Precautions and Warnings With Tranylcypromine (Cont.)

• Tranylcypromine should be used only after other treatments have failed. Anyone taking the medication should be under close supervision of his or her healthcare provider.
   
• Tranylcypromine has several potentially lethal food and drug interactions. In order to take tranylcypromine safely, you must commit to avoiding many foods and medications, including many non-prescription medications. Always check with your healthcare provider before taking any medications (see Drug Interactions With Tranylcypromine and Parnate Food Interactions for more information).
   
• Tranylcypromine can cause a hypertensive crisis, which is a life-threatening increase in blood pressure. Because of this, you should not take tranylcypromine if you have heart problems (including heart disease) or cerebrovascular disease (such as a history of a stroke, TIA, or any bleeding in the brain) or if you already have high blood pressure, since increases in blood pressure can be especially dangerous if you have these conditions. Tell your healthcare provider right away if you have symptoms of a hypertensive crisis, such as:

o Headaches

o Feelings of a rapidly or forcefully beating heart (palpitations)

o Sore or stiff neck

o Nausea or vomiting

o Sweating, with a high fever (or sometimes with cold, clammy skin)

o Sensitivity to light

o Rapid heart rate (tachycardia) or low heart rate (bradycardia)

o Chest pain or throat tightness

o Dilated (wide open) pupils.

• Antidepressants (including tranylcypromine) may increase the risk of suicidal thinking or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thoughts or behavior (see Parnate and Suicide for more information).
   
• Before prescribing tranylcypromine for depression, your healthcare provider should make sure that you do not have bipolar disorder (instead of depression). Sometimes, the symptoms of bipolar disorder and depression are very similar, and tranylcypromine can cause problems in people with bipolar disorder.
   
• Be sure to tell all your healthcare providers (including dentists and surgeons) that you are taking tranylcypromine.
   
• In addition to causing dangerously high blood pressure, tranylcypromine can also cause low blood pressure (hypotension). Let your healthcare provider know if you have symptoms of low blood pressure, such as lightheadedness, dizziness, or fainting.
   
• There have been cases of people becoming dependent on tranylcypromine, especially when taking higher than recommended doses. Stopping tranylcypromine suddenly can lead to withdrawal symptoms, especially after taking high doses for a long time (see Parnate Withdrawal).
   
• For people taking tranylcypromine, caution should be used when driving, operating heavy machinery, or performing other tasks that require concentration, especially when first starting tranylcypromine or when switching dosages. This is because the drug may affect a person's mental or physical ability to perform these tasks. Make sure to understand how tranylcypromine affects you before performing any task that requires mental or physical concentration.
   
• Tranylcypromine may not be safe for use during pregnancy. Discuss the benefits and risks of using tranylcypromine during pregnancy with your healthcare provider (see Parnate and Pregnancy for more information).
   
• It is not known if tranylcypromine passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about what makes most sense for your particular situation (see Parnate and Breastfeeding).
   
• It is recommended to stop taking tranylcypromine at least 48 hours before certain radiology procedures (such as myelography), since tranylcypromine should not be taken with certain contrast materials (dyes or other substances that help provider better images).
   
• Special care should be used when taking tranylcypromine if you have a history of seizures, as tranylcypromine can make seizures worse.
   
• Elderly people appear to be more sensitive to tranylcypromine, and certain tranylcypromine side effects may be more dangerous in elderly people.
   
• Tranylcypromine can cause low blood sugar (hypoglycemia) in people taking diabetes medications. When starting tranylcypromine or changing dosages, make sure to check your blood sugar levels more often.
   
• Talk to your healthcare provider before taking tranylcypromine if you have hyperthyroidism (overactive thyroid) or take thyroid medication.
   
• Do not stop taking tranylcypromine without first discussing it with your healthcare provider. Stopping the medicine abruptly may increase the risk for withdrawal symptoms (see Parnate Withdrawal).