Comprehensive medication guide to Phenelzine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$60–$80 copay for brand Nardil on most commercial plans (75% coverage); generic phenelzine is typically Tier 1–2 and more affordable. Medicare Part D covers generic phenelzine on Tier 2 for most plans.
Estimated Cash Pricing
$44–$60 retail for generic phenelzine sulfate (60 tablets, 30-day supply); brand Nardil runs $94–$163+. With a GoodRx coupon, generic phenelzine can be found for as low as $43.35.
Medfinder Findability Score
55/100
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Phenelzine (brand name Nardil) is a non-selective, irreversible monoamine oxidase inhibitor (MAOI) antidepressant that has been used in clinical psychiatry since the 1950s. It belongs to the hydrazine class of MAOIs and is one of the few non-selective, irreversible MAOIs still in widespread clinical use today.
The FDA has approved phenelzine for the management of treatment-resistant depression (specifically atypical, nonendogenous, or neurotic depression), panic disorder, and social anxiety disorder. It is particularly effective for patients with mixed anxiety-depression features and for those who have not responded adequately to first-line antidepressants such as SSRIs and SNRIs.
Phenelzine is available as 15 mg film-coated oral tablets. The brand name Nardil is manufactured by Pfizer. Generic versions are produced by Lupin and Greenstone and are bioequivalent to the brand. Phenelzine is not a controlled substance.
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Phenelzine works by permanently blocking both subtypes of the monoamine oxidase (MAO) enzyme — MAO-A and MAO-B. MAO is normally responsible for breaking down key mood-regulating neurotransmitters: serotonin, norepinephrine, and dopamine. By irreversibly inactivating these enzymes, phenelzine prevents neurotransmitter degradation, leading to significantly elevated levels of serotonin, norepinephrine, and dopamine in the brain.
The irreversible nature of phenelzine's MAO inhibition means the enzyme cannot recover while the drug is active. New MAO enzymes must be synthesized by the body, a process that takes approximately 2 weeks. This is why a mandatory 14-day washout period is required before starting any other antidepressant after stopping phenelzine.
Beyond MAO inhibition, phenelzine has additional activity on the GABAergic system and inhibits primary amine oxidase (diamine oxidase), which may contribute to its effectiveness in anxiety disorders. Research is also investigating phenelzine's potential neuroprotective and regenerative properties, including activity on GABA-glutamate balance and reactive aldehyde sequestration.
15 mg — tablet
Standard film-coated oral tablet; the only available dose. Starting dose is typically 45 mg/day (three 15 mg tablets); titrate to 60–90 mg/day for therapeutic effect; maintenance may be as low as 15 mg/day.
Finding phenelzine reliably can be a significant challenge. In the United States, Lupin's generic phenelzine sulfate is listed as available by ASHP, and Pfizer's Nardil shortage (declared in January 2021 due to a manufacturing delay) was resolved by July 2021. However, because phenelzine is prescribed to a relatively small number of patients, most pharmacies do not routinely stock it. This means any supply disruption — or simply a pharmacy that doesn't order it regularly — can leave patients without access.
Internationally, the situation is more severe. Health Canada has listed phenelzine as a Tier 3 shortage — the highest priority category — with a global shortage of the active pharmaceutical ingredient and no confirmed resupply date as of 2026. This global API shortage has also caused intermittent supply issues in Australia, the UK, and other countries.
If you're having trouble finding phenelzine, medfinder can help. medfinder is a paid service that calls pharmacies near you to find which ones have phenelzine in stock, then texts you the results — so you don't have to spend hours on hold.
Phenelzine is not a controlled substance, so any licensed prescriber can legally prescribe it in the United States without special DEA authorization. However, due to its complex drug interaction profile, dietary restrictions, and risk of serious adverse effects, phenelzine is most commonly managed by clinicians experienced in psychiatric pharmacotherapy.
Psychiatrists: The primary prescribers of phenelzine, especially those specializing in treatment-resistant depression or complex psychopharmacology
Primary care physicians (PCPs): May prescribe phenelzine in coordination with a consulting psychiatrist
Psychiatric nurse practitioners (NPs): Advanced practice providers with psychiatric specialization can prescribe phenelzine in most states
Physician assistants (PAs): With appropriate psychiatric training and under physician supervision
Neurologists: Occasionally prescribe for patients with comorbid neurological conditions
Phenelzine can also be prescribed via psychiatric telehealth platforms in most states, as it is not a controlled substance. Platforms like Talkiatry and other psychiatry-focused telehealth services may connect patients with experienced MAOI prescribers. Ask specifically about MAOI experience during intake, as complex MAOI management requires clinical expertise.
