Nardil

Nar·dil (närdl)

A trademark for the drug phenelzine.

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Nardil,

trademark for an antidepressant (phenelzine sulfate).

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phenelzine sulfate

Nardil

Pharmacologic class: MAO inhibitor

Therapeutic class: Antidepressant

Pregnancy risk category C

FDA Boxed Warning

• Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. Risk must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family and caregivers to observe patient closely and communicate with prescriber as needed.
• Drug isn't approved for use in pediatric patients.

Action

Nonselectively inhibits metabolism of MAO, an enzyme that increases accumulation of endogenous epinephrine, norepinephrine, and serotonin in CNS

Availability

Tablets: 15 mg

⊘Indications and dosages

➣ Atypical or neurotic depression

Adults: Initially, 15 mg P.O. t.i.d.; may increase rapidly to at least 60 mg/day, then 90 mg/day if needed for adequate response. Then reduce slowly to a maintenance dosage as low as 15 mg/day.

Contraindications

• Hypersensitivity to drug
• Pheochromocytoma
• Heart failure or other cardiovascular disease
• Abnormal liver function tests, history of hepatic disease
• History of headache
• Concurrent use of sympathomimetics, guanethidine, dextromethorphan, CNS depressants, buspirone, or serotonergic drugs

Precautions

Use cautiously in:
• hyperthyroidism, seizure disorders, hypotension, hypomania, diabetes mellitus, hepatic complications, myocardial ischemia
• patients switching from other MAO inhibitors
• suicidal or drug-dependent patients
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 16.

Administration

☞ If hypertensive crisis occurs, discontinue drug immediately and give phentolamine 5 mg I.V. slowly as ordered.
☞ Ask patient about other drugs he's using; MAO inhibitors can cause dangerous interactions with many drugs.

Route	Onset	Peak	Duration
P.O.	Unknown	2-6 hr	Variable

Adverse reactions

CNS: dizziness, headache, drowsiness, hyperreflexia, hypersomnia, tremors, atigue, insomnia, palilalia, euphoria, paresthesia, ataxia, manic reaction, acute anxiety reaction, schizophrenia precipitation, shock-like coma, seizures, toxic delirium , suicidal behavior or ideation (especially in child or adolescent)

CV: orthostatic hypotension, edema, hypertensive crisis, arrhythmias

EENT: blurred vision, glaucoma, nystagmus

GI: nausea, vomiting, diarrhea, constipation, GI disturbances, epigastric or abdominal pain, dry mouth

GU: urinary retention, sexual disturbances

Hematologic: leukopenia

Hepatic: jaundice, fatal progressive necrotizing hepatocellular disease

Metabolic: hypernatremia, hypermetabolic syndrome

Musculoskeletal: muscle twitching

Skin: pruritus, rash, sweating

Other: weight changes, fever, lupus-like syndrome, edema

Interactions

Drug-drug. Amphetamines, CNS depressants, dextromethorphan, dibenzazepine derivatives, other MAO inhibitors, serotonergic agents (such as fluoxetine, paroxetine), tryptophan: hypertensive crisis, seizures, fever, diaphoresis, excitation, delirium, tremor, coma, circulatory collapse

Antidepressants, buspirone: hypertension

Antihypertensives, beta-adrenergic blockers, thiazide diuretics: increased hypotensive effect

Epinephrine, guanadrel, guanethidine, norepinephrine, reserpine, vasoconstrictors: hypertensive crisis

Insulin, oral hypoglycemics: additive hypoglycemia

Drug-diagnostic tests. Sodium, transaminases: increased levels

White blood cells: decreased count

Drug-food. Aged, pickled, fermented, or smoked foods; wine; alcohol-free wine and beer; broad bean pods; cheese (except cottage and cream cheese); excessive amounts of chocolate or caffeine; dry sausage (including hard salami, pepperoni, and Lebanon bologna); foods containing L-tryptophan (such as dairy foods, soy, poultry, and meat); liver; spoiled or improperly refrigerated, handled, or stored protein-rich foods; yeast extract; yogurt: hypertensive crisis

Drug-herbs. Ephedra (ma huang), L-tryptophan: hypertensive crisis

Drug-behaviors. Alcohol use: hypertensive crisis

Patient monitoring

• Monitor blood pressure. Drug may cause orthostatic hypotension or hypertensive crisis.
• Assess patient for symptomatic improvement.
• Monitor CBC, liver function tests, and blood glucose level before and during therapy.
• Watch for increasing depression, suicide attempt, or suicidal ideation (especially in child or adolescent).

Patient teaching

• Explain importance of taking drug exactly as prescribed.
• Tell patient to discontinue drug at least 10 days before elective surgery.
• Stress importance of avoiding alcohol, certain foods and beverages, prescription drugs, and over-the-counter preparations during and for 14 days after therapy. Ask pharmacist to provide patient with complete list of foods to avoid.
☞ Instruct patient to immediately report occipital headache, palpitations, stiff neck, nausea, sweating, dilated pupils, and photophobia (indications of hypertensive crisis).
☞ Advise patient or caregiver to immediately report increasing depression, suicide attempt, or suicidal ideation (especially in child or adolescent).
☞ Tell patient to immediately report nausea, unusual tiredness, yellowing of skin or eyes, or irregular heart beats.
• Advise patient to rise slowly to avoid dizziness.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

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Nardil®

Phenelzine, see there