First AD

Second AD

 The most well-known pharmacodynamic-based interaction occurs between MAOIs and tyramine.


Tyramine is a monoamine produced by MAO-mediated metabolism of tyrosine in some foods (eg, aged cheeses, fermented foods, cured meats). In addition to tyramine, MAO breaks down neurotransmitters such as dopamine, norepinepherine, and serotonin. Inhibition of MAO by certain antidepressants and unrestricted consumption of tyramine can lead to severe hypertension, arrhythmia, and headache.

Many foods were originally contraindicated, but recent data suggest a less restricted list of foods to be avoided.

Patients should be warned that tyramine content may vary, and levels increase when foods are aged or fermented, are stored for a long time (even in a refrigerator), or are not fresh. Given these variables and the erratic GI absorption of tyramine, lack of a serious reaction from (accidental) consumption of a restricted food on one occasion is not guaranteed on a different occasion.

Food-Drug Interactions in Psychiatry: What Clinicians Need to Know

,” by Christina S. Won, PharmD, PhD, on which this quiz was based.

 Gardner DM, Shulman KI, Walker SE, Tailor SA. The making of a user friendly MAOI diet. 

 Shulman KI, Herrmann N, Walker SE. Current place of monoamine oxidase inhibitors in the treatment of depression. 

Psychopharmacology

Quizzes

How do foods containing tyramine (eg, aged cheeses, fermented foods, cured meats) interact with some psychiatric medications?

Mini Quiz: Dietary Effects of Psychiatric Drugs

Christina S. Won, PharmD, PhD