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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548572_"><span class="title" itemprop="name">Tranylcypromine</span></h1><p class="fm-aai"><a href="#_NBK548572_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Tranylcypromine.OVERVIEW"><h2 id="_Tranylcypromine_OVERVIEW_">OVERVIEW</h2><div id="Tranylcypromine.Introduction"><h3>Introduction</h3><p>Tranylcypromine is a nonhydrazine monoamine oxidase inhibitor (MAO inhibitor) used in therapy of severe depression. Tranylcypromine therapy is associated with rare instances of clinically apparent acute liver injury.</p></div><div id="Tranylcypromine.Background"><h3>Background</h3><p>Tranylcypromine (tran" il sip' roe meen) is an antidepressant that acts through irreversible inhibition of monoamine oxidases, enzymes that inactivate several neurotransmitter amines such as norepinephrine and serotonin. Tranylcypromine is a nonspecific MAO inhibitor with activity against both MAO A (found in highest concentrations in the intestines) and MAO B (found largely in the brain and in platelets). By inhibition of catabolism of serotonin and norepinephrine, tranylcypromine increases brain levels of these neurotransmitters, actions which probably underlie its antidepressant effects. Tranylcypromine was approved for use as therapy of major depression in the United States in 1961, but it is now rarely used because of the availability of more potent and better tolerated antidepressants such as the tricyclic antidepressants and the selective serotonin reuptake inhibitors. Tranylcypromine is available in generic forms and under the brand name of Parnate as tablets of 10 mg. The usual adult dose of tranylcypromine is 30 to 60 mg daily in divided doses. Common side effects include drowsiness, dizziness, headache, insomnia, tremor, dry mouth, nausea, and sexual dysfunction. Tranylcypromine interacts with many medications as well as many foods and beverages, and patients require careful monitoring and education. Uncommon but potentially serious adverse events include hypertensive crises [often due to dietary tyramine], serotonin syndrome, withdrawal mania and hypersensitivity reactions.</p></div><div id="Tranylcypromine.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Tranylcypromine, like most monoamine oxidase inhibitors, can cause transient serum aminotransferase elevations in a proportion of patients. These elevations are usually mild, asymptomatic and self-limited and do not require dose modification. Tranylcypromine has also been associated with rare cases of acute, clinically apparent liver injury. The few cases described have resembled those caused by other MAO inhibitors. The time to clinical onset is typically 1 to 4 months and the usual pattern of serum enzyme elevations is hepatocellular (Case 1), although cholestatic injury has also been described. Immunoallergic features (rash, fever, eosinophilia) are uncommon as is autoantibody formation.</p><p>Likelihood score: D (possible rare cause of clinically apparent liver injury).</p></div><div id="Tranylcypromine.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The mechanism by which tranylcypromine causes serum aminotransferase elevation is not known. It undergoes extensive hepatic metabolism and a possible cause of liver injury is production of a toxic intermediate of metabolism. Unlike other nonselective MAO inhibitors, tranylcypromine is not a hydrazine derivative which may account in part for the apparent lower risk of hepatotoxicity compared to phenelzine.</p></div><div id="Tranylcypromine.Outcome_and_Management"><h3>Outcome and Management</h3><p>The serum aminotransferase elevations that occur on tranylcypromine therapy are usually transient and mild and do not require dose modification or discontinuation of therapy. The acute liver injury caused by tranylcypromine is typically self-limited, but progressive and fatal instances of acute hepatitis have been reported. Rechallenge usually causes a prompt recurrence of the liver injury and should be avoided. Patients with tranylcypromine induced liver injury are likely to have cross sensitivity to other monoamine oxidase inhibitors, but should be able to tolerate tricyclic antidepressants or selective serotonin reuptake inhibitors.</p><p>Drug Class: <a href="/books/n/livertox/Antidepressants/?report=reader">Antidepressant Agents</a></p><p>Other drugs in the Subclass, MAO Inhibitors: <a href="/books/n/livertox/Isocarboxazid/?report=reader">Isocarboxazid</a>, <a href="/books/n/livertox/Phenelzine/?report=reader">Phenelzine</a></p></div></div><div id="Tranylcypromine.CASE_REPORT"><h2 id="_Tranylcypromine_CASE_REPORT_">CASE REPORT</h2><div id="Tranylcypromine.Case_1_Acute_selflimited"><h3>Case 1. Acute self-limited hepatitis due to tranylcypromine.