[AF] Consulta sobre retirada de Tranilcipromina

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¡Hola!

Te mando comparativa con otros antidepresivos:

Amitriptyline

Depression
a) Amitriptyline was compared to tranylcypromine and their combination in a
randomized, double-blind, placebo controlled study of 80 inpatients with
major depression. Of 61 patients completing the study, 21 received
tranylcypromine (mean dose 22.4 mg/day, 21 received amitriptyline (mean dose
133 mg/day) and 19 received the combination of amitriptyline and
tranylcypromine (mean doses 123.7 mg/day and 23.4 mg/day, respectively).
Results of the study suggested that the combination offered no advantage
over either drug alone and resulted in a higher incidence of side effects.
This held true whether patients had endogenous or neurotic depression. Of
interest is the number of withdrawals, 11/19 resulting from clinical
deterioration [615].

Brofaromine

Depression, Refractory
a) Tranylcypromine and brofaromine produced similar results in the treatment
of 39 patients who were resistant to adequate trials of maprotiline or
nortriptyline [617]. Response rates were similar between the two groups; 10
out of 22 (45.5%) of patients receiving brofaromine while 5 out of 17
(29.4%) receiving tranylcypromine responded to therapy. The main difference
observed in the side effect profiles of the two agents was orthostatic
hypotension which was observed more often in the brofaromine group. During
the follow-up phase, another 6 patients responded to treatment with
brofaromine (n=5) or tranylcypromine (n=1). Of the patients who did not
respond to either tranylcypromine or brofaromine, 11 received lithium in
addition to the MAOI; in the brofaromine group, 3 out of 6 and in the
tranylcypromine group 4 out of 5 responded to this combination.
Adverse Effects
a) Brofaromine was less likely to cause an increase in blood pressure, after
ingestion of tyramine, than tranylcypromine [618]. Subjects were found to be
7 times more sensitive to the effects of oral tyramine after treatment with
brofaromine 100 mg/day and 56 times more sensitive after tranylcypromine 20
mg/day. After the discontinuation of the test drugs, 8 days were required
for return to normal tyramine response after brofaromine and 30 days were
required for tranylcypromine.

Hydroxytryptophan

Depression
a) The comparative efficacy of tranylcypromine and 5-hydroxytryptophan in
the treatment of depression, resistant to serotonin uptake inhibitors, was
compared in a controlled, open, crossover study [621]. The average maximal
doses were 82 milligrams tranylcypromine and 182 milligrams
hydroxytryptophan. There was no response in the 17 patients that received
hydroxytryptophan; in the group of 26 patients that received
tranylcypromine, 15 patients responded. This difference in response was
significant. Hydroxytryptophan was found to be ineffective. Similar results
were obtained in another study [622].

Imipramine

Depression
a) Tranylcypromine is superior to imipramine in the treatment of patients
with anergic bipolar depression [623]. Fifty-six patients with bipolar
depression (with 73% meeting the criteria for anergic depression) were
randomly assigned to treatment with tranylcypromine 20 to 80 milligrams or
imipramine 100 to 400 milligrams/day in a double-blind comparative study.
The mean dose at the end of six weeks was 36.8 mg of tranylcypromine and
245.5 mg of imipramine. Patients with anergic bipolar depression who did not
respond to therapy in the initial phase (n=16) were then enrolled in a
crossover study with the same doses of each drug [624]. Nine of the 12
patients who were switched to tranylcypromine responded to therapy and only
one out of four patients switched to imipramine improved. Hypomania and
mania developed with both drugs, but occurred earlier (5.8 weeks vs 9.2
weeks) in those receiving imipramine.
b) In a double-blind study of 137 patients with psychotic depression,
tranylcypromine 10 milligrams three times daily was administered for an
average of 22 weeks. Patients were also randomly allocated to receive
phenelzine or imipramine. After 4 weeks of therapy, 47% of tranylcypromine
patients were improved, and after termination of the study 44% were
improved. Tranylcypromine was slightly less effective than imipramine, but
more effective than phenelzine [625].

