Tranylcypromine

INTRODUCTION

Indications

Treatment of major depressive episode without melancholia (usually reserved for patients who do not tolerate or respond to other modes of therapy [e.g., tricyclic antidepressants, SSRIs, SSNRIs, or electroconvulsive therapy]).

Action

Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the body. Therapeutic Effects: Improved mood in depressed patients.

Adverse Reactions/Side Effects

CNS: SEIZURES, confusion, dizziness, drowsiness, headache, insomnia, restlessness, tremor, paresthesia, weakness. EENT: blurred vision, tinnitus. CV: HYPERTENSIVE CRISIS, edema, orthostatic hypotension, tachycardia. GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, hepatitis, nausea. GU: sexual dysfunction, urinary retention. Hemat: AGRANULOCYTOSIS, leukopenia, thrombocytopenia. Derm: alopecia, rashes. MS: muscle spasm.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Measure blood pressure (BP) periodically and compare to normal values (See Appendix F). Immediately report a large, rapid increase in BP (hypertensive crisis). Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, neck stiffness, sweating, and enlarged pupils. The risk of hypertensive crisis is increased when this drug is taken with other antidepressants, excessive caffeine, other drugs that increase BP, or foods that contain tyramine (e.g., fermented wines, cheeses).

• Watch for signs of agranulocytosis and leukopenia (fever, sore throat, mucosal lesions, other signs of infection) and thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs to the physician immediately.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression.

• Be alert for restlessness, confusion, or other alterations in mood and behavior (See Appendix D). Notify health care professional if these symptoms become problematic.

• Assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess paresthesias (numbness, tingling), tremor, or muscle spasms. Perform objective tests, including electroneuromyography and sensory testing, ...