Dosage should be reduced, or a phenothiazine should be administered concomitantly. Some patients exhibit insomnia, restlessness and anxiety, progressing in severe cases to agitation, mental confusion and incoherence. Hypotension, dizziness, weakness and drowsiness may occur, progressing in severe cases to extreme dizziness and shock. A few patients have displayed hypertension with severe headache and other symptoms. Rare instances have been reported in which hypertension was accompanied by twitching or myoclonic fibrillation of skeletal muscles with hyperpyrexia, sometimes progressing to generalized rigidity and coma.
Gastric lavage is helpful if performed early.
Although tranylcypromine is rapidly excreted, its MAO inhibiting action may continue for approximately 1 week. Treatment normally consists of general supportive measures, close observation of vital signs, and steps to counteract specific symptoms as they occur. Management of hypertensive crisis is described under Adverse Effects. If hyperpyrexia occurs, external cooling is recommended, Barbiturates have been reported useful in relieving myoclonic reactions, but their frequency of administration should be controlled carefully because tranylcypromine may prolong barbiturate activity. When hypotension requires treatment, the standard measures for managing circulatory shock should be initiated.