Withdrawal from high-dose tranylcypromine

Clin Toxicol (Phila). 2008 Mar;46(3):261-3. doi: 10.1080/15563650601118085.


A 34-year-old man with a history of multiple substance abuse (now abstinent for six years) became addicted to tranylcypromine, consuming up to 240 mg/day. After discontinuing the drug, he developed thrombocytopenia (52,000/ul) and delirium; there were no other anticholinergic signs. The delirium was unresponsive to haloperidol and diazepam. Intravenous administration of physostigmine (2 mg) on hospital day 6 resulted in prompt, but temporary, clearing of the delirium. Following a recurrence of the delirium after 30 minutes, he was started on an intravenous infusion of physostigmine (2 mg/hr) with good results. Physostigmine administration did not produce any cholinergic signs. By hospital day 8, he did not require any more physostigmine. Thrombocytopenia resolved on hospital day 9 without therapeutic intervention. On hospital day 10, the patient was asymptomatic and left the hospital on his own recognizance.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antidotes / administration & dosage
  • Antidotes / therapeutic use
  • Delirium / psychology
  • Heroin Dependence / complications
  • Humans
  • Infusions, Intravenous
  • Male
  • Migraine Disorders / drug therapy
  • Monoamine Oxidase Inhibitors / adverse effects*
  • Monoamine Oxidase Inhibitors / therapeutic use
  • Physostigmine / administration & dosage
  • Physostigmine / therapeutic use
  • Substance Withdrawal Syndrome / drug therapy
  • Substance Withdrawal Syndrome / psychology*
  • Thrombocytopenia / chemically induced
  • Tranylcypromine / adverse effects*
  • Tranylcypromine / therapeutic use


  • Antidotes
  • Monoamine Oxidase Inhibitors
  • Tranylcypromine
  • Physostigmine