Updated 9/11/23
The food-drug interaction between monoamine oxidase inhibitors (MAOIs) and high tyramine intake is one of the most dangerous combinations out there. I remember working as a clinical dietitian at an inpatient psychiatric hospital where we had a patient on an MAOI. Admittedly, I was not familiar with this food-drug interaction at the time and looked into it very extensively to provide my patient with the best care and safety.
In this post, I’ll share my knowledge on what foods contain tyramine and the most common MAOIs out there that interact with this amino acid.
The tyramine and medication interaction
Foods high in tyramine can cause dangerously high blood pressure, also known as a hypertensive crisis, when taking an MAOI. A hypertensive crisis can lead to stroke and even death if not treated quickly. Blood pressure readings during a hypertensive crisis tend to be higher than 180/120 mmHg.
MAOI medications block the enzyme monoamine oxidase. This is what helps naturally break down tyramine consumed. One thing to keep in mind is that even after stopping an MAOI, it is important to follow at low tyramine diet for 2-3 weeks as the medication can still be present in your body.
If you are concerned that you consumed a food high in tyramine, check your blood pressure at home using an upper arm cuff monitor. Be on the lookout for symptoms of a hypertensive crisis such as extreme headache, nausea and vomiting, fast heart beat, confusion, sweating with severe anxiety, and/or nosebleeds.
What are MAOIs?
Most MAOIs are medications used for severe depression when others fail (usually a last resort scenario). The following medications are considered MAOIs:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
Selegiline (Emsam) is provided as a topical patch and may not require a low tyramine diet at lower doses (usually < 6 mg). If you take this medication, it’s important to confirm with your doctor to see if you need to follow a low tyramine diet.
If you are having trouble making a low tyramine diet work for your lifestyle, contact me! I’ll be happy to tell you more about how I can help.
High tyramine foods
Foods which contain high tyramine and must be avoided while taking an MAOI include:
- Aged and fermented cheeses (aged cheddar, swiss, parmesan, bleu cheese, gorgonzola, stilton)
- Dried sausages (summer sausage, salami, pepperoni)
- Smoked meats (bacon, corned beef, chorizo)
- Fermented and pickled foods (pickles, sauerkraut, kimchee, caviar, tofu)
- Some sauces (soy sauce, shrimp sauce, fish sauce, miso, teryaki)
- Fermented soybeans and fermented soy bean products
- Snow peas, fava beans and their pods
- Overripe fruits (overripe bananas or avocados more commonly)
- Meat tenderizers
- Yeast extracts (Marmite, brewer’s yeast, sour dough bread)
- Alcoholic beverages (tap and home brewed beer, more than 2-4 oz daily of red and white wine)
- Caffeinated food and beverages (cola, coffee, tea)
- Spoiled foods (sounds like a no-brainer but accidents happen!)
- Other fermented or aged food products
What to eat on a low tyramine diet
- Non-fermented cheeses such as cream cheese, cottage cheese, American cheese, or ricotta cheese
- Yogurt and milk
- Eggs, nuts, legumes
- Chicken, turkey, beef, pork, fish (not smoked)
- Fresh, frozen, or canned vegetables
- Fresh, canned, or frozen fruits
- Decaf coffee and decaf tea
- Caffeine-free soft drinks
- Small amounts of chocolate