A monoamine oxidase inhibitor, or MAOI, is a type of antidepressant drug. Tyramine and MAO inhibitors: Mechanism | Medicine Specifics Medical experts took note, and researchers determined that a dangerous and potentially fatal interaction was occurring when these patients ate foods rich in tyramine, an amino acid (protein) found in the diet and also naturally produced in the body.3 Foods rich in tyramine include aged, cured, pickled, smoked and fermented foods, tap or unpasteurized beer, red wine, dried fruit, and fresh citrus. Menkes D, Bosanac P, Castle. Australasian Psychiatry. Also avoid gravies and sauces made with meat extracts, soy products, or cheese. This iatrogenic catastrophe, classically associated with MAOI antidepressants, is not peculiar to their use. Get Medical Pearls directly to your inbox every week! Additionally, speak to your health care provider or pharmacist before you take any prescription or over-the-counter products for weight reduction, allergies, sinus, cold, cough or flu, or mood (including herbal products such as ginseng or St. John’s Wort.) Typically it will have low bioavailability due to extensive first-pass effect in the liver.Â. Though often used synonymously; Trapped Lung and Lung Entrapment technically describe separate entities along the…, It is not clearly understood why patients with pulmonary hypertension (PH) develop pericardial effusions. The vast majority of research in the field focused on the role of MAO in the nervous system. Since the adverse effects of eating tyramine-containing foods can be so serious, strict adherence is needed. 1994 Dec;32(4):219-24. doi: 10.1016/1056-8719(94)90091-4. MAOIs were the first type of antidepressant developed, and became widely used in the 1950s. Meal Ideas and Menus: Avoiding High-tyramine Foods Made Easy. Six milligrams of tyramine is sufficient to elicit a mild reaction in people taking MAOI and 10-25 milligrams can cause a severe reaction. Typically resolving within 4-6 hours, however can be fatal! October 31, 2013; 15(5) Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3907330/ Accessed March 15, 2019, 3. • Tyramine is a naturally occurring substance that is present in certain foods. Because MAOIs inhibit MAO-A and MAO-B, if an MAOI such as tranylcypromine or phenelzine is administered before tyramine ingestion, tyramine sensitivity is dramatically increased. There is some variation of tyramine sensitivity between individuals. and concentrated yeast extract products such as Marmite and Vegemite. (Tyramine levels increase in foods when they are held at room temperature.) Available at: www.mc.vanderbilt.edu/documents/neurology/files/Tyramine%20Menu%20Book%2006227101.pdf  Accessed March 15, 2019, 5. Note – extreme rise in blood pressure is dangerous because it can damage your body’s organs. NOTE: Selegiline (MAO-B selective) and rasagiline do not functionally inhibit MAO-A and are not associated with the “Cheese effect” with doses typically used in clinical practice! High tyramine containing foods can actually cause dangerous spikes in blood pressure while taking a MAOI. But tyramine can reach dangerous levels if you eat foods containing tyramine while on an MAOI. Lactic acid bacteria are no strangers to beer and accordingly some beers test positive for high levels of tyramine. But if the MAO enzymes have been inhibited, tyramine can be freely absorbed in amounts larger than what the body can handle. Tyramine is a compound that affects your blood pressure. Tyramine is an amino acid that helps regulate blood pressure. Vanderbilt University Medical Center. What is tyramine? If excessive tyramine is ingested the blood pressure typically starts to increase from about half an hour after ingestion (sooner for liquids on an empty stomach), and remains elevated for 1-2 hours: the magnitude and duration of that elevation is dose related, so unless a large amount of tyramine has been ingested (50-100 mg) the reaction will be short-lived (about one … National Institutes of Health Clinical Center. Authors C Fankhauser 1 , T Charieras, D Caille, V Rovei. In some people, certain foods and drinks -- or things they contain -- can trigger a migraine.One well-accepted migraine trigger is tyramine.. Tyramine is a substance found naturally in some foods. Take one of our depression medication quiz to see if your symptoms are being helped by your medication. Our bodies contain an enzyme called monoamine oxidase (MAO). Weekly posts with high yield medical knowledge, directly to your mailbox! “They worked particularly well for older adults.”