Tranylcypromine (DB00752): A Comprehensive Clinical and Pharmacological Monograph

Executive Summary

Tranylcypromine is a potent, non-selective, and irreversible monoamine oxidase inhibitor (MAOI) with a unique chemical structure derived from amphetamine.[1] First approved by the U.S. Food and Drug Administration (FDA) in 1961, it occupies a critical, albeit niche, position in the psychiatric armamentarium.[3] Its primary clinical indication is for the treatment of major depressive disorder (MDD) in adult patients who have not responded adequately to other antidepressant therapies.[4] It is particularly valued for its high efficacy in cases of treatment-resistant depression (TRD) and atypical depression, where its broad mechanism of action may succeed after more selective agents have failed.[1]

The therapeutic utility of tranylcypromine is inextricably linked to a demanding and complex safety profile. Its irreversible inhibition of MAO necessitates strict adherence to a tyramine-restricted diet to prevent potentially fatal hypertensive crises.[1] Furthermore, its co-administration with a wide range of medications, particularly serotonergic agents like selective serotonin reuptake inhibitors (SSRIs), is absolutely contraindicated due to the risk of life-threatening serotonin syndrome.[1] These risks mandate a high level of expertise from the prescribing clinician and a deep commitment to education and adherence from the patient.