Nurses Compass
Drug Guide
Pargyline Hydrochloride
Classification
Therapeutic: Antihypertensive, Monoamine Oxidase Inhibitor (MAOI)
Pharmacological: Non-selective Monoamine Oxidase Inhibitor
FDA Approved Indications
- Management of hypertension unresponsive to other therapy
Mechanism of Action
Pargyline inhibits monoamine oxidase (MAO), leading to increased levels of norepinephrine, dopamine, and serotonin in the central nervous system and peripheral tissues, resulting in vasodilation and decreased blood pressure.
Dosage and Administration
Adult: Initially 20 mg 2-3 times daily, titrated as needed up to 40-50 mg 2-3 times daily.
Pediatric: Use not well established; generally not recommended.
Geriatric: Start at lower doses due to increased sensitivity and potential for adverse effects.
Renal Impairment: Adjust dose cautiously; renal function should be monitored.
Hepatic Impairment: Use with caution; hepatic function should be assessed.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Wide distribution; crosses the blood-brain barrier.
Metabolism: Metabolized in the liver.
Excretion: Excreted primarily in the urine.
Half Life: Approximately 2-4 hours, but effects may last longer due to enzyme inhibition.
Contraindications
- History of hypersensitivity to pargyline or other MAO inhibitors.
- Concurrent use with other MAO inhibitors, SSRIs, or tyramine-rich foods.
Precautions
- Use with caution in patients with hepatic impairment, cardiovascular disease, or psychiatric disorders. Avoid foods high in tyramine to prevent hypertensive crises. Monitor blood pressure regularly.
Adverse Reactions - Common
- Orthostatic hypotension (Common)
- Dizziness (Common)
- Insomnia (Common)
Adverse Reactions - Serious
- Hypertensive crisis due to tyramine interactions (Rare)
- Serotonin syndrome (when combined with serotonergic drugs) (Rare)
- Liver toxicity (Rare)
Drug-Drug Interactions
- Other MAO inhibitors, SSRIs, SNRIs, TCAs, sympathomimetics, vasoconstrictors.
Drug-Food Interactions
- Foods high in tyramine (aged cheese, smoked meats, fermented foods)
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure regularly; assess for symptoms of hypertensive crisis.
Diagnoses:
- Risk for hypertensive crisis
- Altered blood pressure regulation
Implementation: Educate patient on dietary restrictions; avoid tyramine-rich foods; monitor for adverse reactions.
Evaluation: Effectiveness in blood pressure control; absence of hypertensive episodes.
Patient/Family Teaching
- Instruct about the importance of dietary restrictions to prevent hypertensive crises.
- Advise to report symptoms such as severe headache, neck stiffness, or palpitations immediately.
Special Considerations
Black Box Warnings:
- Hypertensive crisis risk with tyramine-rich foods.
- Potential for serotonin syndrome when combined with serotonergic agents.
Genetic Factors: Genetic variations affecting MAO enzyme may influence drug response.
Lab Test Interference: May interfere with laboratory tests for monoamine oxidase activity.
Overdose Management
Signs/Symptoms: Severe hypertension, hyperthermia, chest pain, seizures.
Treatment: Supportive care; quick removal of drug; antihypertensive medications as needed; Manage seizures accordingly.
Storage and Handling
Storage: Store at room temperature, away from moisture and light.
Stability: Stable under recommended storage conditions.