MAOIs and diet: Is it necessary to restrict tyramine?

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MAOIs and diet: Is it necessary to restrict tyramine?

Question

I just started taking MAOIs for depression. Do I really need to follow a low-tyramine diet?

Alice
Ohio

Answer

Tyramine is an amino acid that helps regulate blood pressure. It occurs naturally in the body and in certain foods. MAOIs block an enzyme called monoamine oxidase, which breaks down excess tyramine in the body. Blocking this enzyme helps with depression. But, tyramine can quickly reach dangerous levels if you eat high tyramine foods. Your body can't break them down quickly enough. This leads to a spike in blood pressure that may require emergency treatment. Signs and symptoms can include:

  • Headache
  • Nausea
  • Vomiting
  • Sweating
  • Fast heartbeat
  • Dilated pupils
  • Rarely, brain hemorrhage or death

Some foods high in tyramine include:

  • Aged cheeses
  • Cured meats, such as sausage, pepperoni and salami
  • Sauerkraut
  • Soy sauce
  • Yeast-extract spreads, such as Marmite
  • Improperly stored or spoiled foods
  • Broad bean (fava bean) pods
  • Banana peels
  • Tap (draft) beer or unpasteurized beer
  • Some wines

The amount of tyramine can vary among foods due to different processing, storage and preparation methods. While you're taking MAOIs, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates.

One MAOI inhibitor, selegiline (Emsam) is delivered with a patch you put on your skin. With selegiline, you may not need to be as strict with the foods you eat.

Whichever type of MAOI you take, ask your doctor for a list of foods to avoid. Make sure you understand exactly what's safe for you and what isn't. Learn the emergency signs of high blood pressure and know what to do if you accidently eat or drink something with too much tyramine.

Last Updated: 2010-09-01
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