go to the nearest hospital emergency room right away.
• Mania or hypomania (manic episodes) in people who have a history of bipolar disorder.
  • greatly increased energy
  • severe problems sleeping
  • racing thoughts
  • reckless behavior
  • unusually grand ideas
  • excessive happiness or irritability
  • talking more or faster than usual
• Low blood pressure (hypotension) including a drop in your blood pressure when you stand or sit up (postural hypotension). This can happen more often in people who have high blood pressure (hypertension) and when the Parnate dose is changed. Postural hypotension may cause you to feel dizzy and faint (syncope).
• Changes in your blood pressure (hypotension or hypertension) during surgery and during the time around surgery (perioperative). Taking Parnate with certain medicines used for anesthesia can cause hypotension or hypertension. If you plan to have surgery, tell your surgeon or the healthcare provider who will give you anesthesia that you take Parnate. Your healthcare provider should stop Parnate at least 10 days before you have surgery.
  Withdrawal symptoms. Talk with your healthcare provider before you stop taking Parnate. Symptoms of withdrawal may include:
  • dizziness
  • nausea
  • headache
  • irritability and agitation
  • problems sleeping
  • diarrhea
  • anxiety
  • abnormal dreams
  • sweating
  • confusion
  • electric shock sensation (paresthesia)
  • tiredness
  • changes in your mood
  • hypomania
  • ringing in your ears (tinnitus)
  • seizures
• Liver problems
• Seizures (convulsions). Seizures have happened in people who take too much Parnate.
• Low blood sugar (hypoglycemia). Hypoglycemia has happened in people with diabetes who take medicines to lower blood sugar. Talk with your healthcare provider about checking your blood sugar during treatment with Parnate. Tell your healthcare provider if your blood sugar gets low.
• Worsening of symptoms that can happen with depression, such as anxiety and agitation.
  • dry mouth
  • dizziness
  • problems sleeping
  • feeling sleepy
  • headache
  • overexcitement
  • constipation
  • blurry vision
  • shakiness (tremor)

These are not all the side effects of Parnate.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Parnate

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not take Parnate for a condition for which it was not prescribed. Do not give Parnate to other people, even if they have the same symptoms you have. It may harm them. You can ask your healthcare provider or pharmacist for information about Parnate that is written for health professionals.

How should I store Parnate?

• Store Parnate between 59°F to 86°F (15°C to 30°C).
• Store Parnate in a tight, light resistant container.

Keep Parnate and all medicines out of the reach of children.

What are the ingredients in Parnate?

Active Ingredient: tranylcypromine sulfate

Inactive Ingredients: microcrystalline cellulose, anhydrous citric acid, croscarmellose sodium, D&C Red No. 7, FD&C Blue No. 2, FD&C Yellow No. 6, gelatin, lactose, magnesium stearate, talc, titanium dioxide, carnauba wax, polyethylene glycol 400 and 8000 and hypromellose