(<a class="bibr" href="#Tranylcypromine.REF.1" rid="Tranylcypromine.REF.1">1</a>)</h3><p>A 49 year old woman with recurrent depression was treated with tranylcypromine (20 mg per day) and developed fatigue after 6 and jaundice after 7 weeks of therapy. She had no history of liver disease, nor exposure to or risk factors for viral hepatitis, and drank minimal amounts of alcohol. She was not taking other medications. Physical examination showed jaundice and hepatomegaly, but no rash or fever. Blood tests showed elevations in serum enzymes and bilirubin levels of 14.9 mg/dL (Table). All medications were stopped and she began to improve with clearance of jaundice within a week. A liver biopsy showed inflammation, hepatocellular injury and intrahepatic cholestasis thought to be compatible with drug-induced liver injury. At 21 days after presentation, she was rechallenged with tranylcypromine for two days, developing nausea and vomiting with rise in AST levels from 19 U/L to 540 U/L without recurrence of jaundice (but a slight rise in direct bilirubin). A cholecystogram done after recovery was normal.</p><div id="Tranylcypromine.Key_Points"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figTranylcypromineTc"><a href="/books/NBK548572/table/Tranylcypromine.Tc/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figTranylcypromineTc" rid-ob="figobTranylcypromineTc"><img class="small-thumb" src="/books/NBK548572/table/Tranylcypromine.Tc/?report=thumb" src-large="/books/NBK548572/table/Tranylcypromine.Tc/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Tranylcypromine.Tc"><a href="/books/NBK548572/table/Tranylcypromine.Tc/?report=objectonly" target="object" rid-ob="figobTranylcypromineTc">Table</a></h4></div></div></div><div id="Tranylcypromine.Laboratory_Values"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figTranylcypromineTd"><a href="/books/NBK548572/table/Tranylcypromine.Td/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figTranylcypromineTd" rid-ob="figobTranylcypromineTd"><img class="small-thumb" src="/books/NBK548572/table/Tranylcypromine.Td/?report=thumb" src-large="/books/NBK548572/table/Tranylcypromine.Td/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Tranylcypromine.Td"><a href="/books/NBK548572/table/Tranylcypromine.Td/?report=objectonly" target="object" rid-ob="figobTranylcypromineTd">Table</a></h4></div></div></div><div id="Tranylcypromine.Comment"><h4>Comment</h4><p>The monoamine oxidase (MAO) inhibitors are not commonly used and most reported cases of hepatotoxicity were published before 1970. The described case is convincing because of the timing of onset and the response to rechallenge. The case report predates the availability of tests for hepatitis A, B and C and modern imaging methods that have made rechallenge less necessary in confirming the diagnosis. Several case reports have documented cross sensitivity to hepatic injury among the different MAO inhibitors.</p></div></div></div><div id="Tranylcypromine.PRODUCT_INFORMATION"><h2 id="_Tranylcypromine_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Tranylcypromine <i>–</i> Parnate®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Antidepressant Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=TRANYLCYPROMINE+SULFATE&pagesize=20&page=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Tranylcypromine.CHEMICAL_FORMULA_AND_STR"><h2 id="_Tranylcypromine_CHEMICAL_FORMULA_AND_STR_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figTranylcypromineTe"><a href="/books/NBK548572/table/Tranylcypromine.Te/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figTranylcypromineTe" rid-ob="figobTranylcypromineTe"><img class="small-thumb" src="/books/NBK548572/table/Tranylcypromine.Te/?report=thumb" src-large="/books/NBK548572/table/Tranylcypromine.Te/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Tranylcypromine.Te"><a href="/books/NBK548572/table/Tranylcypromine.Te/?report=objectonly" target="object" rid-ob="figobTranylcypromineTe">Table</a></h4></div></div></div><div id="Tranylcypromine.CITED_REFERENCE"><h2 id="_Tranylcypromine_CITED_REFERENCE_">CITED REFERENCE</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="Tranylcypromine.REF.1">Bandt C, Hofbauer FW. Liver injury associated with tranylcypromine therapy. <span><span class="ref-journal">JAMA. </span>1964;<span class="ref-vol">188</span>:752–3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14122685" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14122685</span></a>]</div></dd></dl></dl></div><div id="Tranylcypromine.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Tranylcypromine_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 08 April 2020</p><p>Abbreviations: MAO, monoamine oxidase; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and norepinephrine reuptake inhibitor.</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Tranylcypromine.REF.zimmerman.1999">Zimmerman HJ. Antidepressants. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 493-8.<div><i>(Expert review of hepatotoxicity published in 1999; hepatic injury caused by monoamine oxidase [MAO] inhibitors is similar to that of isoniazid with which they share structural similarity as hydrazines; the pattern of injury is typically hepatocellular and arises within 1-6 months of starting therapy; cases of fatal acute liver failure have been described most commonly with the initial MAO inhibitor, iproniazid, and less commonly with phenelzine and isocarboxazid, and least commonly with the nonhydrazide MAO inhibitor, tranylcypromine).