[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Monoamine oxidase inhibitors (MAOIs)](https://durgical.com/en/pharmacology/classes/monoamine-oxidase-inhibitors/) › Tranylcypromine

# Tranylcypromine

## MAOIs?

Monoamine oxidase inhibitors (MAOIs)

An irreversible MAO inhibitor for depression that has not responded to other drugs. Needs a low-tyramine diet and many drug precautions.

Updated Nov 12, 2026

## Quick facts

**Group**
[Monoamine oxidase inhibitors (MAOIs)](https://durgical.com/en/pharmacology/classes/monoamine-oxidase-inhibitors/)

**Target**
Monoamine oxidase A and B

**Used for**
Depression that has not improved

**Key effects**
Dizziness on standing · Drowsiness or insomnia

**Monitor**
Blood pressure · Mood and suicidal thoughts

**ATC**
N06AF04

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

✂**Monoamine oxidase A and B**Tranylcypromine

ⓘ The figure shows human MAO-B after tranylcypromine has reacted with it: the drug is bound to the FAD cofactor in the active site (as a phenylpropanal adduct).

**Target in 3D:** Monoamine oxidase A and B. PDB structure 2XFU (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/2XFU) · Drag to rotate · pinch to zoom

Tranylcypromine, a non-hydrazine MAO inhibitor structurally related to amphetamine, binds monoamine oxidase A and B irreversibly. Serotonin, noradrenaline and dopamine are no longer broken down inside neurons, so more is stored and released. Gut and liver MAO-A also stop destroying dietary tyramine, which can then release noradrenaline and cause a hypertensive crisis. Enzyme activity returns only as new MAO is made, so the effect lasts for some time after stopping.

- Binds MAO-A and MAO-B irreversibly
- Serotonin, noradrenaline and dopamine accumulate
- Gut MAO no longer clears dietary tyramine
- Recovery needs new enzyme, after stopping

## Indications

- Depression that has not improved with other medicines [Major depressive disorder →](https://durgical.com/en/conditions/major-depressive-disorder/)

## Adverse effects

### Common

- Dizziness on standing
- Drowsiness or insomnia, restlessness
- Dry mouth, constipation or diarrhoea
- Tremor, muscle jerks, tingling
- Sexual dysfunction

### Serious (rare, important)

- Hypertensive crisis after tyramine-rich food or interacting drugs: sudden severe headache, pounding heart, chest pain, stiff neck, sweating (boxed warning)
- Serotonin syndrome with serotonergic drugs
- Suicidal thoughts in children and young adults (boxed warning)
- Liver injury (yellow skin or eyes, right upper abdominal pain)

## Contraindications

- Phaeochromocytoma or other catecholamine-releasing paraganglioma
- Other antidepressants (other MAOIs, SSRIs, SNRIs, tricyclics, bupropion, vortioxetine and others), triptans, amphetamines and methylphenidate
- Sympathomimetic decongestants and weight-loss products (pseudoephedrine, phenylephrine, ephedrine)
- Pethidine (meperidine), dextromethorphan, tapentadol, buspirone, carbamazepine, levodopa, methyldopa, reserpine, tryptophan

## Key interactions

**Tyramine-rich foods (aged cheese, cured or spoiled meat and fish, fermented products, some alcoholic drinks)**
Hypertensive crisis; the diet continues for two weeks after the last dose.

**SSRIs, SNRIs, tricyclics, pethidine, dextromethorphan, tryptophan**
Serotonin syndrome; a washout is needed in both directions when switching.

**Decongestants, amphetamines and other sympathomimetics**
Dangerous rise in blood pressure.

**Alcohol and other CNS depressants**
Used with caution: more drowsiness.

## What is monitored

- Blood pressure, often
- Mood and suicidal thoughts
- Diet and every new medicine, including over-the-counter cough and cold products
- Signs of liver injury

## Administration and safety

- Oral tablet; the dose is raised slowly, no more often than every one to three weeks.
- Not stopped suddenly; it is tapered.
- At least one week passes after stopping before another MAOI or a contraindicated antidepressant is started.
- Stopped at least ten days before elective surgery; anaesthetic and pain drugs are checked for interactions.

## Pregnancy and breastfeeding

Limited reports describe placental problems and congenital anomalies; pregnant women are told of the possible risk to the fetus.

## Nursing care

- Before: give a written list of foods and medicines to avoid.
- During: measure blood pressure regularly; teach the warning signs of a hypertensive crisis.
- Teach to rise slowly and to avoid alcohol and caffeine excess.
- Ask about mood, sleep and suicidal thoughts.

## Pharmacokinetics

**Absorption**
Oral tablet.

**Onset and duration**
Full antidepressant effect may take three weeks or longer; the enzyme effect persists after the drug is stopped.

## Memory aid

TRANYLcypromine needs TRANquil food: no aged cheese, cured meat or tap beer.

## Test yourself

Think of the answer, then tap the question to see it.

## Why can cheese cause a hypertensive crisis in a patient on tranylcypromine?

Gut and liver MAO-A no longer break down dietary tyramine, which then releases noradrenaline from nerve endings.

## Why do the precautions continue for weeks after the drug is stopped?

Inhibition is irreversible; MAO activity returns only as new enzyme is made.

## Which cough suppressant must be avoided with MAO inhibitors?

Dextromethorphan (serotonin syndrome).

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/tranylcypromine/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Phenelzine](https://durgical.com/en/pharmacology/phenelzine/)
- [Selegiline](https://durgical.com/en/pharmacology/selegiline/)
- [Fluoxetine](https://durgical.com/en/pharmacology/fluoxetine/)

## Related conditions 1

- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)

[← Back to the class: Monoamine oxidase inhibitors (MAOIs)](https://durgical.com/en/pharmacology/classes/monoamine-oxidase-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Tranylcypromine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682088.html) (MedlinePlus (U.S. National Library of Medicine), 2017); [TRANYLCYPROMINE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3c14a558-2df4-4d93-97dd-640dec6ee785) (DailyMed (U.S. National Library of Medicine), 2024); [Human monoamine oxidase B with tranylcypromine](https://www.rcsb.org/structure/2XFU) (RCSB Protein Data Bank, 2010); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N06AF04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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