Tranylcypromine (Parnate) in the ambulatory treatment of depressed patients

Hypertensive crisis resulting from avocados and a MAO inhibitor

A hypertensive episode precipitated by avocados in a patient on tranylcypromine is described. The patient complained of severe throbbing headache, chest pain, and diaphoresis upon visiting the emergency room. Intravenous phentolamine was administered repeatedly to treat elevated blood pressure. Approximately 4 1/2 hours later, the patient's blood pressure stabilized, and he was released after a short period of observation. This is the first documented case of avocado induced hypertensive crisis.

Hypertensive interactions between monoamine oxidase inhibitors and foodstuffs

Hypertensive attacks during treatment with amine oxidase inhibitors were first described in tuberculous patients, and were “rediscovered'’ when these drugs were introduced into psychiatry. In an assessment of iproniazid for tuberculosis (Ogilvie, 1955), 4 out of 42 patients experienced “attacks of a most distressing nature”, with severe throbbing occipital headache and high blood pressure. Six years later, similar attacks were observed in 5 out of 212 patients treated for depression with nialamide (Davies, 1959), but it was not until the introduction of tranylcypromine that reports again appeared (Lurie and Salzer, 1961; Clark, 1961). By the beginning of 1963, over 40 such cases had been reported, including several complicated by intracerebral haemorrhage or cardiac failure due to the rise in blood pressure (Songco, 1961; McClure, 1962; Dorrell, 1963).

Intracranial haemorrhage in patients treated with monoamineoxidase inhibitors

The monoamineoxidase inhibitor drugs are now widely used in the treatment of depression, and complications occurring in patients so treated have been reported with varying frequency. The drugs most frequently implicated have been tranylcypromine (Parnate), tranylcypromine plus trifluoperazine (Parstelin) and phenelzine (Nardil) in decreasing order of frequency. These complications may be divided into three symptom-complexes which may merge one into the other, as they have the common basis of rapid elevation of systemic blood pressure.