</i></div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.larrey.2013">Larrey D, Ripault MP. Hepatotoxicity of psychotropic drugs and drugs of abuse. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 443-62.<div><i>(Review of hepatotoxicity of antidepressants mentions that among MAO inhibitors iproniazid most commonly caused liver injury and phenelzine rarely; tranylcypromine is not discussed).</i></div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.odonnell.2018">O'Donnell JM, Bies RR, Shelton RC. Drug therapy of depression and anxiety disorders. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 267-77.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.rosenblum.1960">Rosenblum LE, Korn LJ, Zimmerman HJ. Hepatocellular jaundice as a complication of iproniazid therapy. Arch Intern Med 1960; 105: 115-25. 14438978. [<a href="https://pubmed.ncbi.nlm.nih.gov/14438978" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14438978</span></a>]<div><i>(Classic paper on iproniazid hepatotoxicity; review of 90 patients; more common in women, ages 25-75 years, onset in 1-4 months [~95%], usually hepatocellular pattern similar to viral hepatitis, 22% mortality and demonstration that this is higher than in acute viral hepatitis).</i></div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.bandt.1964.752">Bandt C, Hofbauer FW. Liver injury associated with tranylcypromine therapy. <span><span class="ref-journal">JAMA. </span>1964;<span class="ref-vol">188</span>:752–3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14122685" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14122685</span></a>]<div>
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<i>(49 year old developed fatigue after 6 and jaundice after 7 weeks of tranylcypromine therapy [bilirubin 14.9 mg/dL, AST 670 U/L, Alk P 2x ULN], with rapid rise in AST [to ~600 U/L] with rechallenge: Case 1).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.holdsworth.1961.621">Holdsworth CD, Atkinson M, Goldie W. Hepatitis caused by the newer amine-oxidase-inhibiting drugs. <span><span class="ref-journal">Lancet. </span>1961;<span class="ref-vol">2</span>:621–3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/13715243" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 13715243</span></a>]<div>
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<i>(Four cases of severe liver injury with cross sensitivity to several MAO inhibitors including iproniazid, pheniprazine and nialamide; case 4 was 56 year old woman who developed jaundice and itching after 5 months of phenelzine [bilirubin 2.8 mg/dL, ALT 150 U/L Alk P 3 times ULN], resolving rapidly upon stopping).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.crisp.1961.17">Crisp AH, Hays P, Carter A. Three amine-oxidase inhibitor drugs in the treatment of depression. Relative value and toxic effects. <span><span class="ref-journal">Lancet. </span>1961;<span class="ref-vol">1</span>:17–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/13696480" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 13696480</span></a>]<div>
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<i>(Prospective study of liver test abnormalities during courses of iproniazid [n=17], nialamide [18] and peniprazine [20] with minor enzyme increases noted; no data on frequency of levels above normal).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.cook.1965.175">Cook GC, Sherlock S. Jaundice and its relation to therapeutic agents. <span><span class="ref-journal">Lancet. </span>1965;<span class="ref-vol">1</span>:175–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14238042" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14238042</span></a>]<div>
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<i>(Summary of cases of drug induced liver disease seen at Royal Free Hospital from 1959-65; 11 cases of acute liver failure due to drugs including iproniazid [n=3], phenelzine [2], phenoxypropazine [2], prochlorperazine [1], and halogenated anesthetics [3]; 20 cases of cholestatic hepatitis due to drugs, 18 due to chlorpromazine, 1 perphenazine and 1 nitrofurantoin).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.steingart.1995.1407">Steingart AB, Cotterchio M. Do antidepressants cause, promote, or inhibit cancers? <span><span class="ref-journal">J Clin Epidemiol. </span>1995;<span class="ref-vol">48</span>:1407–12.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7490604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7490604</span></a>]<div>
