What foods high in tyramine should be avoided by patients taking monoamine oxidase inhibitors (MAOIs) for depression?

High-Tyramine Foods to Avoid with MAOIs

Patients taking MAOIs for depression must completely avoid aged cheeses, concentrated yeast extracts (like Marmite), sauerkraut, broad bean pods (fava beans), and any aged, fermented, cured, smoked, or pickled meats, as these contain dangerously high tyramine levels that can trigger life-threatening hypertensive crises. 1

Absolutely Restricted Foods (High Tyramine Content)

The following foods contain tyramine levels ≥6 mg per serving and must be completely eliminated from the diet:

Cheeses

• All aged cheeses are strictly prohibited due to unpredictable and often dangerously high tyramine concentrations 1, 2
• Modern cheese production has reduced tyramine in some varieties, but the wide variability within the same cheese category makes blanket avoidance the safest approach 3

Meats and Proteins

• Any aged, fermented, cured, smoked, or pickled meats must be avoided 1
• Chicken liver aged 9 days contains extremely high tyramine (63.84 mg per 30g serving) 4
• Air-dried sausages contain dangerous levels (7.56 mg per 30g serving) 4
• Fresh meats are safe, but any meat that is unfresh or overripe poses risk 5

Fermented Foods and Condiments

• Sauerkraut contains high tyramine (7.75 mg per 250g serving) and must be avoided 1, 4
• Soy sauce contains significant tyramine (0.941 mg/mL) and should be restricted 4
• Concentrated yeast extracts like Marmite or Vegemite are strictly prohibited 1, 5

Vegetables

• Broad bean pods (fava beans) must be completely avoided due to high tyramine content 1, 5

Foods Requiring Caution or Moderation

Alcoholic Beverages

• Certain alcoholic beverages, particularly those that are fermented or aged, can contain tyramine 5
• The American College of Cardiology recommends limiting alcohol to ≤1 drink daily for women and ≤2 drinks for men when on MAOIs 6

Other Considerations

• Overripe or unfresh foods of any type should be avoided, as tyramine content increases with aging and bacterial decomposition 5, 3
• Many foods previously restricted (like fresh bananas, raspberries, and most fresh sliced meats) are actually safe when fresh 4

Critical Mechanism and Threshold

• Tyramine triggers norepinephrine release, and when MAO-A is inhibited, as little as 8-10 mg of ingested tyramine can cause life-threatening blood pressure elevations 2
• Under normal conditions, MAO-A degrades tyramine and prevents norepinephrine accumulation, but MAOIs eliminate this protective mechanism 2
• The pressor response shows significant interpatient variability, making strict adherence to dietary restrictions essential for all patients 3

Common Pitfalls to Avoid

• Do not assume "low tyramine" versions of restricted foods are safe - tyramine levels vary widely even within the same food category, making it impossible to predict safety 3
• Freshness is critical - even normally safe foods become dangerous when overripe, aged, or improperly stored 5, 4
• Restaurant foods pose particular risk - patients cannot verify the freshness or preparation methods of meats and cheeses when dining out 3
• Over-the-counter medications containing sympathomimetics (pseudoephedrine, phenylephrine) are absolutely contraindicated and can cause hypertensive crisis when combined with dietary tyramine 6, 2

Patient Education Essentials

• Provide written dietary instructions before starting MAOI treatment 5
• Patients should carry Medic-Alert identification or drug manufacturer warning cards 5
• Instruct patients to contact their clinician before taking any over-the-counter medication or supplements 5
• Emphasize that the MAOI diet is manageable - minimizing intake of the small number of truly risky foods is all that's required, and many patients need minimal dietary changes 3