Nardil: Uses, Side Effects and Dosage

What is Nardil used for?

Nardil is used to treat depression where anxiety or fear is the main symptom and treatment with other drugs has failed. Symptoms of depression include:

• feeling sad, restless, irritable, tired
• change in appetite or weight, difficulty concentrating or sleeping, headaches, unexplained aches and pains

How does Nardil work?

Nardil belongs to a group of antidepressant medicines called monoamine oxidase inhibitors (MAOIs). Nardil works by increasing some chemical messengers (norepinephrine, serotonin and dopamine) found naturally in your brain and other parts of your body.

What are the ingredients in Nardil?

Medicinal ingredients: phenelzine sulfate.

Non-medicinal ingredients: croscarmellose sodium, editate disodium, magnesium stearate, mannitol, opadry orange, povidone.

Nardil comes in the following dosage forms:

15mg tablets.

Do not use Nardil if you:

• are allergic to any of the ingredients in Nardil (please read “What are the ingredients in Nardil?” above)
• have been diagnosed with a growth on the adrenal glands near your kidneys which is causing high blood pressure (phaeochromocytoma)
• have been diagnosed with congestive heart failure
• have or ever have had liver problems
• are taking drugs that affect your nervous system (e.g. amphetamines, cocaine, methylphenidate, dopamine, epinephrine and norepinephrine, methyldopa, L-dopa, L-tryptophan, L-tyrosine and phenylalanine)
• are taking dextromethorphan, guanethidine, reserpine or narcotics.
• consume alcohol. You must not drink alcohol while taking Nardil.
• are taking strong pain killers such as meperidine

• are taking or have recently taken other antidepressant drugs (amitriptyline, amitriptyline and amoxapine, carbamazepine, clomipramine, cyclobenzaprine, desipramine, doxepin, imipramine, maprotiline, nortriptyline,

  protriptyline, trimipramine, buproprion hydrochloride), other MAOIs, Selective Serotonin Reuptake Inhibitors (SSRI e.g. fluoxetine), venlafaxine or dibenzazepine derivatives.

You should wait for at least 5 weeks between stopping the use of fluoxetine and starting the use of NARDIL, and at least 10 days between stopping the use of Nardil and starting the use of fluoxetine or other serotonin re-uptake inhibitors (SSRIs).

• are taking or have recently taken a medication to treat anxiety, such as buspirone hydrochloride

You should wait for at least 10 days between stopping the use of Nardil and starting the use of another antidepressant or buspirone hydrochloride or stopping the use of another MAOI and starting the use of Nardil.

• have a scheduled surgery

You should stop taking Nardil at least 10 days before the scheduled surgery.

While taking Nardil you should not eat a lot of high protein food that has been aged, fermented, pickled, or smoked; for a detailed list of foods and beverages to avoid, see: “Other warnings you should know about”.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take Nardil. Talk about any health conditions or problems you may have, including if you:

• have had seizures or you have epilepsy
• are agitated
• have mania or hypomania (feelings of euphoria, overactive behaviour and thoughts)
• have Schizophrenia
• have diabetes
• are taking sedatives or drugs to help you sleep
• are taking drugs to treat high blood pressure
• are under 16 years of age

• are pregnant or planning to become pregnant. Nardil is not recommended to be used during pregnancy.

• are breast-feeding or planning to breastfeed

Other warnings you should know about:

Dangerous Increase in Blood Pressure

The most serious reactions to Nardil involve changes in blood pressure which have caused death. Seek immediate medical attention if you experience the following symptoms: headache at the base of your skull that may travel to the front of your head, irregular heartbeat, neck stiffness or soreness, nausea, vomiting, sweating (sometimes with fever and sometimes with cold, clammy skin), very large pupils, and extreme sensitivity to light. You may feel your heart beating either very fast or abnormally slow and you might also feel pain and tightness in your chest. Your blood pressure should be checked regularly by your healthcare professional and Nardil should be stopped if you start getting heart palpitations or frequent headaches.

Angle-Closure Glaucoma

Nardil can cause an acute attack of glaucoma (increased pressure in the eye). Seek immediate medical attention if you experience eye pain, changes in vision, swelling or redness in or around the eye.

Changes in your behaviour and feelings, thoughts and actions about suicide:

Treatment with these types of medications is most safe and effective when you and your healthcare professional have good communication about how you are feeling. You may find it helpful to tell a relative or close friend that you are depressed or have anxiety disorder. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.

Some patients may feel worse instead of better when first starting drugs like Nardil or when changing the dose. You may feel more anxious, agitated, hostile, aggressive, impulsive, and feel like you are not yourself or become less inhibited. You may have thoughts of suicide, hurting yourself or other people. Thoughts and actions about suicide can occur especially if you have had thoughts of hurting yourself in the past. These changes in behaviour and feelings can happen in patients of any age treated with Nardil. If this happens, seek immediate medical help. Do NOT stop taking Nardil on your own.

