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Possible drug interactions with Phenelzine (Nardil):health-center:"Remember, always follow your physician's recommendations on how to take your medication. Even if you are taking one of the following substances, continue taking your medication as prescribed and consult your physician. Also, if you are taking any herbal remedies, vitamins, and/or over-the-counter medications, be sure to tell your physician. The following section offers some, but not necessarily all, of the possible drug interactions. Many different types of medications, food, and beverages should not be taken with a MAO Inhibitor such as Phenelzine Sulfate. The following is a list of substances, that when combined with MAO Inhibitors, could lead to adverse interactions, even fatal ones: Amphetamines, Narcotics (Opium, Heroin, etc.), Alcohol, Antihypertensives, Antihistamines, Excessive Caffeine, Diuretics, Buspirone (BuSpar), Meperidine (Demerol), Dextromethorphan HCL, SSRIs, TCAs, Bupropion HCL (Wellbutrin)"
http://www2.health-center.com/db/PageReq?SessionID=31107813.1037343400988&TopicID=375&PageID=1489&Action=view

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Phenelzine (Nardil) description:citizen.org:"Phenelzine (fen el zeen) is approved by the Food and Drug Administration to treat depression, particularly atypical (non-endogenous or neurotic). It belongs to the group of antidepressants called monoamine oxidase inhibitors (MAOIs). Type A MAOIs inhibit the metabolism (breakdown) of the neurotransmitters dopamine, epinephrine, norepinephrine, and serotonin. MAOIs are reserved for use only after other antidepressants have not worked. Phenelzine may improve, but does not cure, depression. The dose is gradually increased over a few weeks. It may take up to six weeks for phenelzine to work. After the maximum benefit is realized, the dose is then gradually lowered. People who are "slow acetylators" (those who metabolize the drug slowly) may need lower doses to lessen adverse effects. Lower doses of phenelzine should also be used in older people, who tend to experience more adverse effects, such as changes in blood pressure. MAOIs are not usually started in people over age 60. In children under age 16, MAOIs are not approved for use. Safety in women who are pregnant or breastfeeding or during labor has not been established. People with high blood pressure, heart disease, or pheochromocytoma should not take phenelzine. This table compares the most common adverse effects of the antidepressant drugs"
http://www.citizen.org/eletter/drugprofiles/phenelzine.htm

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Foods that interact with Phenelzine (Nardil):survivorscorner:"Foods to avoid while taking MAOIs Meats/Fish: pickled herring, anchovies, liver, caviar, dry sausage, salami, or meats prepared with a tenderizer. Dairy: yogurt, sour cream, cheese, (cream or cottage cheese is ok). Beverages: beer, red wine, sherry. Avoid excessive amounts of caffeine containing colas, coffee and tea. Fruits/Vegetables: avocado, bananas, figs, raisins, broad beans, or sauerkraut. Other foods: Yeast extract, soy sauce, chocolate."
http://www.survivorscorner.com/nardil.htm

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Phenelzine (Nardil) contraindications:mentalhealth.com:"Known hypersensitivity to the drug, pheochromocytoma, congestive heart failure, history of liver disease or abnormal liver function tests. The potentiation of sympathomimetic substances and related compounds by MAO inhibitors may result in hypertensive crises (see Warnings). Therefore, patients taking phenelzine should not be given sympathomimetic drugs (including amphetamines, cocaine, methylphenidate, dopamine, epinephrine and norepinephrine), or related compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine and phenylalanine). Hypertensive crises during phenelzine therapy may also be caused by ingestion of foods with a high concentration of tyramine or dopamine. Therefore patients being treated with phenelzine should avoid high protein food that has undergone protein breakdown by aging, fermentation, pickling, smoking or bacterial contamination; patients should also avoid cheeses (especially aged varieties), pickled herring, beer, wine, liver, yeast extract (including brewer's yeast in large quantities), dry sausage (including Genoa salami, hard salami, pepperoni and Lebanon bologna), pods of broad beans (fava beans) and yogurt. Excessive amounts of caffeine or chocolate can also potentiate hypertensive reactions"
http://www.mentalhealth.com/drug/p30-n01.html#Head_3

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The most important information you should know about Phenelzine (Nardil):ahealthyme:"Avoid alcohol, chocolate, and all of the foods listed in the "What should I avoid while taking phenelzine?" section of this leaflet. Foods high in tyramine can cause a severe reaction, including a severe headache, large pupils, neck stiffness, nausea, vomiting, sweating, irregular heartbeats, and chest pain. Call your doctor immediately if you experience any of the symptoms listed above. Do not take any prescription or over-the-counter medicines without the approval of your doctor. Medicines can also cause severe reactions if they are taken with phenelzine. Use caution when driving, operating machinery, or performing other hazardous activities. Phenelzine may cause dizziness, drowsiness, or blurred vision. If you experience dizziness, drowsiness, or blurred vision, avoid these activities. Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Do not stop taking this medication without the approval of your doctor "
http://www.ahealthyme.com/topic/topic100590963

