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Phenelzine

Class
Antidepressants
Subclass
Monoamine oxidase inhibitors
Substance name
Phenelzine sulfate
Common formulations
Film-coated tablet
Indications for use
Off-label indications
Adults
•
Treatment of panic disorder
•
Treatment of social anxiety disorder
•
Prevention of migraine attacks
Safety risks
Contraindications
Alcoholism, and concomitant use of other MAOI therapy or CNS depressants
Cirrhosis
Known hypersensitivity to phenelzine or any of its inactive ingredients
Pheochromocytoma
Warnings and precautions
Bronchospasm
•
Use caution with asthma or bronchitis.
Drug abuse
•
Use caution with a history of substance abuse.
Hypoglycemia
•
Use caution with diabetes mellitus.
Manic or mixed episodes
•
Use caution at risk for Bipolar disorder.
Seizures
•
Use caution with epilepsy or a pre-existing seizure disorder.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Do not use.
Unexplained abnormality in LFTs
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Monitor neonates for withdrawal symptoms. Neonates exposed to antidepressants late in the third trimester have shown drug withdrawal symptoms such as dyspnea, lethargy, colic irritability, hypotension or hypertension, and tremor or spasms.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Common 1-10%
•
Coma, ↓ WBC count, hyperreflexia, myoclonus, nystagmus, orthostatic hypotension, constipation, euphoria, serotonin syndrome
Rare < 0.1%
•
Hepatic necrosis, suicide attempt
Unknown frequency
•
Ataxia, coma, delirium, diaphoresis, drug withdrawal syndrome, drug-induced liver injury, dystonia, edema, hyperreflexia, hypertensive crisis, ↑ liver enzymes, jaundice, jaundice, laryngeal edema, metabolic syndrome, methemoglobinemia, muscle twitching, myoclonus, neuroleptic malignant syndrome, parkinsonism, peripheral neuropathy, psychosis, abdominal discomfort, anorgasmia, asthenia, depression, dizziness, dry mouth, erectile dysfunction, fatigue, fever, headache, ↑ appetite, mania, palpitations, priapism, seizure, skin rash, somnolence, suicidal ideation, tremor, urinary retention, visual disturbances, weight gain, respiratory depression, systemic lupus erythematosus, schizophrenia, tardive dyskinesia, vitamin B6 deficiency
Interactions
Drug(s)
Check Interactions
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