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Clinical Notes
June 23, 1978

Lupus-like Reaction to Phenelzine

Author Affiliations

From the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City.

JAMA. 1978;239(25):2693. doi:10.1001/jama.1978.03280520065024

AN ADVERSE reaction was encountered in a patient with depression who was receiving phenelzine sulfate, a reaction which, to my knowledge, has not been previously reported.

Phenelzine is an antidepressant of the monoamine-oxidase-inhibiting (MAO) class. It is customarily reserved for treating major depressions in which tricyclic antidepressants and electroconvulsive therapy are ineffective or contraindicated, and for anxiety states. Within the class of MAO-inhibitors, there are hydrazines (such as phenelzine) and nonhydrazines (such as tranylcypromine sulfate, but there are no data of statistical significance on differential effectiveness between these two subclasses.

Best known among adverse effects is supersensitivity to exogenous sympathomimetic substances, with resulting severe hypertension and occasional secondary cerebral hemorrhage, arrhythmia, pulmonary edema, headache, or acute glaucoma. Anticholinergic side effects of dry mouth, gastrointestinal hypoperistalsis, hesitancy of micturition, and impotence are also seen.1 Maximum dosage is commonly delimited by intolerable orthostatic hypotension.

Some lesser-known effects include hyperpyrexia and seizures in