Key points
- It is for adults with major depressive disorder who have not responded adequately to other antidepressants, not for first treatment.
- The boxed warning has two parts: suicidal thoughts in young people, and hypertensive crisis from tyramine or certain medicines.
- Many medicines are contraindicated, including other antidepressants, stimulants, triptans and many cold products.
- Food limits continue for two weeks after treatment ends.
- The label reports misuse and withdrawal effects, so it should not be stopped suddenly.
What tranylcypromine is
Tranylcypromine is a tablet in the monoamine oxidase inhibitor (MAOI) group of antidepressants. It is sold as Parnate and as a generic.
NIMH says older antidepressants such as MAOIs are associated with more side effects, while still suiting some people. When earlier medicines have not brought enough relief, it can be encouraging to know there are further options to talk about, along with a clear view of what each one asks of you.
Approved use, and why it is not a first choice
The FDA label says tranylcypromine is for major depressive disorder in adults who have not responded adequately to other antidepressants. It says it is not for first treatment, because of possible serious reactions and drug interactions and the need for food limits. It is not approved for children.
MedlinePlus says it is sometimes prescribed for other uses without naming them, so this page does not list any.
How it is thought to work
The label says its antidepressant action is not fully understood, but is presumed to come from permanently blocking the enzyme monoamine oxidase, which strengthens the activity of chemical messengers in the brain. The drug itself leaves the body quickly, but the label says this enzyme effect may last up to 10 days after treatment ends. That is why food and medicine limits continue after the last tablet.
What taking it can be like
MedlinePlus says it may take 3 weeks or longer to feel the full benefit. You will likely think about food more than usual. The label says to avoid these high-tyramine items during treatment and for 2 weeks after:
- Air-dried, aged or fermented meats, sausages and salamis, pickled herring, and any spoiled or poorly stored meat, poultry, fish or liver.
- Aged cheeses and fava bean pods.
- Tap beer and unpasteurized beer, and excessive caffeine.
- Concentrated yeast extract, sauerkraut, most soybean products such as soy sauce and tofu, chocolate, and supplements containing tyramine.
- Alcohol is not recommended with this medicine.
Side effects and warnings
Boxed warning on suicide risk: antidepressants increased the risk of suicidal thoughts and behaviors in children and young adults in short-term studies, and all patients should be closely watched for worsening mood. If you have thoughts of suicide or are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page has more.
Boxed warning on hypertensive crisis: too much tyramine from food or drink, or certain medicines during or after treatment, can cause a sudden, severe rise in blood pressure. The label says this can lead to stroke and death. Signs can include a severe headache, pounding or changed heartbeat, stiff or sore neck, nausea, vomiting, sweating, wide pupils, light sensitivity, chest pain, shortness of breath or confusion. Call 911 if these occur. People with an overactive thyroid may be at greater risk.
The label says it must not be used with other MAOIs, SSRIs, SNRIs, tricyclics, other antidepressants such as bupropion and trazodone, amphetamines and methylphenidate, triptans, many cold, hay fever and weight products, buspirone, dextromethorphan, meperidine, carbamazepine, and tryptophan, among others. Check any over-the-counter medicine or supplement with a healthcare provider first. It is also contraindicated with pheochromocytoma and related tumors.
MedlinePlus lists drowsiness, weakness, dry mouth, loss of appetite, diarrhea, constipation, stomach pain, blurred vision, ringing in the ears, muscle jerks, shaking, tingling, trouble urinating, sexual problems, hair loss and rash.
Other label warnings include low blood pressure and fainting, mania in people with bipolar disorder, liver problems, low blood sugar in people with diabetes, and seizures. Tell any surgeon or dentist you take it, because the label calls for planning before elective surgery. Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.
Do not stop tranylcypromine without talking to your prescriber. The label reports dizziness, nausea, headache, irritability, trouble sleeping, anxiety and more after stopping abruptly, and sometimes delirium or rapid return of depression. It also says misuse has been reported, some in people with a history of substance use, and MedlinePlus says it may be habit-forming. Take it only as prescribed.
Managing tranylcypromine online in Pennsylvania and New York
Tranylcypromine is taken at home, and its label does not limit it to a certified healthcare setting. Still, the boxed warning says blood pressure should be monitored, and a video visit cannot do that directly. Ask how blood pressure checks would be arranged. A suspected hypertensive crisis needs 911 and emergency care, not an online visit.
A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, offers online depression treatment by secure video for people physically located in Pennsylvania or New York during each visit. Learn what follow-up involves on our medication management page. 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. Asking questions is a strong and useful step.
Common questions
Why is tranylcypromine not used first for depression?
The label says it is not for first treatment because of its potential for serious reactions and drug interactions and the need for food limits. It is approved for adults with major depressive disorder who have not responded adequately to other antidepressants. Your prescriber can go over what you have already tried and what the next options are.
Is bottled beer or wine allowed with tranylcypromine?
The label says bottled and canned beers and wines contain little or no tyramine, while tap and unpasteurized beers are high in it. It also says using alcohol with this medicine is not recommended at all. So low tyramine does not make drinking advisable. Talk with your prescriber openly about alcohol before making any decision.
How long do the food limits last after treatment?
The label says to avoid foods and drinks with significant tyramine during treatment and for 2 weeks after. It also says the effect on the enzyme may last up to 10 days after treatment ends, even though the drug leaves the body quickly. Tell any new prescriber that you took it recently, so they can plan around it.
Sources
Published by Locascio Wellness. Published November 5, 2026. Clinically reviewed by Kenneth M. Levy, DO, Psychiatrist (Pennsylvania license OS007464L). This page is general information, not medical advice or a diagnosis.