Hydroxyzine and Parnate (Tranylcypromine) Combination
Hydroxyzine can be safely used with Parnate (tranylcypromine), as hydroxyzine is an antihistamine without serotonergic or sympathomimetic properties that would interact with MAOIs.
Mechanism and Safety Profile
Hydroxyzine is an H1-receptor antagonist (antihistamine) used primarily for anxiety and allergic conditions 1. Unlike medications that are contraindicated with MAOIs, hydroxyzine does not:
- Increase serotonin levels (it is not a serotonin reuptake inhibitor)
- Have sympathomimetic activity (it does not increase norepinephrine or dopamine)
- Inhibit monoamine oxidase enzymes
Medications That ARE Contraindicated with Parnate
The following drug classes pose serious risks when combined with MAOIs like Parnate and should be avoided 2:
- Sympathomimetic agents (phentermine, pseudoephedrine, phenylephrine) - risk of hypertensive crisis 2
- Serotonergic antidepressants (SSRIs, SNRIs, tricyclics) - risk of serotonin syndrome 2, 3, 4
- Certain opioids (meperidine, tramadol, methadone, dextromethorphan) - risk of serotonin toxicity 3, 5
- Other MAOIs - risk of hypertensive crisis and reduced efficacy 2
Key Distinction
Hydroxyzine does not fall into any of these contraindicated categories. The primary side effects of hydroxyzine are sedation and drowsiness 1, which do not interact with MAOI mechanisms. The antihistamine properties of hydroxyzine work through a completely different pathway than monoamine oxidase inhibition.
Clinical Considerations
- Monitor for additive sedation when combining hydroxyzine with Parnate, as both medications can cause drowsiness 1
- Hydroxyzine has been studied and used safely for generalized anxiety disorder without concerns regarding MAOI interactions 1
- The combination may actually be beneficial for patients on MAOIs who need additional anxiolytic therapy without the risks associated with serotonergic agents 6