Moclobemide

Depression
a) Moclobemide 150 to 300 milligrams daily tended to be less effective than
tranylcypromine 15 to 30 milligrams daily in 1 controlled study involving 40
patients, largely suffering with endogenous depression. Tranylcypromine was
better tolerated [619]. However, differences in efficacy and toxicity did
not reach statistical significance in this small study.
b) In another double-blind study, also involving 40 patients (endogenous
depression), moclobemide 100 to 350 milligrams daily was reported
statistically superior to tranylcypromine 10 to 30 milligrams daily with
regard to improvements on the Hamilton Rating Scale for Depression (HRSD).
Toxicity was more frequent with tranylcypromine, including the occurrence of
tyramine reactions in several patients [620]. However, most patients in this
study also received neuroleptics and/or benzodiazepines, which may have
affected both efficacy and toxicity evaluations. Further studies comparing
the efficacy of these 2 monoamine oxidase inhibitors would appear warranted.

Molindone

Depression, Refractory
a) Molindone was found to be more effective and less toxic than
tranylcypromine in a single-blind, parallel study of 20 hospitalized
patients with refractory depression [626]. Patients received either
molindone 10 to 30 milligrams/day or tranylcypromine 20 to 30
milligrams/day. Patients treated with molindone showed a positive response
within the first week, especially in the areas of anxiety and agitation.
Although extrapyramidal symptoms developed in 50% of the patients taking
molindone, these were effectively managed with amantadine. Seven patients
receiving tranylcypromine withdrew from the study due to clinical worsening
and/or side effects. None of the patients receiving the molindone withdrew
from the study. Molindone appears to be superior to tranylcypromine in the
management of refractory depression.

Nortriptyline

Depression
a) Both tranylcypromine and nortriptyline produced significant improvement
when compared to placebo in the treatment of 122 depressed patients; little
difference between the 2 active drugs was noted except in the area of side
effects [616]. Patients were randomized to double-blind treatment with
tranylcypromine 30 to 60 milligrams/day (n=37), nortriptyline 75 to 150
milligrams/day (n=40) or placebo (n=45). The mean daily dosages of
tranylcypromine and nortriptyline were 44.4 mg and 109.4 mg, respectively.
The 3 treatment groups were similar in terms of age, sex distribution,
proportion of endogenous versus non-endogenous depression and initial
severity of depression. However, the number of endogenous depressives was
too small to draw any meaningful conclusion about the different treatments
in this subgroup. Evaluation of depression was accomplished with the
Hamilton Depression Scale, the New Physicians' Rating Scale (NPRL) and the
Zung Self-Rating Depression Scale (completed by the patient). No significant
differences in patient outcome between the 2 active drugs emerged on any of
these scales. The type, but not the incidence, of side effects differed
between the 2 active medications with tranylcypromine being associated with
dizziness (65%), insomnia (54%), and overexcitement (24%). Nortriptyline was
associated with a greater incidence of anticholinergic effects such as dry
mouth, constipation, blurred vision, and confusion. Headache was reported
slightly more often with tranylcypromine (30%) than with nortriptyline
(24%). Blood pressure was consistently lowered by tranylcypromine and raised
by nortriptyline. Tranylcypromine appears to be an effective and safe
alternative to tricyclic antidepressants; however, distinct advantages over
the TCAs have not been demonstrated.

Phenelzine

1) Adverse Effects
a) A retrospective chart review of patients taking phenelzine and
tranylcypromine revealed tranylcypromine to have a lower incidence of side
effects than phenelzine [45]. Nineteen patients took tranylcypromine and 42
took phenelzine (some patients took both drugs at different times).
Thirty-five side effects were reported by 15 patients in the tranylcypromine
and 125 side effects were reported by 39 patients in the phenelzine group.
The number of side effects per patient was 1.84 and 2.98 for the
tranylcypromine and phenelzine groups, respectively; this difference was
significant. A significantly larger number of patients experienced
hypomania/mania with phenelzine (N=27), than tranylcypromine (N=3). Side
effects resulted in the discontinuation of the drug in 1 patient in the
tranylcypromine group and in 9 patients in the phenelzine group. The most
common side effect experienced was insomnia; 10 patients in the
tranylcypromine group and 26 patients in the phenelzine group. Other side
effects reported in both groups include sedation, hypotension, sexual
dysfunction, weight gain/edema, hypertension, and myoclonic jerking

Sobre la retirada del medicamento, he encontrado esto, que más bien lo
enfoca al revés, pero igual te sirve :

c) In patients taking another monoamine oxidase inhibitor or a
dibenzazepine-related entity, the other agent should be discontinued and one
week elapse before starting tranylcypromine [2]. Then tranylcypromine should
be initiated at one-half the usual starting dose for at least the first week
of therapy.

Saludos.

Rosario Cáceres Fernández-Bolaños  

Centro de Información del Medicamento y Atención Farmacéutica

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