Nardil (phenelzine) is a monoamine oxidase inhibitor (MAOI) that has been forgotten by physicians because it was developed over five decades ago or ignored secondary to fear of drug/food interactions. This unfortunate neglect has failed treatment resistant patients who otherwise might have responded to Nardil.
Uses for Nardil
- Treatment resistant depression
- Atypical depression characterized by sluggishness, excessive sleep, weight gain, worry, hypochondria and a feeling of heaviness in the extremities
- Panic disorder
- Social anxiety disorder
- Dysthymia—a low-grade, lifetime unhappy mood
- Bulimia
Nardil Works By:
- Noradrenergic, serotonin and dopamine neurotransmission
- Increasing GABA level in the central nervous system resulting in suppression of anxiety, panic and stress
- Enhances phenethylamine (PEA) that contributes to overall antidepressant effects
Dosing:
- The initial dose is usually 15 mg three times daily
- If there is no response the dose can be gradually increased to a maximum dose of 90 mg daily in divided doses
- Half life is 11-12 hours
- May require several weeks of treatment to achieve full therapeutic effects
- Myths about the danger of tyramine can be exaggerated
Most Common Side Effects
- Although dietary and drug restrictions must be followed to prevent hypertensive crises and serotonin syndrome these side effects are rare
- Weight gain
- Hypotension when standing
- Dizziness
- Sedation
- Dry mouth
Hypertensive Crisis
Hypertensive crisis may result from the overconsumption of tyramine-containing foods. As a result, patients must avoid excess quantities of certain foods that contain tyramine such as:
- Aged cheeses
- Dried, smoked or fermented meat
- Broad bean pods
- Tap and unpasteurized beer
- Sauerkraut
- Soy products/tofu
- Banana peal
- Tyramine containing nutritional supplements
Medications to Avoid:
- SSRIs
- SNRIs
- Tricyclic antidepressants
- Phenylephrine
- Pseudoephedrine
- Methylphenidate
- Amphetamine
- Phentermine
- Opioids
- St John’s wort