Nardil (phenelzine)

How does it work?

Nardil tablets contain the active ingredient phenelzine, which is a type of antidepressant known as a monoamine oxidase inihibitor (MAOI).

Depression is a complicated disease that is not fully understood. It is thought that depression may be linked to an imbalance of chemicals within the brain. When depression occurs, there may be a decrease in the amount of chemicals released from nerve cells in the brain. These chemicals are called monoamines.

Monoamines are broken down by a chemical called monoamine oxidase. Phenelzine prevents monoamine oxidase from breaking down the monoamines. This results in an increased amount of active monoamines in the brain.

By increasing the amount of monoamines in the brain, the imbalance of chemicals thought to cause depression is altered. This helps relieve depression.

Phenelzine is used to treat depression that is classified as atypical, non-endogenous or neurotic. It is also used to treat depression that has failed to respond to other antidepressant medicines.

It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.

What is it used for?

Depressive illness.

Warning!

Depression is associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.

You must not consume foods that are rich in the amino acid tyramine while you are taking this medicine. This is because the combination could cause a dangerous increase in blood pressure. An early warning symptom of this is a throbbing headache. You should only eat fresh foods, and avoid food that has been matured in some way or is suspected of being stale or ‘going off'. Foods that you should avoid include cheese, yeast extracts (eg Oxo, Bovril, Marmite), brewer's yeast, fermented soya bean products, eg soy sauce, hung game, pickled herrings, liver, dry sausage (salami, pepperoni etc), broad bean pods, avocado, caviar, peanuts, excessive amounts of tea and coffee, and alcoholic drinks or non-alcoholic beers, lagers or wines. You should also avoid these foods and drinks for a further two weeks after stopping treatment with this medicine. You can get further advice from your pharmacist.

This medicine can interact with various other medicines, including those that can be bought without a prescription. It is important to check with your pharmacist before taking any over-the-counter medicines, particularly cough and cold remedies, while you are taking this one. See the end of this factsheet for further details.

This medicine may cause drowsiness, dizziness and blurred vision that may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.

This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.

Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary.

You should not suddenly stop taking this medicine, unless otherwise directed by your doctor, as this may cause withdrawal symptoms such as nausea, vomiting, generally feeling unwell, nightmares and agitation. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over at least two weeks. Follow the instructions given by your doctor when it is time to stop treatment with this medicine.

If you are due to have elective surgery or dental procedures, this medicine should be stopped two weeks beforehand. Follow the instructions given by your doctor.

Your blood pressure should be regularly monitored while you are taking this medicine, as it may cause it to increase. If you experience heart palpitations or frequent headaches you should consult your doctor so your blood pressure can be checked. You may need to stop taking this medicine if it does affect your blood pressure.

Your liver function should also be monitored while you are taking this medicine. Symptoms that may suggest a liver problem include persistent nausea and vomiting, abdominal pain, or the development of jaundice (a yellow colouring to the skin and the whites of the eyes). Consult your doctor if you experience any of these symptoms.

Use with caution in

Elderly people

Agitated people

Bipolar disorder (manic depression)

Schizophrenia

People having electroconvulsive therapy (ECT)

Disease involving the heart and blood vessels

Diabetes

Epilepsy

Hereditary blood disorders called porphyrias

People with disturbances in the normal levels of blood cells in the blood.

Not to be used in

Children under 16 years of age

History of liver disease

Decreased liver function

Congestive heart failure

Disease of the blood vessels in and around the brain

Tumour of the adrenal gland (phaeochromocytoma)

Manic phase of manic depression.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine for use in pregnancy has not been established. It should not be used during pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.

It is not known if this medicine passes into breast milk, however it is possible that it may. As it could have serious side effects on a nursing infant, a decision should be made about whether to stop the medicine, or not breastfeed. This will depend on the importance of the medicine for the mother. Seek medical advice from your doctor.

Label warnings

Follow the printed instructions you have been given with this medication.

This medication may cause drowsiness. If affected do not drive or operate machinery.

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