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All about: Nardil

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Generic name: Phenelzine sulfate
Brand names: Nardil

Why is Nardil prescribed?

Nardil is a monoamine oxidase (MAO) inhibitor used to treat depression as well as anxiety or phobias mixed with depression. MAO is an enzyme responsible for breaking down certain neurotransmitters (chemical messengers) in the brain. By inhibiting MAO, Nardil helps restore more normal mood states. Unfortunately, MAO inhibitors such as Nardil also block MAO activity throughout the body, an action that can have serious, even fatal, side effects--especially if MAO inhibitors are combined with other foods or drugs containing a substance called tyramine.

Most important fact about Nardil

Avoid the following foods, beverages, and medications while taking Nardil and for 2 weeks after stopping it:

Beer (including alcohol-free or reduced-alcohol beer)
Caffeine (in excessive amounts)
Cheese (except for cottage cheese and cream cheese)
Chocolate (in excessive amounts)
Dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna)
Fava bean pods
Liver
Meat extract
Pickled herring
Pickled, fermented, aged, or smoked meat, fish, or dairy products
Sauerkraut
Spoiled or improperly stored meat, fish, or dairy products
Wine (including alcohol-free or reduced-alcohol wine)
Yeast extract (including large amounts of brewer's yeast)
Yogurt

Medications to avoid:

Amphetamines
Appetite suppressants such as Redux and Tenuate
Antidepressants and related medications such as Celexa, Effexor, fluvoxamine, Paxil, Prozac, Remeron, Serzone, Wellbutrin, Zoloft, Elavil, Triavil, Tegretol, and Flexeril
Asthma inhalants such as Proventil and Ventolin
Cold and cough preparations including those with dextromethorphan, such as Robitussin DM
Hay fever medications such as Contac and Dristan
L-tryptophan-containing products
Nasal decongestants in tablet, drop, or spray form such as Sudafed
Sinus medications such as Sinutab
Stimulants such as Ritalin and epinephrine (EpiPen)

Taking Nardil with any of the above foods, beverages, or medications can cause serious, potentially fatal, high blood pressure. Therefore, when taking Nardil you should immediately report the occurrence of a headache, heart palpitations, or any other unusual symptom. In addition, make certain that you inform any other physician or dentist you see that you are currently taking Nardil or have taken Nardil within the last 2 weeks.

How should you take Nardil?

Nardil may be taken with or without food. Take it exactly as prescribed. It can take up to 4 weeks for the drug to begin working.

Use of Nardil may complicate other medical treatment. Always carry a card that says you take Nardil, or wear a Medic Alert bracelet.

--If you miss a dose...

Take it as soon as you remember. If it is within 2 hours of your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Nardil.

  • More common side effects may include:
    Constipation, dizziness, drowsiness, dry mouth, headache, liver problems, low blood pressure upon standing, sexual problems, sleep disturbances, stomach and intestinal problems, water retention, weight gain

Why should Nardil not be prescribed?

You should not take Nardil if you have pheochromocytoma (a tumor of the adrenal gland), congestive heart failure, or a history of liver disease, or if you have had an allergic reaction to it.

You should not take Nardil if you are taking medications that may increase blood pressure (such as amphetamines, cocaine, allergy and cold medications, or Ritalin), other MAO inhibitors, L-dopa, methyldopa (Aldomet), phenylalanine, L-tryptophan, L-tyrosine, fluoxetine (Prozac), buspirone (BuSpar), bupropion (Wellbutrin), guanethidine (Ismelin), meperidine (Demerol), dextromethorphan, or substances that slow the central nervous system such as alcohol and narcotics; or if you must consume the foods, beverages, or medications listed above in the "Most important fact about Nardil" section.

Special warnings about Nardil

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Nardil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Nardil is not approved for treating children.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Nardil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

You must follow the food and drug limitations established by your physician; failure to do so may lead to potentially fatal side effects. While taking Nardil, you should promptly report the occurrence of a headache or any other unusual symptoms.

If you are diabetic, your doctor will prescribe Nardil with caution, since it is not clear how MAO inhibitors affect blood sugar levels.

If you are taking Nardil, talk to your doctor before you decide to have elective surgery.

If you stop taking Nardil abruptly, you may have withdrawal symptoms. They may include nightmares, agitation, strange behavior, and convulsions.

Possible food and drug interactions when taking Nardil

If Nardil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is important that you closely follow your doctor's dietary and medication limitations when taking Nardil. Consult the "Most important fact about Nardil" and "Why should Nardil not be prescribed?" sections for lists of the foods, beverages, and medications that should be avoided while taking Nardil.

In addition, you should use blood pressure medications (including water pills and beta blockers) with caution when taking Nardil, since excessively low blood pressure may result. Symptoms of low blood pressure include dizziness when rising from a lying or sitting position, fainting, and tingling in the hands or feet.

Special information if you are pregnant or breastfeeding

The effects of Nardil during pregnancy have not been adequately studied. Nardil should be used during pregnancy only if the benefits of therapy clearly outweigh the potential risks to the fetus. If you are pregnant or plan to become pregnant, inform your doctor immediately. Nursing mothers should use Nardil only after consulting their physician, since it is not known whether Nardil appears in human milk.

Recommended dosage

ADULTS

The usual starting dose is 15 milligrams (1 tablet) 3 times a day. Your doctor may increase the dosage to 90 milligrams per day.

It may be 4 weeks before the drug starts to work.

Once you have had good results, your doctor may gradually reduce the dose, possibly to as low as 15 milligrams daily or every 2 days.

OLDER ADULTS

Because older people are more likely to have poor liver, kidney, or heart function, or other diseases that could increase the likelihood of side effects, a relatively low dose of Nardil is usually recommended at the start.

CHILDREN

Nardil is not recommended, since safety and efficacy for children have not been determined.

Overdosage

Any medication taken in excess can have serious consequences. An overdose of Nardil can be fatal. If you suspect an overdose, seek medical help immediately.

  • Symptoms of overdose may include:
    Agitation, backward arching of the head, neck, and back, cool, clammy skin, coma, convulsions, difficult breathing, dizziness, drowsiness, faintness, hallucinations, high blood pressure, high fever, hyperactivity, irritability, jaw muscle spasms, low blood pressure, pain in the heart area, rapid and irregular pulse, rigidity, severe headache, sweating

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