Generic Name: phenelzine (FEN-el-zeen)

Brand Names: Nardil®

Classification: Monoamine Oxidase Inhibitor (MAOI)

Issue Date: 1979

Phenelzine is a monoamine oxidase inhibitor (MAOI) that works by increasing the levels of certain chemicals in the brain. Phenelzine is used to treat symptoms of depression that may include feelings of sadness, fear, anxiety, or worry about physical health (hypochondria). This medication is usually given after other anti-depressants have been tried without successful treatment of symptoms. Phenelzine is not for treating severe depression or bipolar disorder (manic depression). Phenelzine may also be used for purposes other than those listed here.

There are many other medicines that can cause serious or life-threatening medical problems if you take them together with Phenelzine. Do not take Phenelzine before telling your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. While you are taking this medication you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor promptly if you have any of the following side effects:

• mood changes
• anxiety, panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/or physical hyperactivity)
• thoughts of suicide or hurting yourself

While you are taking Phenelzine, you must not drink alcohol or eat foods that are high in tyramine. Eating tyramine while you are taking Phenelzine can raise your blood pressure to dangerous levels, causing symptoms that include:

• sudden and severe headache
• rapid heartbeat
• stiffness in your neck
• nausea
• vomiting
• cold sweat
• vision problems
• sensitivity to light

Stop taking Phenelzine and call your doctor at once if you have any of these symptoms.

You should become very familiar with the list of foods and medicines you must avoid while you are taking Phenelzine. Eating tyramine while you are taking Phenelzine can raise your blood pressure to dangerous levels which could cause life-threatening side effects.

FOODS HIGH IN TYRAMINE:

• aged or smoked meats
• fermented meats, dry sausage (including salami, pepperoni, Lebanon bologna)
• liver
• pickled herring
• any spoiled or improperly stored meats, fish, or dairy products
• beer and wine (including non-alcoholic beer or wine)
• cheese (other than cottage cheese or cream cheese)
• sauerkraut
• over-the-counter medicines that contain dextromethorphan or tyramine
• large amounts of chocolate or caffeine
• yogurt
• fava beans
• meat extracts
• yeast extracts (including Brewer's yeast)

Phenelzine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Take this medication exactly as it was prescribed for you.

Phenelzine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication. Take each dose with a full glass of water. To be sure this medication is not causing harmful effects, your blood pressure will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

Take this medication for the entire length of time prescribed by your doctor. It may take 4 weeks or longer before you notice improvement in your symptoms. Store Phenelzine at room temperature away from moisture and heat.

Do not use this medication if you have used another MAOI such as:

• isocarboxazid (Marplan®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)
• tranylcypromine (Parnate®)

within the past 14 days. Serious, life-threatening side effects can occur if you take Phenelzine before another MAOI has cleared from your body.

Do not take this medication if you are allergic to Phenelzine, or if you have:

• pheochromocytoma (tumor of the adrenal gland)
• congestive heart failure
• a history of liver problems
• if you need any type of surgery with anesthesia

There are many other medicines that can cause serious or life-threatening medical problems if you take them together with Phenelzine. The following drugs should NOT be used while you are taking Phenelzine:

• diet pills
• caffeine, stimulants
• ADHD medication
• asthma medication
• over-the-counter cough and cold or allergy medicines
• tryptophan (also called L-tryptophan®)
• levodopa (Larodopa®, Parcopa®, Sinemet®)
• methyldopa (Aldomet®)
• meperidine (Demerol®, Mepergan®)
• furazolidone (Furoxone®)
• procarbazine (Matulane®)
• buspirone (BuSpar®)
• bupropion (Wellbutrin®, Zyban®)
• dexfenfluramine (Redux®)
• guanethidine (Ismelin®)
• alcohol
• medicines that make you sleepy
• cold medicine
• pain medication
• muscle relaxers
• medicine for seizures, depression or anxiety
• citalopram (Celexa®)
• duloxetine (Cymbalta®)
• escitalopram (Lexapro®)
• fluoxetine (Prozac®, Sarafem®)
• fluvoxamine (Luvox®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)
• venlafaxine (Effexor®)

Before taking Phenelzine, tell your doctor if you have:

• high blood pressure, heart disease
• diabetes
• schizophrenia
• epilepsy or other seizure disorder
• if you have taken another antidepressant within the past 5 weeks

If you have any of these conditions, you may not be able to use Phenelzine, or you may need a dosage adjustment or special tests during treatment.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. While you are taking Phenelzine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety, panic attacks
• trouble sleeping
• irritability, agitation, aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Phenelzine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Phenelzine should not be given to a child without a doctor's advice.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• skin rash or hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Stop using Phenelzine and call your doctor at once if you have any of these SERIOUS side effects:

• sudden and severe headache
• rapid heartbeat
• stiffness in your neck
• nausea
• vomiting
• cold sweat
• sweating
• vision problems
• sensitivity to light
• chest pain
• fast or slow heart rate
• swelling
• rapid weight gain
• agitation
• unusual thoughts or behavior
• feeling light-headed
• fainting

Continue taking this medication and talk to your doctor if you have any of these less serious side effects:

• dizziness
• feeling weak or drowsy
• sleep problems (insomnia)
• constipation, upset stomach
• dry mouth, decreased urination
• impotence, difficulty having an orgasm

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

There are many other medicines that can cause serious or life-threatening medical problems if you take them together with Phenelzine. Do not take Phenelzine before telling your doctor about all other prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor, dentist, or other healthcare provider who treats you.