Driving and Using Machines

Nardil might cause drowsiness or blurred vision. Do not drive or operate with machines until you know how Nardil affects you.

Food and Beverages to Avoid While Taking Nardil

While taking Nardil, as well as for two weeks after stopping it, you should avoid the following foods, beverages:

• MEAT AND FISH: Pickled herring, liver, dry sausage (including Genoa salami, hard salami, pepperoni and Lebanon bologna)
• VEGETABLES: Broad bean pods (Fava beans) and sauerkraut
• DAIRY PRODUCTS: Cheese, yogurt (cottage cheese and cream cheese are allowed)
• BEVERAGES: Beer and wine, alcohol-free and reduced-alcohol beer and wine products
• MISCELLANEOUS: Yeast extract (including brewer’s yeast in large amounts), meat extract, large amounts of chocolate or caffeine

You should also avoid any spoiled or improperly refrigerated, handled or stored protein-rich foods such as meats, fish and dairy products. You should also avoid any food that has been aged, pickled, fermented, or smoked.

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

The following may interact with Nardil:

• Medications used to treat high blood pressure, including water-pills (diuretics) and beta-blockers
• Medications to treat colds and coughs
• Nasal decongestants (tablets, drops or spray)
• Hay-fever medications
• Sinus medications
• Asthma inhalers
• Medicines used to reduce your appetite
• Weight loss medications

For a list of other drugs that must not be taken with Nardil see the “Do not use Nardil if you:” section above.

How to take Nardil:

Always take Nardil exactly as your healthcare professional told you. You should check with your healthcare professional if you are not sure. Do not change your dose unless your healthcare professional tells you to.

Swallow the tablets with some water.

Usual adult dose

The usual starting dose of Nardil is one tablet (15mg) three times a day.

It may take four weeks before you feel the full effect of Nardil.

If your symptoms have not improved after two weeks, your healthcare professional may increase the dose to two tablets two times a day. If necessary, your healthcare professional may increase the dose up to two tablets three times daily. Once Nardil is helping your depression, your healthcare professional may slowly lower the dose. Your maintenance dose may be as low as one tablet every other day.

Overdose

If you think you have taken too much Nardil, contact your healthcare professional, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms. Take this leaflet and the pack of tablets along with you, if you can.

Missed Dose

If you miss a dose of Nardil, take your next dose at the usual time and continue taking the tablets according to your healthcare professional’s instructions. Do not take a double dose to make up for a forgotten individual dose.

If you stop taking Nardil

Do not stop taking Nardil unless your healthcare professional tells you to. Stopping Nardil can cause nausea, and vomiting and make you feel unwell. If Nardil is stopped suddenly this can cause serious side effects.This may happen one to three days after stopping Nardil and symptoms may include: nightmares, agitation, psychosis (seeing or hearing things that are not there, or believing things which are not true) and fits.

If this happens, tell your healthcare professional immediately.

What are possible side effects from using Nardil?

These are not all the possible side effects you may feel when taking Nardil. If you experience any side effects not listed here, contact your healthcare professional.

Side effects may include:

• Dizziness
• Headache
• Drowsiness
• Sleep disturbances
• Weakness and feeling tired
• Shaking, twitching, muscle jerking, stronger than normal reflexes
• Constipation, dry mouth, digestion problems
• Weight gain
• Swelling
• Sexual problems such as difficulty to reach orgasm, problems ejaculating and trouble getting or keeping an erection
• Speech changes (repeating the last word of a sentence)
• Feeling tense and nervous, intense feelings of well-being, elation, happiness, excitement and joy

•

•

•

• Uncontrolled body movements.
• Fever with tight muscle.

Nardil can cause abnormal blood test results. Your doctor will decide when to perform blood tests and will interpret the results.

Serious side effects and what to do about them

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, talk to your healthcare professional.

Reporting Side Effects

You can help improve the safe use of health products for Canadians by reporting serious and unexpected side effects to Health Canada. Your report may help to identify new side effects and change the product safety information.

3 ways to report:

• Online at MedEffect (www.hc-gc.ca/medeffect);
• By calling 1-866-234-2345 (toll-free);

• By completing a Consumer Side Effect Reporting Form and sending it by:

  • Fax to 1-866-678-6789 (toll-free), or

  • Mail to: Canada Vigilance Program

    Health Canada, Postal Locator 0701E

    Ottawa, ON

    K1A 0K9

    Postage paid labels and the Consumer Side Effect Reporting Form are available at MedEffect.

NOTE: Contact your healthcare professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.

Storage:

Store at controlled room temperature 15 - 30°C. Protect from heat and moisture.

Keep out of reach and sight of children.

If you want more information about Nardil:

• Talk to your healthcare professional
• Find the full product monograph that is prepared for healthcare professionals and includes this Patient Medication Information by visiting the Health Canada website (www.hc-sc.gc.ca); the manufacturer’s website www.searchlightpharma.ca , or by calling 1-647-945-9762.

Last Revised OCT 4, 2022