Medicines

Phenelzine (Nardil): Uses, Dosage, Side effects, Foods to Avoid

What Is Phenelzine (Nardil) And What Does It Treat?

Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI) and is used for the treatment of major depressive disorder (MDD) in adults when other medicines have not been effective.

Studies indicate that phenelzine is effective in treating social phobia that has been unresponsive to other treatments. Phenelzine (Nardil) is not for treating severe depression or bipolar disorder (manic depression).

What Is The Most Important Information I Should Know About Phenelzine (Nardil)?

Do not stop taking Phenelzine (Nardil), even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine.

Missing doses of Phenelzine (Nardil) may increase your risk for relapse in your symptoms.

Stopping Phenelzine (Nardil) abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, dizziness, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for “switching” from depression into mania. Symptoms of mania include “high” or irritable mood, very high self-esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs/symptoms.

What Should I Discuss With My Health Care Provider Before Taking Phenelzine (Nardil)?

•        Symptoms of your condition that bother you the most

•        If you have thoughts of suicide or harming yourself

•        Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects

•        If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.

•        Any other psychiatric or medical problems you have, including a history of bipolar disorder

•        All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have

•        Other non-medication treatments you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.

•        If you are pregnant, plan to become pregnant, or are breastfeeding

•        If you drink alcohol or use drugs

How Should I Take Phenelzine (Nardil)?

Phenelzine (Nardil) is usually taken three to four times per day with or without food.

Typically, patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 15mg to 90mg. Only your health care provider can determine the correct dose for you.

Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Phenelzine (Nardil)?

If you miss a dose of Phenelzine (Nardil), take it as soon as you remember unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

What foods should be avoided when taking Nardil

What Should I Avoid While Taking Phenelzine (Nardil)?

Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

Special dietary considerations: Foods rich in tyramine may cause a sudden and severe high blood pressure (hypertensive crisis). Avoid high protein food that has undergone protein breakdown via aging, fermentation, pickling, smoking, or bacterial contamination. Also, avoid beverages containing tyramine. Food freshness is also important; avoid any food that may potentially be spoiled, improperly refrigerated, stored, or handled. It is important to also avoid food with excessive amounts of caffeine and/or chocolate.

Examples of food to avoid include:

•        Dry sausage (salami, pepperoni)

•        Cheeses (aged cheeses including parmesan, aged cheddar, bleu cheese)

•        Beer, wine

•        Pickled herring

•        Liver

•        Fava or broad bean pods

•        Sauerkraut

•        Avoid foods/beverages with excessive amounts of caffeine/chocolate

These dietary considerations should be taken into consideration for 2 weeks even after Phenelzine (Nardil) is discontinued. Discuss with the health care provider any other foods or specific dietary concerns.

What Happens If I Overdose With Phenelzine (Nardil)?

If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222. A specific treatment to reverse the effects of Phenelzine (Nardil) does not exist.

How Long Does It Take For Phenelzine (Nardil) To Work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Can a pregnant woman take Phenelzine (Nardil)?

If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Can a breastfeeding woman take Phenelzine (Nardil)?

Regarding breastfeeding, caution is advised since it is not known if Phenelzine (Nardil) passes into breast milk. New research suggests that phenelzine can elevate serum prolactin in some patients and has caused galactorrhea in nonpregnant, nonnursing patients. The clinical relevance of these findings in nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

What Are The Possible Side Effects Of Phenelzine (Nardil)?

Common side effects

•        Sedation

•        Dry mouth

•        Weight gain

•        Decreased blood pressure (hypotension)

•        Headache

•        Constipation

•        Sexual dysfunction

•        Blurred vision

•        Urinary retention

Rare side effects

•        Elevated sodium levels

•        Liver dysfunction

•        Skin rash

•        Seizures

•        Hypertensive crisis; especially if a low tyramine diet is not followed

•        Serotonin Syndrome

Hypertensive crisis (symptoms may include occipital headache-start in the back and radiate to the front, heart palpitations, nausea/vomiting, neck stiffness/soreness, light sensitivity, sweating)

Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death)

Are There Any Risks For Taking Phenelzine (Nardil) For Long Periods Of Time?

To date, there are no known problems associated with long-term use of Phenelzine (Nardil). It is a safe and effective medication when used as directed.

What Other Medications May Interact With Phenelzine (Nardil)?

Phenelzine (Nardil) should not be taken with or within 2 weeks (5 weeks for fluoxetine) of any other mental health medications including other antidepressants, mood stabilizers, antipsychotics, and anti-anxiety medications. Phenelzine (Nardil) may also interact with some pain medication, medications for migraines, amphetamines, and antibiotics. Please inform your health care providers of all your current medications and any substance use at the time of prescribing to avoid any potential side effects.

There is an increased risk of serotonin syndrome when Phenelzine (Nardil) is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®), amphetamines, and the antibiotic linezolid (Zyvox®).

The following medications may increase the levels and effects of Phenelzine (Nardil): alcohol, alfuzosin, amantadine, antipsychotics, barbiturates, blood pressure-lowering agents, buprenorphine, buspirone, carbamazepine, cyclobenzaprine, fentanyl, ipratropium (oral inhalation), levodopa, methadone, methylene blue, oxycodone, opioid analgesics, pentoxifylline, pheniramine, phosphodiesterase 5 inhibitors (including sildenafil), tramadol, tetrabenazine, valbenazine.

The following medications may decrease the levels and effects of Phenelzine (Nardil): acetylcholinesterase inhibitors, amifampridine, cyproheptadine, domperidone.

Phenelzine (Nardil) may increase the levels and effects of antipsychotics, atomoxetine, bupropion, cyproheptadine, deutetrabenazine, dopamine, dextromethorphan, codeine, heroin, hydrocodone, lithium, methylphenidate, morphine, mirtazapine, MAO-Is, norepinephrine, opioid analgesics, pindolol, SSRIs, SNRIs, topiramate, tramadol, tricyclic antidepressants.

Phenelzine (Nardil) may decrease the levels and effects of acetylcholinesterase inhibitors, gastrointestinal agents, amifampridine, domperidone, and nitroglycerin.

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