Clonidine Transdermal Patch and Tranylcypromine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tranylcypromine
Clonidine Transdermal Patch
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased risk of hypertensive reaction, including intracerebral hemorrhage
Interaction Deep Dive
Use of tranylcypromine, a monoamine oxidase inhibitor (MAOI), concomitantly or within rapid succession of a sympathomimetic agent is contraindicated due to increased risk of an additive hypertensive reaction, including risk of intracerebral hemorrhage. If use of a contraindicated drug, such as a direct-acting sympathomimetic drug, is required in the absence of therapeutic alternatives during an emergency, discontinue tranylcypromine as soon as possible prior to starting treatment with the sympathomimetic agent, and monitor closely during use for adverse effects. Prior to initiating tranylcypromine in a patient receiving a contraindicated drug, discontinue the drug and wait at least 4 to 5 half-lives of the contraindicated drug or its active metabolites before starting tranylcypromine67. The potential for interactions persists after discontinuation of tranylcypromine until MAO activity has sufficiently recovered. Inhibition of MAO may persist up to 10 days following discontinuation 6.
Why it happens (mechanism)
Unknown
Literature reports
4 reports — tap to read
a) Severe headaches and hypertensive crises are well-documented in the literature as being associated with ePHEDrine and tranylcypromine. Other potential reactions include cardiac arrhythmias, chest pain, hyperpyrexia, and death 1.
b) DOPamine is metabolized by MAO, thus DOPamine effects will be prolonged in patients receiving MAO inhibitors. The interaction could result in severe hypertension and/or cardiac arrhythmias. No more than one-tenth of the usual dose of DOPamine should be given to patients receiving MAO inhibitors 8.
c) A 40-year-old woman, who was using the MAOI phenelzine for chronic depression, began Midrin® (isometheptene, dichloralphenazone, and acetaminophen) for headaches. Within 40 minutes of her first dose of Midrin®, she experienced diaphoresis, neck pain, increased headache pain, palpitations, nonsustained ventricular tachycardia, and premature ventricular contractions. In the ER, she was treated for hypertensive crisis and given phentolamine IV, which provided rapid resolution of her symptoms. Approximately 6 hours later, her symptoms recurred. On reexamination, the patient was found to have a small elevation of creatine phosphokinase enzyme with positive MB fractions. She had no history of or risk factors for coronary artery disease and, on ECG, had no ST-segment or T-wave abnormalities. Follow-up echocardiogram and treadmill-testing were normal 9.
d) Isoproterenol, a direct-acting, catecholamine sympathomimetic, may interact with a coadministered MAOI to produce clinically significant hypertensive effects 4235.
Common questions
Can I take Clonidine Transdermal Patch and Tranylcypromine together?
Increased risk of hypertensive reaction, including intracerebral hemorrhage Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clonidine Transdermal Patch and Tranylcypromine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Clonidine Transdermal Patch or Tranylcypromine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (9)
- Goldberg LI: Monoamine oxidase inhibitors. Adverse reactions and possible mechanisms. JAMA 1964; 190:456-462. DOI
- Smookler S & Bermudez AJ: Hypertensive crisis resulting from an MAO inhibitor and an over-the-counter appetite suppressant. Ann Emerg Med 1982; 11:482-484. PubMed
- Cuthbert MF, Greenberg MP, & Morley SW: Cough and cold remedies: a potential danger to patients on monoamine oxidase inhibitors. Br Med J 1969; 1:404-406. DOI
- Horler AR & Wynne NA: Hypertensive crisis due to pargyline and metaraminol. Br Med J 1965; 2:460-461. PubMed
- Boakes AJ, Laurence DR, Teoh PC, et al: Interactions between sympathomimetic amines and antidepressant agents in man. Br Med J 1973; 1:311-315. DOI
- Product Information: Tranylcypromine oral tablets, tranylcypromine oral tablets. Solco Healthcare US, LLC (per DailyMed), Somerset, NJ, 2024. DailyMed
- Product Information: PARNATE(R) oral tablets, tranylcypromine oral tablets. Concordia Pharmaceuticals, Inc. (per FDA), Kansas City, MO, 2018. DailyMed
- Horwitz D, Goldberg LI, & Sjoerdsma A: Increased blood pressure responses to dopamine and norepinephrine produced by monoamine oxidase inhibitors in man. J Lab Clin Med 1960; 56:747.
- Kraft KE & Dore FH: Computerized drug interaction programs: how reliable (letter)?. JAMA 1996; 275:1087. DOI
Keep reading about Tranylcypromine
Keep reading about Clonidine Transdermal Patch
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