Phenelzine
Nardil
Monoamine Oxidase InhibitorGeneric available
DESCRIPTION NARDIL ® (phenelzine sulfate) is a potent inhibitor of monoamine oxidase (MAO). Phenelzine sulfate is a hydrazine derivative. It has a molecular weight of 234.27 and is chemically described as C 8 H 12 N 2 • H 2 SO 4 . Its chemical structure is shown below: Each NARDIL film-coated tablet for oral administration contains phenelzine sulfate equivalent to 15 mg of phenelzine base and the following inactive ingredients: mannitol, USP; croscarmellose sodium, NF; povidone, USP; edetate disodium, USP; magnesium stearate, NF; isopropyl alcohol, USP; purified water, USP; opadry orange Y30-13242A. Chemical Structure
Compare Phenelzine →FDA-Approved Indications
- Atypical/nonendogenous/neurotic depression with mixed anxiety, phobic, or hypochondriacal features (adults; second-line)
Common Off-Label Uses
- Social anxiety disorder
- Panic disorder
- PTSD
- Bulimia nervosa
What Sets This Drug Apart
- Irreversible non-selective MAOI; particularly effective for atypical depression (rejection sensitivity, hypersomnia, hyperphagia) and treatment-resistant depression
- Strict dietary tyramine restriction required: aged cheeses, cured meats, yeast extract, draft beer can trigger hypertensive crisis — patient compliance is essential
- 14-day washout required before and after serotonergic drugs (SSRIs, SNRIs); 5 weeks after fluoxetine due to long norfluoxetine half-life
- More sedating than tranylcypromine; may cause weight gain and orthostatic hypotension — side effect profile resembles older antidepressants
- Not a CYP substrate — metabolized by N-acetyltransferase (NAT2); minimal CYP drug interactions beyond the MAOI mechanism itself
- Excellent efficacy but high monitoring burden makes it a last-line agent reserved for treatment-resistant cases in experienced hands
Boxed Warning
Suicidality and Antidepressant Drugs Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality)