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    Depression (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention

    Table 4. Tyramine-Containing Foodsa

    Class of Food and Beverage Tyramine-Rich Foods and Beverages To Avoid Acceptable Foods Containing Little or No Tyramine
    OTC = over-the-counter.
    a Adapted from the EMSAM Medication Guide.[46]The foods and beverages listed above should be avoided beginning on the first day of treatment with selegiline 9 mg/24 h or 12 mg/24 h and should continue to be avoided for 2 weeks after a dose reduction to 6 mg/24 h or following the discontinuation of selegiline 9 mg/24 h or 12 mg/24 h.
    Meat, poultry, and fish Air-dried, aged, and fermented meats, sausages, and salamis (including cacciatore, hard salami, and mortadella); pickled herring; and any spoiled or improperly stored meat, poultry, and fish (e.g., foods that have undergone changes in color or odor or that have become moldy); spoiled or improperly stored animal livers Fresh meat, poultry, and fish, including fresh processed meats (e.g., lunch meats, hot dogs, breakfast sausage, and cooked sliced ham)
    Vegetables Broad bean pods (fava bean pods) All other vegetables
    Dairy Aged cheeses Processed cheeses, mozzarella, ricotta cheese, cottage cheese, and yogurt
    Beverages All varieties of tap beer, and beers that have not been pasteurized so as to allow for ongoing fermentation As with other antidepressants, concomitant use of alcohol with selegiline is not recommended. (Bottled and canned beers and wines contain little or no tyramine.)
    Miscellaneous Concentrated yeast extract (e.g., Marmite), sauerkraut, most soybean products (including soy sauce and tofu); OTC supplements containing tyramine Brewer's yeast, baker's yeast, soy milk, commercial chain-restaurant pizzas prepared with cheeses low in tyramine

    Selegiline is a nonselective MAOI, inhibiting not only the monoamine oxidase B (MAO-B) enzyme in the central nervous system but also monoamine oxidase A (MAO-A) elsewhere in the body. In the digestive tract, MAO-A normally metabolizes tyramine, a dietary amine that is found in high concentrations in foods such as aged cheese and red wine. The breakdown of tyramine in the gut prevents significant amounts of it from being absorbed and circulated throughout the body. Tyramine is a potent pressor-leading to constriction of blood vessels-which ultimately results in increased blood pressure. Large amounts of tyramine can lead to hypertensive crises, resulting in stroke, heart attack, and even death. Because the medication is absorbed from the skin patch and bypasses the gut wall, it is thought that transdermal selegiline will have a significantly reduced effect on MAO-A in the digestive tract. In addition, at lower doses, selegiline is thought to inhibit MAO-B preferentially, while at higher doses both A and B isoenzymes are affected. With significantly reduced inhibition of digestive tract MAO-A, dietary restrictions are not considered necessary for the lower dose. In considering starting this drug, consult with a pharmacist about multiple classes of drug-drug interactions. This drug has not been evaluated in people with cancer.[47]

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