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<i>(Conflicting data from animal studies and epidemiological surveys have provided little evidence of a link between antidepressant use and breast, liver or other cancer after control for confounding variables).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.lucena.2003.249">Lucena MI, Carvajal A, Andrade RJ, Velasco A. Antidepressant-induced hepatotoxicity. <span><span class="ref-journal">Expert Opin Drug Saf. </span>2003;<span class="ref-vol">2</span>:249–62.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12904104" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12904104</span></a>]<div>
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<i>(Review of hepatotoxicity of antidepressants; antidepressant use has increased markedly between 1992 and 2002, accounting for 5% of cases of hepatotoxicity; MAO inhibitors were first antidepressants developed; iproniazid caused a severe hepatitis and was withdrawn; phenelzine is still in use, but has been associated with severe cases of hepatitis and development of cirrhosis).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.chalasani.2008.1924">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. <span><span class="ref-journal">Gastroenterology. </span>2008;<span class="ref-vol">135</span>:1924–34.</span> [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div>
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<i>(Among 300 cases of drug induced liver disease in the US collected from 2004 to 2008, none were attributed to tranylcypromine or other MAO inhibitors).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.shulman.2013.789">Shulman KI, Herrmann N, Walker SE. Current place of monoamine oxidase inhibitors in the treatment of depression. <span><span class="ref-journal">CNS Drugs. </span>2013;<span class="ref-vol">27</span>:789–97.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23934742" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23934742</span></a>]<div>
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<i>(History of the discovery that hydrazine-based drugs had potent antidepressant activity and subsequent development of nonspecific and specific, irreversible and reversible MAO A and B inhibitors which have similar antidepressant effects but different relative risks for complications such as hypertension from dietary intake of tyramine [as in aged cheese] and serotonin syndrome from use of a second serotonin-enhancing agent, such as a tricyclic, SSRI or SNRI as well as some opiates).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.hern_ndez.2014.231">Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A, Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America. An analysis of published reports. <span><span class="ref-journal">Ann Hepatol. </span>2014;<span class="ref-vol">13</span>:231–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div>
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<i>(Systematic review of literature of drug induced liver injury in Latin American countries published from 1996 to 2012 identified 176 cases, only one of which was attributed to an antidepressant [amitriptyline] and none to a MAO inhibitor, SSRI or SNRI).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.heijnen.2015.700">Heijnen WT, De Fruyt J, Wierdsma AI, Sienaert P, Birkenhäger TK. Efficacy of tranylcypromine in bipolar depression: a systematic review. <span><span class="ref-journal">J Clin Psychopharmacol. </span>2015;<span class="ref-vol">35</span>:700–5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26479223" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26479223</span></a>]<div>
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<i>(Systematic review identified 4 studies in 145 patients showing a 74% response rate overall and conversion to mania in 6% of patients, but no discussion or adverse events or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.chalasani.2015.1340">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:1340–52.e7.</span> [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div>
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<i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 20 cases [2%] were attributed to antidepressants including 9 due to SNRIs [7 to duloxetine, 1 each to nefazodone and trazodone], 5 to bupropion, 5 to SSRIs [3 to escitalopram, and 1 each to fluoxetine and sertraline], and only 1 to tricyclics [imipramine] but none to MAO inhibitors).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.voican.2016.e0155234">Voican CS, Martin S, Verstuyft C, Corruble E, Perlemuter G, Colle R. Liver function test abnormalities in depressed patients treated with antidepressants: a real-world systematic observational study in psychiatric settings. <span><span class="ref-journal">PLoS One. </span>2016;<span class="ref-vol">11</span>:e0155234. </span> [<a href="/pmc/articles/PMC4865191/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4865191</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27171561" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27171561</span></a>]<div>
