NARDIL (Phenelzine)

NARDIL (Phenelzine)

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What is this medication?

Phenelzine, Nardil
Antidepressant, Monoamine Oxidase Inhibitor

“ALERT: US Boxed Warning

Suicidality and antidepressant drugs:
Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of phenelzine or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Closely observe and appropriately monitor patients of all ages who are started on antidepressant therapy for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider. Phenelzine is not approved for use in pediatric patients.”

How does this medication work?

Phenelzine, Nardil is an inhibitor of monoamine oxidase (MAO) in the central nervous system, which plays a major role in the catabolism of dopamine, epinephrine, and serotonin.

How should I take this medication? 

Oral: Start at 15 mg 3 times daily and increase rapidly, based on patient tolerance, to 60 to 90 mg/day; may take ≥ 4 weeks of 60 mg/day therapy before clinical response.  After maximum benefit is obtained, slowly reduce dose over several weeks; dose may be as low as 15 mg once daily to 15 mg every other day.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature.

You Need to Avoid:  Alcohol may increase toxic effects of MAO inhibitors and should be avoided.  Concurrent ingestion of foods rich in tyramine, dopamine, tyrosine, phenylalanine, tryptophan, or caffeine may cause sudden and severe high blood pressure (hypertensive crisis or serotonin syndrome).

Management: Avoid foods containing high amounts (>150 mg) of tyramine (aged or matured cheese, air-dried or cured meats including sausages and salamis; fava or broad bean pods, tap/draft beers, Marmite concentrate, sauerkraut, soy sauce, and other soybean condiments). Food’s freshness is also an important concern; improperly stored or spoiled food can create an environment in which tyramine concentrations may increase. Avoid these foods during and for 2 weeks after discontinuation of medication.
When discontinuing antidepressant treatment that has lasted for >3 weeks, gradually taper the dose to minimize withdrawal symptoms and detect reemerging symptoms. If intolerable withdrawal symptoms occur, resume the previously prescribed dose and/or decrease dose at a more gradual rate.

What should I watch for while using this medication? 

Before starting Phenelzine, Nardil make sure your physician is aware of any allergies or medications you currently take, if you have diabetes, glaucoma, a history of drug abuse, a history of mania/hypomania, a seizure disorder, thyroid dysfunction, a history of suicidal ideation, are pregnant, or breastfeeding. Phenelzine, Nardil use has been associated with rare but serious adverse events such as CNS depression, hypertensive crisis, hypotension, intracranial bleeding, and serotonin syndrome.  Phenelzine, Nardil has many drug interactions, so discuss any supplements, natural health products, or nonprescription medications with your prescriber/pharmacist prior to using.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times.  Store at room temperature, 59 to 86° F (15 to 30° C).  Protect from light.  Keep the container tightly closed.  Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication? 

Edema, orthostatic hypotension, 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), diaphoresis, pruritus, skin rash, hypernatremia, weight gain, constipation, glottis edema, xerostomia, sexual disorder (anorgasmia, ejaculatory disorder, impotence), urinary retention, leukopenia, increased serum transaminases, jaundice, lupus-like syndrome, tremor, weakness, blurred vision, glaucoma, nystagmus, respiratory depression (following ECT; transient), fever

Note the frequency of side effects is not defined.