Mayo Clinic Health Library

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?

Updated: 01-17-2013

Answer

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MAOIs, although effective, generally have been replaced by newer antidepressants that are safer and cause fewer side effects.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.

Site view: at a glance