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<i>(Among 321 psychiatric inpatients, only 116 [36%] had liver tests performed and only 18 during therapy with an antidepressant, 3 of which were suspected to have drug induced liver injury, 1 each with escitalopram, venlafaxine and amitriptyline, all without jaundice and 2 without symptoms, all 3 resolving).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.friedrich.2016.pyv126">Friedrich ME, Akimova E, Huf W, Konstantinidis A, Papageorgiou K, Winkler D, Toto S, et al. Drug-induced liver injury during antidepressant treatment: results of AMSP, a drug surveillance program. <span><span class="ref-journal">Int J Neuropsychopharmacol. </span>2016;<span class="ref-vol">19</span>(4):pyv126. </span> pii. [<a href="/pmc/articles/PMC4851269/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4851269</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26721950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26721950</span></a>]<div>
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<i>(Among 184,234 psychiatric inpatients from 80 hospitals, 149 cases [0.08%] of drug induced liver injury were reported including 22 of 70,060 [0.03%] receiving SSRIs, 71 of 50,201 [0.14%] patients treated with tricyclics and 3 of 3869 receiving MAO inhibitors [0.08%]).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.chen.2017.30464">Chen VC, Lin CF, Hsieh YH, Liang HY, Huang KY, Chiu WC, Lee Y, McIntyre RS, et al. Hepatocellular carcinoma and antidepressants: a nationwide population-based study. <span><span class="ref-journal">Oncotarget. </span>2017;<span class="ref-vol">8</span>:30464–70.</span> [<a href="/pmc/articles/PMC5444756/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5444756</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27783998" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27783998</span></a>]<div>
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<i>(Among almost 50,000 cases of hepatocellular carcinoma registered in the Taiwan National Health Insurance Research Database, the rate of antidepressant use was lower than in approximately 250,000 matched controls from the database).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.ulrich.2017.697">Ulrich S, Ricken R, Adli M. Tranylcypromine in mind (Part I): Review of pharmacology. <span><span class="ref-journal">Eur Neuropsychopharmacol. </span>2017;<span class="ref-vol">27</span>:697–713.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28655495" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28655495</span></a>]<div>
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<i>(Review of the mechanism of action, pharmacology and toxicity of tranylcypromine).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.ricken.2017.714">Ricken R, Ulrich S, Schlattmann P, Adli M. Tranylcypromine in mind (Part II): Review of clinical pharmacology and meta-analysis of controlled studies in depression. <span><span class="ref-journal">Eur Neuropsychopharmacol. </span>2017;<span class="ref-vol">27</span>:714–31.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28579071" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28579071</span></a>]<div>
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<i>(Review of the clinical efficacy and adverse events of tranylcypromine therapy mentions that the most common adverse events are dizziness, sedation, insomnia, headache and dry mouth and that weight gain and hypertension are uncommon; no mention of hepatotoxicity or ALT elevations).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.ferrajolo.2018.95">Ferrajolo C, Scavone C, Donati M, Bortolami O, Stoppa G, Motola D, Vannacci A, et al. DILI-IT Study Group. Antidepressant-Induced Acute liver injury: a case-control study in an Italian inpatient population. <span><span class="ref-journal">Drug Saf. </span>2018;<span class="ref-vol">41</span>:95–102.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28770534" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28770534</span></a>]<div>
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<i>(Among 179 cases of hospitalizations for unexplained acute liver injury enrolled in an Italian prospective study between 2010 and 2014, 17 had been exposed to antidepressants the major implicated agents being citalopram [n=4], sertraline [n=3], paroxetine [n=3], tricyclics [n=2], trazodone [n=1], fluoxetine [n=1], and duloxetine [n=1]; no MAO inhibitors listed).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.billioti_de_gage.2018.673">Billioti de Gage S, Collin C, Le-Tri T, Pariente A, Bégaud B, Verdoux H, Dray-Spira R, et al. Antidepressants and hepatotoxicity: a cohort study among 5 million individuals registered in the French National Health Insurance Database. <span><span class="ref-journal">CNS Drugs. </span>2018;<span class="ref-vol">32</span>:673–84.</span> [<a href="/pmc/articles/PMC6061298/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6061298</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29959758" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29959758</span></a>]<div>
