Phenelzine (Nardil): Uses, Food Rules and Drug Warnings

What phenelzine is

Phenelzine is a tablet in the group called monoamine oxidase inhibitors (MAOIs). It is sold as Nardil and as a generic. NIMH says older antidepressants such as MAOIs are associated with more side effects than those prescribed most often, while still being a good fit for some people.

For people who have tried several medicines without enough relief, hearing that an older option exists can bring some hope. It also comes with more rules than most medicines, so this page spends time on what those rules are.

What it is approved for, and off-label uses

The FDA label says phenelzine has been found effective in depressed people described as atypical, nonendogenous or neurotic, who often have mixed anxiety and depression along with phobic or hypochondriacal features. Evidence is less conclusive for severe depression with endogenous features.

The label says it should rarely be the first antidepressant used, and is more suitable for people who have not responded to the more common medicines. MedlinePlus agrees that it is used for depression in people who have not been helped by other medicines. The label says it is not approved for any use in children. Although the label mentions anxiety as a feature of the depressed patients studied, anxiety alone is not a listed use. MedlinePlus names no specific off-label use, so this page does not list any.

How it is thought to work

Phenelzine strongly blocks monoamine oxidase, an enzyme found throughout the body. The label says it is not known whether blocking this enzyme, its other actions or both account for its effects. The label links this medicine to dangerous reactions with foods high in tyramine, which is why the food rules below matter.

What taking it can be like

MedlinePlus says it may take 4 weeks or longer to feel the full benefit, and that a prescriber will usually raise the amount slowly. The label says side effects tend to be mild or moderate and often ease as treatment continues.

Daily life changes too, especially at the grocery store and the pharmacy. The label says all patients should avoid these foods and drinks while taking it and for two weeks after:

• Pickled herring, liver, dry sausage such as Genoa or hard salami and pepperoni, and meat extract.
• Cheese, except cottage cheese and cream cheese, and yogurt.
• Fava bean pods and sauerkraut.
• Beer and wine, including alcohol-free and reduced-alcohol versions, and yeast extract.
• Excessive chocolate and caffeine.
• Any spoiled or poorly stored protein food, or food changed by aging, pickling, fermenting or smoking.

Side effects and warnings

Boxed warning: antidepressants increased the risk of suicidal thoughts and behavior in children, teens and young adults in short-term studies. That increase was not seen in adults over 24, and adults 65 and older had a lower risk. Close observation matters at any age. If you are in crisis or thinking about suicide, call or text 988, or call 911. Locascio Wellness does not provide emergency services. See our crisis resources too.

The most serious reaction is a hypertensive crisis, a sudden dangerous rise in blood pressure that has sometimes been fatal. Signs include a headache at the back of the head, pounding heartbeat, stiff or sore neck, nausea, vomiting, sweating, wide pupils and light sensitivity. Chest pain can occur. Treat these as an emergency and call 911. The label says palpitations or frequent headaches are a reason for prescribers to end treatment immediately, so report them right away.

Medicines matter just as much as food. The label says to avoid over-the-counter cold, cough, nasal, sinus, hay fever, asthma inhaler, appetite and weight products, and tryptophan. It also lists stimulants and other sympathomimetic drugs, dextromethorphan, meperidine, buspirone, SSRIs and other serotonin medicines, other MAOIs, and alcohol. Combinations with tricyclic antidepressants call for a warning from the prescriber. Always tell every doctor and dentist you see, and check before taking anything new.

The label says not to use it with pheochromocytoma (a rare gland tumor), congestive heart failure, severe kidney disease, a history of liver disease or abnormal liver tests.

Common effects include dizziness, headache, drowsiness, sleep changes, tiredness, weakness, shaking, constipation, dry mouth, weight gain, dizziness on standing, swelling and sexual problems. Do not stop it without talking to your prescriber: the label reports an uncommon withdrawal syndrome after abrupt stopping, from nightmares and agitation to psychosis and seizures. Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.

Can it be managed online in Pennsylvania and New York

Phenelzine tablets are taken at home, and the label does not limit them to a certified healthcare setting. But the label says blood pressure should be observed frequently in everyone taking it, and a video visit cannot measure blood pressure. Ask how that would be handled, including whether you would use a home monitor or see a local clinician. An emergency reaction always needs 911, not a video visit.

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, offers online depression treatment and medication management by secure video for people physically located in Pennsylvania or New York during each visit. Our therapists do not prescribe.

Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help through our medication contact form.