. My suspicion is correct. Low Tyramine Diet . MAOI low tyramine diet involves few changes. MAOIs occasionally react with tyramine-rich foods or a variety of other medicines to cause severe hypertension, excruciating headache, and sometimes a subarachnoid or intracerebral hemorrhage – a hypertensive crisis. Tyramine is found mainly in … Available at: www.cc.nih.gov/ccc/patient_education/drug_nutrient/maoi1.pdf     Accessed March 15, 2019, Hyped on Hypnosis: Inside the Mind with a Hypnotherapist, How Actor Zachary Levi Is Using His Superpowers Off Screen to Help Others with Depression. Vermouth and Korean beers are also known to be high in tyramine. Make sure your prescriber is aware of all medications and supplements you take for any reason. © 2021 Remedy Health Media, LLC ALL RIGHTS RESERVED, MAOIs and Tyramine: Foods in Your Diet May Lead to Dangerous Side Effects, www.ncbi.nlm.nih.gov/pmc/articles/PMC3907330/ Accessed March 15, 2019, www.mc.vanderbilt.edu/documents/neurology/files/Tyramine%20Menu%20Book%2006227101.pdf  Accessed March 15, 2019, www.mayoclinic.org/diseases-conditions/depression/expert-answers/maois/faq-20058035  Accessed March 15, 2019, www.cc.nih.gov/ccc/patient_education/drug_nutrient/maoi1.pdf     Accessed March 15, 2019, Depression Central: Tell Me All I Need to Know About Depression. instance,For foods that have been aged, matured, fermented, pickled, smoked or that are past the “best before” or “use by” date. Monoamine Oxidase Inhibitors (MAOIs), like most other antidepressants, work by targeting and, to some degree, preventing changes in brain chemistry that result in a depressed mood. That’s what causes side effects such as headaches and elevated blood pressure, as well as gastrointestinal upset, rapid heartbeat, shortness in breath, and neurological problems like confusion, anxiety, and vision changes that accompany sudden surges in blood pressure. Tyramine is found in aged foods and fermented foods. It's regulated and broken down by the MAO enzyme. Aged (mature) cheeses, including Cheddar, Stilton, Swiss, camembert, blue, and gorgonzola varieties. Newer classes often have fewer side effects than MAOIs. Italo Biaggioni; David Robertson,  Chapter 179: Monoamine Oxidase Inhibitors. an amino acid that regulates blood pressure It occurs naturally in the body “When combined with MAOIs, these substances can cause the same problems with hypertension as tyramine, leading to increased heart rate and stroke.”, 1. Although MAOIs have, for the most part, been replaced by newer generations of antidepressant medications, they are still in use because they are particularly effective for treating some major and treatment-resistant forms of depression. Patients on Monoamine oxidase inhibitors (MAO) inhibitors (especially MAO-A inhibitors or non-selective MAO inhibitors) are advised to avoid Tyramine rich foods. Tyramine is a chemical in foods and in the body that forms from the breakdown of certain proteins. Mycophenolate mofetil (Cellcept) is a semi…, Serum Creatinine can be a deceptive surrogate during an acute kidney injury. February 25, 2016; 24(4): 371-373 Accessed March 15, 2019, 2. For those with diagnosed Tyramine Intolerance, a low tyramine diet will be recommended and for those with suspected Tyramine Intolerance a low tyramine diet may be trialed to see if symptoms improve. If you're taking a monoamine oxidase inhibitor (MAOI), it's important to avoid foods high in tyramine, as the interaction could raise blood pressure to dangerously high levels. Beer on tap and unpasteurized or home-brewed beers. Use of this website is conditional upon your acceptance of our User Agreement. Interaction of MAO inhibitors and dietary tyramine: a new experimental model in the conscious rat J Pharmacol Toxicol Methods. While they are in your body, MAOI medications inhibit, or block, the action of an enzyme known as monoamine oxidase. That is why some tyramine data in processed food that were made decades ago may not be applicable anymore. If you consume those foods while taking one of these drugs you could have a hypertensive crisis where your blood pressure shoots up … I found out