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Phenelzine (Nardil) mechanism of action:parkinsons-information-exchange-network:"Phenelzine inhibits monoamine oxidase by binding to it irreversibly. Isocarboxazid and pargyline are similar; tranylcypromine binds reversibly. Depression is believed to result from dysregulation of CNS neurotransmitter systems. Antidepressant activity arises from the increased availability of monoamines, resulting from the inhibition of the enzyme monoamine oxidase (MAO). Reduction of MAO activity causes an increased concentration of neurotransmitters, such as epinephrine, norepinephrine, and dopamine, at various storage sites in the central nervous system and sympathetic nervous system. Phenelzine is a nonselective MAOI and desensitizes ›and œadrenergic and serotonin receptors. The delay of up to 4 weeks in therapeutic response to MAOI drugs may be accounted for by alterations in receptor characteristics rather than by increased neurotransmitter concentration. MAOIs also have a variable hypotensive action, probably due to central inhibition of vasomotor centers. Inhibition of MAO in the GI tract and liver can cause systemic absorption of large amounts of tyramine, which can result in severe hypertension because of massive release of norepinephrine. MAOIs also interfere with the hepatic metabolism of many drugs"
http://www.parkinsons-information-exchange-network-online.com/drugdb/102.html

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Phenelzine (Nardil) pharmacokinetics:medsafe:"There is little information available on the pharmacokinetics of phenelzine sulfate. Orally administered phenelzine sulfate is rapidly absorbed from the gastro-intestinal tract and has a short half life reported to be 1.2 hours in humans. The decay in the action-time curve for MAO inhibitors is not dependent on the pharmacokinetic parameters but on the rate of protein synthesis which restores the functional levels of MAO in the tissue compartments where it has been irreversibly inactivated. Although the biological activity of phenelzine sulfate is prolonged due to the characteristics of their interaction with the enzyme, its clinical efficacy appears to be reduced when given less frequently than once daily. Phenelzine sulfate is metabolised primarily by acetylation. The rate of metabolism is dependent upon the kinetic profile of the patient who may be a "slow" or "rapid" acetylator. There has been no consistent correlation noted between acetylator status and adverse effects of the drug. The major metabolites of phenelzine sulfate are phenylacetic acid and parahydroxyphenyl acetic acid. These metabolites constitute up to 79% of a single administered phenelzine dose excreted in the urine within 96 hours. It is not known whether these metabolites have clinical activity"
http://www.medsafe.govt.nz/Profs/datasheet/n/Nardiltab.htm

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Phenelzine (Nardil) contraindications, warnings and precautions:Red Oak Psychiatry:" Contraindicated in patients with hypersensitivity to the drug, congestive heart failure, pheochromocytoma, hypertension, significant renal impairment, cerebrovascular defects, liver disease, or cardiovascular disease. Do not take sympathomimetic drugs, including amphetamines, cocaine, methylphenidate (Ritalin), dopamine, epinephrine, and norepinephrine or related compounds because use with MAO inhibitors may result in a hypertensive crisis, which has sometimes been fatal and are characterized by occipital headache, palpitation, neck stiffness and soreness, nausea, vomiting, sweating, dilated pupils and photophobia. Hypertensive crises may also be caused by the ingestion of foods that have a high concentration of tyramine or dopamine, so high protein foods that have undergone protein breakdown by aging, fermentation, pickling, smoking or bacterial contamination must be avoided. Some other foods to avoid are cheeses, yogurt, pickled herring, beer (including non alcoholic), wine, liver, yeast extract, dry sausage, fava beans and chocolate. Cottage cheese and cream cheese are allowed. Do not use with or within 10 days of Buspar or serotoninergic agents. At least 5 weeks should elapse between the discontinuation of Prozac and initiation of Nardil. Do not use with Wellbutrin or within 14 days of each other. Patients on Nardil should not have elective surgery requiring general anesthesia. Discontinue at least 10 days before elective surgery."
http://www.redoakpsychiatry.com/medications/nardil.html

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Phenelzine (Nardil) action and kinetics: Nursespdr:"MAO inhibitor that prevents MAO from metabolizing biogenic amines. Antidepressant effect due to accumulation of biogenic amines in presynaptic granules, increasing the concentration of neurotransmitter released upon nerve stimulation. Slight anticholinergic, sedative, and orthostatic hypotensive effects. Onset: Few days to several months. Beneficial effects at doses of 60 mg/day may not be seen for at least 4 weeks. Clinical effects of the drug may be observed for up to 2 weeks after termination of therapy."
http://www.nursespdr.com

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Why Phenelzine (Nardil) should Not be prescribed:healthsquare:"You should not take this d rug if you have pheochromocytoma (a tumor of the adrenal gland), congestive heart failure, or a history of liver disease, or if you have had an allergic reaction to it. You should not take Nardil if you are taking medications that may increase blood pressure (such as amphetamines, cocaine, allergy and cold medications, or Ritalin), other MAO inhibitors, L-dopa, methyldopa (Aldomet), phenylalanine, L-tryptophan, L-tyrosine, fluoxetine (Prozac), buspirone (BuSpar), bupropion (Wellbutrin), guanethidine (Ismelin), meperidine (Demerol), dextromethorphan, or substances that slow the central nervous system such as alcohol and narcotics; or if you must consume the foods, beverages, or medications listed above in the "Most important fact about this drug" section."
http://www.healthsquare.com/newrx/NAR1284.HTM

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