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selegiline transdermal

MAOIs/Tyramine Containing Foods

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug, changing your diet or commencing any course of treatment.

Medical warning:

Most important. A change in your diet, medicine, or dosage is likely to be necessary. Promptly consult your doctor or pharmacist.

How the interaction occurs:

Tyramine is normally broken down in your body by an enzyme called MAO (monoamine oxidase). When MAO inhibitor (MAOI) medicines are taken, excessive amounts of tyramine enter the bloodstream, leading to the release of adrenaline-like substances (norepinephrine) in the body. Increased blood pressure then occurs.

What might happen:

Large increases in blood pressure may occur, which could lead to very serious problems such as strokes or chest pain/heart attacks.

What you should do about this interaction:

It is very important that you follow special dietary restrictions in order to limit the amount of tyramine in your diet while you are taking this medicine.Foods and beverages high in tyramine should be avoided (see list below). Excessive amounts of coffee, chocolate, sour cream, or avocados have also produced symptoms of high blood pressure in some cases. The following is a tyramine food list:High tyramine level foods include aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, brick, bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, colby, edam); aged, dried, fermented, salted, smoked, pickled and processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring); banana peel; beef and chicken liver (stored, not fresh); bouillon cubes, commercial gravies; concentrated yeast extracts (marmite); fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread; kim chee (Korean fermented cabbage); miso, orange pulp; overripe or spoiled fruits; packaged soups, red wine, sauerkraut, sherry, snow pea pods, sourdough bread, soy sauce, soya bean, soya bean paste; tap beer and ale; vermouth.Moderate-to-low tyramine level foods include alcohol-free beer, avocados, bananas; bottled beer and ale; chocolate and products made with chocolate; coffee, cola; cultured dairy products (e.g. buttermilk, yogurt, sour cream); distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.Tell your doctor or pharmacist immediately if you notice symptoms of high blood pressure such as fast or slow heartbeat, vomiting, sweating or headache, chest pain, sudden vision changes, one-sided weakness or slurred speech.Contact your healthcare professional (e.g., doctor, pharmacist or dietician) for more information, including recommendations for your diet.Your healthcare professionals may be aware of this interaction and may be monitoring you for it. Do not start, stop, or change your medicine or diet before checking with them first.

References:

1.Pare CM, Al Mousawi M, Sandler M, Glover V. Attempts to attenuate the 'cheese effect'. Combined drug therapy in depressive illness. J Affect Disord 1985 Sep;9(2):137-41.
2.Shulman KI, Walker SE, MacKenzie S, Knowles S. Dietary restriction, tyramine, and the use of monoamine oxidase inhibitors. J Clin Psychopharmacol 1989 Dec;9(6):397-402.
3.TEDESCHI DH, FELLOWS EJ. MONOAMINE OXIDASE INHIBITORS: AUGMENTATION OF PRESSOR EFFECTS OF PERORAL TYRAMINE. Science 1964 Jun 5;144:1225-6.
4.Brown C, Taniguchi G, Yip K. The monoamine oxidase inhibitor-tyramine interaction. J Clin Pharmacol 1989 Jun;29(6):529-32.
5.Pettinger WA, Oates JA. Supersensitivity to tyramine during monoamine oxidase inhibition in man. Mechanism at the level of the adrenergic neuron. Clin Pharmacol Ther 1968 May-Jun;9(3):341-4.
6.Maxwell MB. Reexamining the dietary restrictions with procarbazine (an MAOI). Cancer Nurs 1980 Dec;3(6):451-7.
7.Monoamine oxidase inhibitors for depression. Med Lett Drugs Ther 1980 Jul 11;22(14):58-60.
8.Zyvox (linezolid) US prescribing information. Pfizer January, 2014.
9.Cantarini MV, Painter CJ, Gilmore EM, Bolger C, Watkins CL, Hughes AM. Effect of oral linezolid on the pressor response to intravenous tyramine. Br J Clin Pharmacol 2004 Nov;58(5):470-5.
10.Generali JA, Hogan LC, McFarlane M, Schwab S, Hartman CR. Hypertensive crisis resulting from avocados and a MAO inhibitor. Drug Intell Clin Pharm 1981 Nov;15(11):904-6.

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