60 Years of Combining Tranylcypromine: A Systematic Review of Available Evidence.

Abstract

BACKGROUND:

Tranylcypromine is the only irreversible monoamine oxidase inhibitor that is approved in the United States and in Europe for the management of treatment-resistant major depressive disorder. Comprehensive data in the literature regarding the efficacy and tolerability of tranylcypromine (TCP) combination strategies have not been systematically investigated yet.

METHODS:

We conducted a systematic review of available literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Study types considered eligible for inclusion were studies that reported information on efficacy and/or tolerability/adverse effects of pharmacological TCP add-on or coadministration strategies among people with psychiatric disorders.

RESULTS:

Ninety-six articles were included in qualitative analyses. A relevant body of evidence shows that TCP combined with first- and second-generation antipsychotics seems relatively safe and might have beneficial effects in some patients with depressive disorders, although caution is needed with some second-generation antipsychotics that have proserotonergic activity. Although evidence is not entirely consistent, amitriptyline as add-on agent might be efficacious and associated with a low rate of severe adverse events. Although available data from case reports are scarce, certain other agents, such as trazodone, but also lithium, seem to have a good risk-benefit profile with regard to TCP that should be further investigated in the context of high-quality studies.

CONCLUSIONS:

Any combination of a psychotropic with TCP should be preceded by an evaluation of drug-to-drug interaction and an informed consent process and followed by close monitoring. Before any combination strategy, doctors should reevaluate factors of pseudo-treatment resistance, such as rapid-metabolizing status, noncompliance, trauma, alternative diagnosis, or drug abuse.

• Authors: Elias Wagner, Florian Seemüller, Alkomiet Hasan
• Journal: Journal of clinical psychopharmacology (J Clin Psychopharmacol) 2022 Jan-Feb 01 Vol. 42 Issue 1 Pg. 51-70 ISSN: 1533-712X [Electronic] United States
• PMID: 34928561 (Publication Type: Journal Article, Systematic Review)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Monoamine Oxidase Inhibitors
• Psychotropic Drugs
• Tranylcypromine

Topics

• Depressive Disorder, Treatment-Resistant (drug therapy)
• Drug Interactions
• Drug Therapy, Combination
• Humans
• Mental Disorders (drug therapy)
• Monoamine Oxidase Inhibitors (adverse effects, pharmacology)
• Psychotropic Drugs (administration & dosage, adverse effects, pharmacology)
• Tranylcypromine (administration & dosage, adverse effects, pharmacology)