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<i>(Among 5 million persons identified in a national French health insurance database who started an antidepressant between 2010 and 2015, 382 developed serious liver injury resulting in hospitalization, rates per 100,0000 persons-years being 19 for SSRIs, 22 venlafaxine, 13 duloxetine, and 33 mirtazapine; no MAO inhibitors discussed).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.van_der_heide.2018.544">van der Heide D, Merckelbach H, van Harten P. <span><span class="ref-journal">Tijdschr Psychiatr. </span>2018;<span class="ref-vol">60</span>:544–7.</span> [Tranylcypromine and khat: a potentially fatal combination] [<a href="https://pubmed.ncbi.nlm.nih.gov/30132583" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30132583</span></a>]<div>
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<i>(30 year old immigrant from East Africa to the Netherlands was treated with low doses of tranylcypromine and developed a severe headache and inability to speak after chewing 8 leaves of khat but then spontaneously recovered without residual neurologic defects, and was diagnosed as have hypertension related reversible cerebral vasoconstriction syndrome perhaps related to the inhibition of MAO and neurotransmitter substances in khat).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF.ferreiragarcia.2018.502">Ferreira-Garcia R, da Rocha Freire RC, Appolinário JC, Levitan MN, Halkjær-Lassen RD, Bueno JR, Nardi AE. Tranylcypromine plus amitriptyline for electroconvulsive therapy-resistant depression: A Long-Term Study. <span><span class="ref-journal">J Clin Psychopharmacol. </span>2018;<span class="ref-vol">38</span>:502–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30106881" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30106881</span></a>]<div>
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<i>(Among 30 patients with resistant depression treated with the combination of tranylcypromine and amitriptyline, adverse events were common [dizziness, headache, dry mouth, nausea, sexual dysfunction] but generally mild, and there were no severe adverse events, no hypertensive crises, new onset hypertension or serotonin syndrome; no mention of hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Tranylcypromine.REF26">Drugs for depression. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2020;<span class="ref-vol">62</span>(1592):25–32.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32320387" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32320387</span></a>]<div>
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<i>(Concise review of the mechanism of action, clinical efficacy, safety and costs of drugs for depression, mentions that tricyclics and MAO inhibitors remain valuable alternatives for treatment of moderate-to-severe depression, despite concerns about their safety; hepatotoxicity is mentioned only for nefazodone [now rarely used because of severe hepatotoxicity] and duloxetine [in heavy drinkers]).</i>
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</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548572_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">April 8, 2020</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Tranylcypromine. [Updated 2020 Apr 8].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Transplant_Drugs/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/Trastuzumab/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobTranylcypromineTc"><div id="Tranylcypromine.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548572/table/Tranylcypromine.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Tranylcypromine.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Tranylcypromine.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_Tranylcypromine.Tc_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tranylcypromine (20-30 mg daily)</td></tr><tr><th id="hd_b_Tranylcypromine.Tc_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_Tranylcypromine.Tc_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hepatocellular (R=9)</td></tr><tr><th id="hd_b_Tranylcypromine.Tc_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_Tranylcypromine.Tc_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3+ (jaundice, hospitalization)</td></tr><tr><th id="hd_b_Tranylcypromine.Tc_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Latency:</th><td headers="hd_b_Tranylcypromine.Tc_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 weeks initially, within 24 hours on rechallenge</td></tr><tr><th id="hd_b_Tranylcypromine.Tc_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_Tranylcypromine.Tc_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">~1 month</td></tr><tr><th id="hd_b_Tranylcypromine.Tc_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_Tranylcypromine.Tc_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None mentioned</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobTranylcypromineTd"><div