Can beer be consumed with Parnate (tranylcypromine)?

Beer Consumption with Tranylcypromine (Parnate) is Contraindicated

Beer should absolutely not be consumed with tranylcypromine (Parnate) due to the risk of potentially fatal hypertensive crisis. 1

Why Beer and Tranylcypromine Don't Mix

Tranylcypromine is a monoamine oxidase inhibitor (MAOI) that inhibits intestinal MAO, which normally breaks down tyramine in food and beverages. When MAO is inhibited:

• Tyramine from beer can enter the systemic circulation and cause sudden, dangerous elevations in blood pressure 1
• This can lead to hypertensive crisis, which can be life-threatening
• Beer, particularly tap beers and unpasteurized beers that allow ongoing fermentation, contain significant amounts of tyramine 1

The FDA label for tranylcypromine specifically lists "all varieties of tap beer and beers that have not been pasteurized" as tyramine-rich beverages that must be avoided 1. Even bottled and canned beers, while containing less tyramine, are not recommended for use with tranylcypromine.

Documented Risks

The risks of combining MAOIs like tranylcypromine with tyramine-containing foods and beverages are well-established:

• Case reports document fatal malignant hyperthermia resulting from the combination of tranylcypromine with wine and cheese 2
• The FDA label explicitly states: "Concomitant use of alcohol with tranylcypromine tablets is not recommended" 1

Dietary Restrictions with Tranylcypromine

Patients taking tranylcypromine must follow strict dietary guidelines:

• All tyramine-rich foods and beverages must be avoided during treatment and for 2 weeks after stopping the medication 1
• This includes all tap beers and unpasteurized beers
• Even bottled and canned beers should be avoided as a precaution

Alcohol Guidelines for the General Population vs. MAOI Patients

While general guidelines for the population suggest moderate alcohol consumption may be acceptable (1-2 drinks per day for men, 1 drink per day for women) 3, these guidelines do NOT apply to patients taking MAOIs like tranylcypromine.

Common Pitfalls and Caveats

1. Misconception about "safe" alcoholic beverages: Some patients mistakenly believe certain alcoholic beverages are safe with MAOIs. No alcoholic beverages are recommended with tranylcypromine.

2. Underestimating the risk: The interaction between tranylcypromine and tyramine-containing beverages like beer can cause rapid, severe, and potentially fatal hypertensive reactions.

3. Delayed reaction: Reactions can occur even hours after consumption, giving a false sense of safety.

4. Inconsistent tyramine content: The tyramine content in beer can vary widely, making it impossible to predict which beers might be "safer."

Bottom Line

The risks of combining beer with tranylcypromine far outweigh any potential benefits. Patients taking tranylcypromine should completely avoid all beers and other alcoholic beverages to prevent potentially life-threatening hypertensive crisis. This restriction applies during the entire course of treatment and for at least 2 weeks after discontinuing the medication.