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MAOIs and diet: Is it necessary to restrict tyramine?
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/maois/HQ01575
- With Mayo Clinic psychiatrist
Daniel K. Hall-Flavin, M.D.
read biographyclose windowBiography of
Daniel K. Hall-Flavin, M.D.
Daniel K. Hall-Flavin, M.D.
Dr. Daniel Hall-Flavin, board certified in general psychiatry and addiction psychiatry, is a St. Louis native looking to the Internet as a way to help people improve their health and be more active participants in their own health care by learning from Mayo Clinic's experts.
Dr. Hall-Flavin served on the faculties of Cornell University Medical College, New York Medical College and The George Washington University Medical School before joining the Mayo Clinic staff in 1996. He has special interests in adult psychiatry, addiction psychiatry, pharmacogenetics and personalized medicine. He served as medical director of the National Council on Alcoholism and Drug Dependence from 1986 to 1999, and is currently involved in translational medicine research involving the introduction of pharmacogenetic technology into the daily practice of community psychiatry.
"With the advent of pharmacogenetics and related fields and the advances in translational medicine, informed collaborative relationships between knowledgeable, capable health professionals and informed, proactive individuals and their families are more vital than ever," he said.
"I'm optimistic that our Internet health education activities will contribute to ever-improving health outcomes for all who participate and apply what is learned."
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Question
MAOIs and diet: Is it necessary to restrict tyramine?
I just started taking MAOIs for depression. Do I really need to follow a low-tyramine diet?
Answer
from Daniel K. Hall-Flavin, M.D.
Tyramine (TIE-ruh-meen) is an amino acid that helps regulate blood pressure. It occurs naturally in the body and is found in certain foods. When taking a monoamine oxidase inhibitor (MAOI), you need to avoid consuming foods high in tyramine. These foods can cause a dangerous increase in blood pressure when combined with MAOIs.
MAOIs block an enzyme called monoamine oxidase, which breaks down excess tyramine in the body. Blocking this enzyme helps relieve depression. However, tyramine can quickly reach dangerous levels if you eat high tyramine foods, which may cause a spike in blood pressure and require emergency treatment.
Tyramine is naturally found in small amounts in protein-containing foods. As these foods age, the tyramine level increases. Some foods high in tyramine include:
- Aged cheeses, such as aged cheddar and Swiss; blue cheeses such as Stilton and Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine, including American cheese, cottage cheese, ricotta, farm cheese and cream cheese.
- Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami.
- Fermented cabbage, such as sauerkraut and kimchee.
- Soy sauce, fish sauce and shrimp sauce.
- Yeast-extract spreads, such as Marmite.
- Improperly stored foods or spoiled foods.
- Broad bean pods, such as fava beans.
Tyramine amounts can vary among foods due to different processing, storage and preparation methods. While you're taking an MAOI, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates.
Examples of MAOIs include:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam, Eldepryl, Zelapar)
- Tranylcypromine (Parnate)
MAOIs, although effective, generally have been replaced by newer antidepressants that are safer and cause fewer side effects. Still, MAOIs are a good option for some people. In certain cases, they relieve depression when other treatments have failed.
Selegiline in patch form (Emsam) delivers the medication through a patch you put on your skin. With the lowest doses of selegiline in patch form, you may not need to be as strict with the foods you eat, but check with your doctor or pharmacist.
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, which may include:
- Headache
- Nausea
- Vomiting
- Sweating
- Fast heartbeat
- Dilated pupils
- Rarely, bleeding in the brain (hemorrhagic stroke) or death
Be prepared. Ask your doctor what to do if you accidently eat or drink something with too much tyramine so you have a plan in place.
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- Hirsch M, et al. Monoamine oxidase inhibitors (MAOIs) for treating depressed adults. http://www.uptodate.com/index. Accessed Dec. 11, 2012.
- Flockhart DA. Dietary restrictions and drug interactions with monoamine oxidase inhibitors: An update. The Journal of Clinical Psychiatry. 2012;73(suppl):17.
- Thase ME. The role of monoamine oxidase inhibitors in depression treatment guidelines. The Journal of Clinical Psychiatry. 2012;73(suppl):10.
- Julios Costa MJ, et al. Monoamine oxidase inhibitors: An important but underutilized treatment. Part II: Safety and tolerability. Psychopharm Review. 2012;47:81.
- Emsam (prescribing information). Tampa, Fla.: Somerset Pharmaceuticals; 2007. http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021336s002lbl.pdf. Accessed Dec. 11, 2012.
- Nelson JK (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 19, 2012.
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