id="Tranylcypromine.Td" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548572/table/Tranylcypromine.Td/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Tranylcypromine.Td_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_Tranylcypromine.Td_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_Tranylcypromine.Td_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_Tranylcypromine.Td_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">ALT<br />(U/L)</th><th id="hd_h_Tranylcypromine.Td_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(KA U/L)</th><th id="hd_h_Tranylcypromine.Td_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Bilirubin<br />(mg/dL)</th><th id="hd_h_Tranylcypromine.Td_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1 hd_h_Tranylcypromine.Td_1_1_1_2 hd_h_Tranylcypromine.Td_1_1_1_3 hd_h_Tranylcypromine.Td_1_1_1_4" colspan="4" scope="col" rowspan="1" style="text-align:center;vertical-align:top;">Tranylcypromine taken for 7 weeks</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 weeks</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">670</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">26.5</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">14.9</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 weeks</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">410</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">5.0</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 weeks</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">340</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3.2</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 weeks</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">36</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">6.5</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.9</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1 hd_h_Tranylcypromine.Td_1_1_1_2 hd_h_Tranylcypromine.Td_1_1_1_3 hd_h_Tranylcypromine.Td_1_1_1_4" colspan="4" scope="col" rowspan="1" style="text-align:center;vertical-align:top;">Tranylcypromine restarted for 2 days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 weeks (0)</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.6</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Rechallenge</td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 (0) days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">540</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.1</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 (<a class="bibr" href="#Tranylcypromine.REF.1" rid="Tranylcypromine.REF.1">1</a>) day</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">420</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 (2) days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">200</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.5</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 (3) days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">67</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 (4) days</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">31</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.4</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Tranylcypromine.Td_1_1_1_1 hd_h_Tranylcypromine.Td_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
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<b>Normal Values</b>
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</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><35</b>
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</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><13</b>
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</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><1.2</b>
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</td><td headers="hd_h_Tranylcypromine.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Dates and values estimated from Figure 1. Numbers in parentheses are days after starting and stopping rechallenge doses.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobTranylcypromineTe"><div id="Tranylcypromine.Te" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548572/table/Tranylcypromine.Te/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Tranylcypromine.Te_lrgtbl__"><table><tbody><tr><th id="hd_b_Tranylcypromine.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_b_Tranylcypromine.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_b_Tranylcypromine.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_b_Tranylcypromine.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr><tr><td headers="hd_b_Tranylcypromine.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tranylcypromine</td><td headers="hd_b_Tranylcypromine.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134974261" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">95-62-5</a>
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</td><td headers="hd_b_Tranylcypromine.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C9-H11-N</td><td headers="hd_b_Tranylcypromine.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134974261" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134974261" alt="image 134974261 in the ncbi pubchem database" /></a>
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