No. Phenelzine (Nardil) is not a DEA-controlled substance and is not scheduled under the Controlled Substances Act. It does not have abuse potential and does not require the special prescribing restrictions that apply to Schedule II–V medications such as stimulants, benzodiazepines, or opioids.
Because phenelzine is not a controlled substance, it can be prescribed via telehealth in most states without the restrictions that apply to Schedule II medications. It can also be called in or faxed to pharmacies, and refills can be authorized by phone or electronically without requiring in-person visits for each refill. However, given its complex safety profile and dietary requirements, most psychiatrists prefer regular follow-up appointments to monitor patients on phenelzine.
The most commonly reported side effects include:
Sedation and drowsiness
Weight gain
Sexual dysfunction (delayed orgasm, impotence)
Orthostatic hypotension (dizziness when standing)
Dry mouth, constipation, blurred vision
Insomnia and muscle stiffness
Hypertensive crisis: Sudden severe headache, neck stiffness, nausea — call 911 immediately
Serotonin syndrome: Agitation, fever, muscle rigidity — medical emergency
Hepatotoxicity: Jaundice, dark urine, upper abdominal pain — contact prescriber immediately
Pyridoxine (B6) deficiency: Numbness or tingling in hands/feet (peripheral neuropathy)
Suicidal thinking: FDA boxed warning for increased suicidal thoughts in patients under 25
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Tranylcypromine (Parnate)
Non-hydrazine MAOI; most commonly used alternative to phenelzine; less weight gain and sexual dysfunction; 10 mg tablets, dose 30–60 mg/day; requires same tyramine-restricted diet; 14-day washout between MAOIs required.
Isocarboxazid (Marplan)
Hydrazine MAOI similar in class to phenelzine; 10 mg tablets, approved up to 60 mg/day; requires same dietary restrictions; some patients tolerate better than phenelzine.
Selegiline transdermal (Emsam)
MAOI skin patch; at 6 mg/24hr, no dietary tyramine restrictions required; FDA-approved for MDD; generally less potent than oral MAOIs for treatment-resistant cases; available in 6, 9, 12 mg/24hr strengths.
Venlafaxine (Effexor XR)
SNRI antidepressant; first-line treatment typically tried before phenelzine; must wait 14 days after stopping phenelzine before starting; effective for depression and anxiety disorders.
Prefer Phenelzine? We can find it.
SSRIs (fluoxetine, sertraline, paroxetine, citalopram, escitalopram)
majorAbsolutely contraindicated — risk of life-threatening serotonin syndrome. Require 14-day washout from phenelzine (5 weeks if starting fluoxetine after stopping phenelzine).
SNRIs (venlafaxine, duloxetine)
majorAbsolutely contraindicated — serotonin syndrome risk. 14-day washout required in both directions.
Sympathomimetics (amphetamines, methylphenidate, pseudoephedrine, epinephrine)
majorContraindicated — risk of acute, severe hypertensive crisis.
Meperidine (Demerol)
majorAbsolutely contraindicated — can cause severe unpredictable reactions including hyperpyrexia, seizures, and death.
Dextromethorphan (DXM)
majorContraindicated — found in many OTC cough medicines; can cause serotonin syndrome.
Other MAOIs (tranylcypromine, isocarboxazid, selegiline)
majorNever combine two MAOIs. 14-day washout required between any MAOI switch.
Tricyclic antidepressants (clomipramine)
majorClomipramine is absolutely contraindicated. Other TCAs require extreme caution and specialist supervision.
Buspirone (Buspar)
majorCombination may cause hypertensive reactions; avoid concomitant use.
Barbiturates
moderatePhenelzine potentiates barbiturate hypnosis; significantly reduced barbiturate doses required if use is unavoidable.
Insulin and oral hypoglycemics
moderatePhenelzine may potentiate hypoglycemic effects; monitor blood glucose carefully.
Phenelzine remains one of psychiatry's most powerful tools for treatment-resistant depression, atypical depression, panic disorder, and social anxiety. For patients who have failed SSRIs, SNRIs, and other first-line treatments, it can be genuinely life-changing. Its complex safety requirements — particularly the tyramine diet and drug interaction profile — are manageable with proper education and a committed prescriber.
The most significant practical challenge with phenelzine in 2026 is access. Intermittent pharmacy-level stockouts make it genuinely difficult for some patients to fill their prescriptions consistently. A proactive approach — filling early, using a 90-day supply, and identifying a reliable pharmacy — significantly reduces this risk. Generic phenelzine (from Lupin or Greenstone) is generally both cheaper and sometimes more available than brand Nardil.
If you're struggling to find phenelzine at your pharmacy, medfinder can call pharmacies near you to find which ones have it in stock and text you the results. Don't stop your medication — use every available resource to maintain your supply, and contact your prescriber immediately if you're running low.
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