The tranylcypromine label bars amphetamines, cold remedies and most antidepressants for life-threatening reactions
Parnate's Table 1 of contraindicated products: SSRIs, SNRIs, tricyclics, bupropion and trazodone; "Amphetamines and methylphenidates and derivatives"; decongestants; triptans; buspirone, dextromethorphan and tryptophan.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: A contraindication list is the regulator's judgement, not a set of measured rates; the Gillman 2011 row in the interactions wave argues the food and some drug risks of MAOIs are smaller than the label era assumed, while not disputing the stimulant and serotonergic contraindications.
An MAOI label is the longest list of "do not combine" in psychiatry, and much of it describes things sold on the street or over the counter.
Significant findings
PARNATE (tranylcypromine) prescribing information (Advanz, July 2025), Contraindications 4.1: "Concomitant use of PARNATE or use in rapid succession with the products in Table 1 is contraindicated. Such use may cause severe or life-threatening reactions such as hypertensive crises or serotonin syndrome". Medication-free periods between Parnate and the listed agents are required.
Table 1, by class: other MAOIs; SSRIs and SNRIs; tricyclic antidepressants; "Other antidepressants (e.g., amoxapine, bupropion, maprotiline, nefazodone, trazodone, vilazodone, vortioxetine)"; "Amphetamines and methylphenidates and derivatives"; "Sympathomimetic products (e.g., cold, hay fever or weight reducing products that contain vasoconstrictors such as pseudoephedrine, phenylephrine, and ephedrine; or dietary supplements that contain sympathomimetics)"; triptans; and individual drugs including buspirone, dextromethorphan, meperidine, tapentadol, methyldopa, levodopa, tryptophan, hydroxytryptophan, SAM-e, cyclobenzaprine, carbamazepine and tetrabenazine.
Section 5.2 describes the hypertensive crisis the list is meant to prevent: "severe hypertension (e.g., with a blood pressure of more than 180/120 mm Hg) and evidence of organ dysfunction. Symptoms may include occipital headache (which may radiate frontally), palpitations, neck stiffness or soreness, nausea or vomiting, sweating". The label's own emergency rule, 5.7: if a contraindicated drug such as epinephrine or linezolid cannot be avoided, "discontinue PARNATE as soon as possible before initiating treatment with the other product and monitor closely".
Worth asking
Read the amphetamine line as covering methamphetamine and MDMA, which are amphetamines, and the sympathomimetic line as covering cocaine's effect even though cocaine is not named in this table (the phenelzine label names it outright). If you take an MAOI, the pharmacology does not distinguish a prescription from a purchase. The question for anyone on one is which over-the-counter products in the house, decongestants, cough syrup with dextromethorphan, supplements with tryptophan or SAM-e, are on this list.
Source
PARNATE (tranylcypromine sulfate) tablets: FDA-approved prescribing information, Contraindications 4.1 (Table 1), Warnings and Precautions 5.2 and 5.7 — Advanz Pharma (US) Corp.; US Food and Drug Administration (2025)
Regulator or national health body
How this was scored
- Study design
- Regulatory safety determination
- Funding
- Industry funded
- Published in
- Regulator or national health body
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 57 out of 100 on our published rubric. One caveat travels with that badge: A contraindication list is the regulator's judgement, not a set of measured rates; the Gillman 2011 row in the interactions wave argues the food and some drug risks of MAOIs are smaller than the label era assumed, while not disputing the stimulant and serotonergic contraindications. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
PARNATE (tranylcypromine sulfate) tablets: FDA-approved prescribing information, Contraindications 4.1 (Table 1), Warnings and Precautions 5.2 and 5.7 — Advanz Pharma (US) Corp.; US Food and Drug Administration (2025). Published in: Regulator or national health body. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Regulatory safety determination. Funding: Industry funded. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.