Phenelzine

Phenelzine is oral, MAOI (monoamino oxidase inhibitor)-type antidepressant. Phenelzine is a derivative of hydrazine and irreversibly inhibits monoamine oxidase. Phenelzine is used to treat major depression, particularly atypical depression, nonendogenous depression, anxiety, double depression (in which the patient can have a dysthymic mood and major depression), and psychotic depression (in which there are prominent psychotic features), as well as obsessive-compulsive disorder, panic disorder, and phobic disorder. It was approved by the FDA in 1959. 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 CNS.

Brands
Adult Dose
Dose: 0.857 to 1.285 mg/kg
Single Dose: 1.1 (1.071)
Frequency: 24 hourly
Route: PO
Instructions: -
Neonatal
Dose: Not indicated in children
Single Dose:
Frequency:
Route:
Instructions:
Paedriatic
Dose: Not indicated in children
Single Dose:
Frequency:
Route:
Instructions:
Characteristics
Phenelzine Sulfate is the derivative of Phenelzine. It is of Synthetic origin and belongs to Hydrazine. It belongs to Psychotherapeutic Drugs and Antidepressant pharmacological group.The Molecular Weight of Phenelzine is 234.30.
Contraindications
Phenelzine is contraindicated in conditions like Epilepsy,Phaeochromocytoma,Blood dyscrasias,Liver diseases,Cardiovascular disease,Cerebrovascular disease.
Effects
The severe or irreversible adverse effects of Phenelzine, which give rise to further complications include Orthostatic hypotension, Insomnia, Jaundice, Peripheral neuropathy, Leucopenia, Psychosis, Hypomania, Agitation.Phenelzine produces potentially life-threatening effects which include Cerebral hemorrhage. which are responsible for the discontinuation of Phenelzine therapy.The signs and symptoms that are produced after the acute overdosage of Phenelzine include Convulsions, Hyperthermia, nervousness, Confusion, Hyperpyrexia, Agitation, Hypertension, Extrapyramidal effects, Neuromuscular weakness, Involuntary movements.The symptomatic adverse reactions produced by Phenelzine are more or less tolerable and if they become severe, they can be treated symptomatically, these include Weakness, Dizziness, Headache, Drowsiness, Fatigue, Constipation, Nervousness, Dry mouth, Cardiac arrhythmias, Tremor, Convulsions, GI disturbance.
Indications
Phenelzine is primarily indicated in conditions like Anxiety, Depression, Obsessive-compulsive disorders, Pain, Phobias.
Interactions
Phenelzine is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlbuterolShould not use concurrently without doctors prescription.Amantadine (HCl)Amiodarone (HCl)Phenelzine sulfate may interact with Amiodarone HCl.Apraclonidine (HCl)Atomoxetine HClSevere adverse reactions are possible in this combination.Azelastine (HCl) Increased antimuscarinic and sedative effects when antihistamines (e.g Azelastine) given with MAOIs antidepressants (e.g Phenelzine).ChlorpropamidePhenelzine inhibits gluconeogenesis thus potentiate the hypoglycemic effect of chlorpropamide.ModerateAdjust the dose of chlorpropamide if necessary. Closely monitor the blood sugar level especially in patients of advance age or renal impairent.Citalopram (HBr)DextromethorphanDiazoxideEnhanced hypotensive effect when Diazoxide gven with MAOIs (e.g.Phenelzine).DroperidolFluoxetine (HCl)MetaraminolCoadministration involve synergistic sympathomimetic effect because metaraminol enhance noradrenaline storage in adrenergic neurons and phenelzine increased secretion of catecholamines.In some cases death has been reported.other reactions include hyperpyrexia and hypertensive reactions.MajorThis combination should not be used or give a gap of atleast 2 weeks after discontinuing phenelzine to start metaraminol.MirtazapineNaphazolineConcurrent use may result in interaction. Dosage adjustment or special monitoring during concurrent use is necessary.Nefazodone (HCl)OxypertineTheoretical potential for OXYPERTINE increasing the CNS STIMULANT effect of PHENELZINE. MajorParegoricThe coadministration of narcotic analgesics and monoamine oxidase inhibitors (MAOIs) may rarely result in hypotension, respiratory depression, or coma. The mechanism is unknown but may be related to additive CNS and respiratory depressant effects. Rare case reports of severe hypotensive reactions have included propoxyphene (with multiple medications), morphine, and methadone, although others have reported the safe use of MAOIs with narcotic analgesics including methadone and morphine.MajorSome manufacturers consider the administration of narcotics and MAOIs within 2 weeks of each other to be contraindicated. However, morphine has been safely used in MAOI patients who previously had an adverse reaction with meperidine and is generally suggested as an alternative to meperidine in anesthesia, as long as vital signs are closely monitored. Other recommendations include giving patients small initial test doses of narcotics and monitoring vital signs for adverse reactions.ParoxetinePheniramine (Maleate)MOAI Inhibitor like phenelzine, tranylcypromine intensify the anticholenergic effect of pheniramine and hence should not be use with pheniramine.PhenylalaninePhenylalanine supplementation may cause a severe increase in blood pressure in people taking Phenelzine.Pirbuterol (Acetate)Concurrent use may potentiate the action of pirbuterol on the vascular system.Pirbuterol should be administered with extreme caution to patients being treated with Phenelzine.Potassium GuaiacolsulphonatePotassium Guaiacolsulphonate should not be used with or within 14 days of taking Phenelzine.PropylhexidrinePotential for enhanced sympathomimetic effects. Use concomitantly with caution.RizatriptanRizatriptan should not be used within 2 weeks of having used Phenelzine.SalmeterolAction of salmeterol on the vascular system may be potentiated by Phenelzine. Sertraline (HCl)St.Johns Wort ExtractConcurrent use can produce a dangerous rise in blood pressure or hypertensive crisis, along with severe anxiety, fever, muscle tension and confusion.Suxamethonium (Cl)Tetrahydrozoline (HCl)Concurrent use may increase the hypertensive effect.Tramadol (HCl)Phenelzine and other MAOI inhibitors causes serotonergic over activity.Trazodone (HCl)Vortioxetine increase toxicity of vortioxetinenever use combination These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, Geriatrics, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Tab Store in a well closed container, at room temperature. Protect from Sunlight and Moisture.
Warnings
Take adequate precautions when treating epileptic patients. Phenelzine should be used with caution in patients with impaired renal (kidney) function, diabetic, and hyperthyroidism. Perform periodic liver function tests, discontinue use at the first sign of hepatic (liver) dysfunction or jaundice. It should be withdrawn gradually to decrease risk of withdrawl symptoms. Avoid alcohol. It is not approve for children as it increase risk of suicidal thinking.
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