From the Guidelines
Patients taking MAOIs who consume tyramine-rich foods are at risk of a dangerous hypertensive crisis, and therefore, it is crucial to avoid tyramine-containing foods with MAOIs. When MAOIs block the enzyme monoamine oxidase, they prevent the breakdown of tyramine in the body. Consuming tyramine while on these medications allows it to accumulate in the bloodstream, triggering the release of stored norepinephrine, which causes a sudden and severe spike in blood pressure. This hypertensive crisis can lead to symptoms including severe headache, neck stiffness, sweating, nausea, vomiting, and in severe cases, stroke or death. Common tyramine-rich foods that must be avoided include aged cheeses, cured meats, fermented foods, certain alcoholic beverages (especially red wine and tap beer), and some condiments like soy sauce. The reaction typically occurs within minutes to hours after consumption and requires immediate medical attention. Patients on MAOIs must follow strict dietary guidelines and should carry emergency medication like nifedipine to use if symptoms of hypertensive crisis develop. The severity of this interaction is why many physicians now prefer newer antidepressants over MAOIs when possible, as noted in the guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Additionally, it is essential to consider alternative agents, such as SSRIs, depending on the indication, to minimize the risk of hypertensive crisis 1.
Some key points to consider:
- Avoid tyramine-containing foods with MAOIs
- Follow strict dietary guidelines
- Carry emergency medication like nifedipine
- Consider alternative agents, such as SSRIs, depending on the indication
- Be aware of the potential for hypertensive crisis and its symptoms, including severe headache, neck stiffness, sweating, nausea, vomiting, and in severe cases, stroke or death.
It is also important to note that MAOIs can cause a hypertensive crisis if taken with sympathomimetic medications or with high tyramine-containing foods, as reported in a study on the treatment of nightmare disorder in adults 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
MAOIs and Tyramine Interaction
- When a patient taking Monoamine Oxidase Inhibitors (MAOIs) consumes tyramine, it can lead to a hypertensive crisis due to the accumulation of tyramine in the body 2, 3.
- MAOIs inhibit the enzyme monoamine oxidase, which is responsible for metabolizing tyramine, a trace amine found in some foods that acts as a sympathomimetic 2.
- The accumulation of tyramine can cause the release of norepinephrine, leading to a sudden increase in blood pressure 2, 3.
- Hypertensive crisis can also be precipitated by using MAOIs in conjunction with other drugs that have vasoconstrictive properties, act as sympathomimetics, or inhibit the reuptake of norepinephrine 2.
Case Studies and Examples
- A case study reported a 51-year-old lady who presented with left-sided chest pain, palpitations, and headache after eating soft cheese while taking tranylcypromine, a non-selective irreversible MAOI 3.
- Another study found that administration of amitriptyline greatly diminished the pressor response to intravenous tyramine in patients receiving MAOIs, suggesting that a combination of amitriptyline and an MAOI may protect patients against the potential dangers of eating tyramine-containing foods 4.
Safety Precautions and Recommendations
- Patients taking MAOIs should follow dietary restrictions to avoid tyramine-rich foods, such as cheese, to minimize the risk of hypertensive crisis 2, 5.
- Co-administration of certain drugs, such as amitriptyline, may help reduce the risk of hypertensive crisis, but patients should still avoid eating tyramine-containing foods 4.
- In cases where patients require parenteral nutrition (PN) while taking MAOIs, close monitoring for signs of hypertensive crisis is recommended, and the dose of MAOI should be adjusted accordingly 6.