Phenelzine

Phenelzine, sold under the brand name Nardil among others, is a non-selective and irreversible monoamine oxidase inhibitor (MAOI) of the hydrazine family which is primarily used as an antidepressant and anxiolytic to treat depression and anxiety. Along with tranylcypromine and isocarboxazid, phenelzine is one of the few non-selective and irreversible MAOIs still in widespread clinical use.

Medical uses

Phenelzine is primarily used in the treatment of major depressive disorder, including treatment-resistant depression. Modern guidance on classic MAOIs recommends considering phenelzine, tranylcypromine, or isocarboxazid after insufficient response to other antidepressant treatments and before electroconvulsive therapy when a rapid treatment response is not required.

Patients with atypical depression may respond particularly well to phenelzine, but evidence also supports the use of classic MAOIs in melancholic depression. Phenelzine may be especially useful when depression is accompanied by premorbid anxiety, comorbid panic disorder, or other treatment-resistant anxiety symptoms, reflecting its additional effects on GABA metabolism.

Phenelzine has also been studied or used in anxiety-related and other psychiatric conditions including panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), obsessive–compulsive disorder (OCD), dysthymia, bipolar depression, and bulimia nervosa.

Side effects

Common or clinically important adverse effects of phenelzine include orthostatic hypotension, dizziness, dry mouth, constipation, urinary retention, sedation or somnolence, insomnia, weight gain, edema, sweating, sexual dysfunction, and reduced vitamin B6 levels or pyridoxine deficiency. Hypoglycemia and clinically relevant cytochrome P450 interactions may also occur, particularly with hydrazine MAOIs such as phenelzine.

Rare adverse effects reported with phenelzine include hypomania or mania, psychosis, hepatotoxicity, and acute liver failure, the last of which has been reported mainly in susceptible individuals, including people with pre-existing liver damage, old age, long-term effects of alcohol consumption, or viral infection.