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Phenelzine is a monoamine oxidase inhibitor (MAOI) antidepressant.
Due to numerous interactions with drugs and foodstuffs, its use is reserved mainly for patients who have failed to respond to other antidepressants.
There is a small but important group of patients who historically have responded well to treatment and who have been treated with phenelzine for many years (decades in some cases).
The UK licensed version of phenelzine (Nardil) has been unavailable since August 2019.
Clinicians were asked to review all affected patients and where possible withdraw treatment or switch to an alternative antidepressant. However, the availability of imported foreign licensed phenelzine tablets has allowed patients to be maintained on treatment.
The Covid-19 pandemic has severely disrupted the supply of non-UK phenelzine and supply of the drug is very unreliable. Consequently GPs and psychiatrists were asked to urgently review all remaining patients prescribed phenelzine as continued treatment cannot not be guaranteed.
Any patient prescribed phenelzine is likely to have been taking it for many years. Most likely at the point of prescribing they will have had unsuccessful treatment with a number of antidepressants. They will require a clear explanation of why this review is happening and what their options may be. They are likely to be very anxious about this given the long history of successful treatment and have fears about any proposed change.
Consider the following points:
For some patients it may be possible to completely withdraw treatment and not prescribe a replacement antidepressant.
Each patient’s experience of treatment and withdrawal will differ and an individualised approach will be required.
However availability of supply may curtail the withdrawal period. Please contact Leverndale Pharmacy for advice if issues arise.
Factors to consider for a successful withdrawal:
This is likely to be the more common scenario for most patients. As it takes 2 weeks for monoamine oxidase enzyme activity to recover there will be a mandatory wash out period after phenelzine has been discontinued before any new treatment can be initiated safely.
Factors to consider for a successful change of treatment:
PMG(MH) expects the majority of patients to be managed via one of the options above however there may be some for whom it may to be too distressing to have treatment changed or for whom alternative treatment fails. In those instances consider the following:
Last reviewed: 24 July 2020
Next review: 01 August 2021
Approved By: PMG-MH
Reviewer Name(s): Andrew Walker, Suzanne Burke