that it was from the cheese and peanut butter that I have been eating. But back in the 1950s, when MAOI medications were first introduced and prescribed to treat depression, patients began having problems with high blood pressure and migraine headaches, especially after eating specific types of foods. Antidepressants: from MAOIs to SSRIs and more. Dried fruit such as raisins, apricots, and prunes. Tyramine is a known migraine trigger, and doctors have long recommended a low-tyramine diet to their patients to reduce the frequency of migraine attacks. These side effects include a very bad headache, fast heartbeat, nausea, vomiting, and high blood pressure. This information is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. This can lead to a sudden spike in blood pressure, and to stroke, brain hemorrhage and death. Some foods contain substantial amounts of tyramine. It may lag…, Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic diseases (i.e SLE, Juvenile idiopathic…, After creation of a percutaneous tracheotomy site for prolonged ventilation, one of the immediate complications…. Available at: www.mayoclinic.org/diseases-conditions/depression/expert-answers/maois/faq-20058035  Accessed March 15, 2019, 6. You can have side effects if you take MAOIs and eat foods that are high in tyramine. If monoamine metabolism is compromised by the use of monoamine oxidase inhibitors (MAOIs) and foods high in tyramine are ingested, a hypertensive crisis can result, as tyramine also can displace stored monoamines, such as dopamine, norepinephrine, and epinephrine, from pre- synaptic vesicles. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3136031/ Accessed March 15, 2019, 4. Low Tyramine Diet A low tyramine diet is recommended if you are taking certain medicines such as monoamine oxidase inhibitors (MAOIs), some medicines used to treat Parkinson’s disease, and certain antibiotics. This normal process of elimination also prevents tyramine from building up to unsafe levels in your body, whether it occurs naturally or comes from your diet. Tyramine And Maois. Fermentation, aging, or the spoiling of foods can also produce tyramine. Symptoms may include a severe headache (particularly at the back of the head), dizziness, flushing, sweating, nausea, vomiting, a pounding heart, numbness or You’ll need to avoid certain foods while you’re using this type of medication. You need to limit the amount of tyramine you eat if you use an MAO inhibitor (MAOI) medicine. MAOIs prevent this removal, allowing these “feel good” chemicals to flood those areas of your brain that are involved in depression and help elevate your mood. However,…, The two drugs are not interchangeable nor dose equivalents. At the same time, however, MAOIs also prevent this enzyme from doing another one of its usual jobs, which is to metabolize, or break down, tyramine to a form that is easily eliminated from your body. Because of the … However, for some individuals, this class works well and is sometimes still used. MAOIs restrict the MAO enzyme to reduce symptoms of depression and anxiety. Tyramine is also a substrate for the dopamine β-hydroxylase enzyme found in storage vesicles, so following uptake into the storage granules, it will be converted to octopamine (β,4 … MAOIs act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Foods and to eliminate from your diet include the following specific types, as well as any combination foods (such as soups, stews, casseroles, stir-fries, and baked goods) that may include these as ingredients, as well as certain other types of drugs and supplements:2, 4, 5, 6. In those taking MAO Inhibitor medication or specific medications for treating Parkinson’s disease, a tyramine-free dietis prescribed. “Be especially careful with cough and cold medications, decongestants, antihistimes, and any other products that contain epinephrine, pseudoephedrine or phenylpropanolamine (banned in the U.S and many other, but not all, countries),” Dr Edlund warns. Basic & Clinical Pharmacology, 13e. Food manufacturing was adjusted to lower the resulting tyramine content. MAOIs—does the evidence warrant their resurrection? The MAOI’s fell out of favor because they have a lot of drug interactions and a serious interaction with foods high in tyramine. Onset is typically rapid (15 mins- 1hr); the hallmark presentation of the Tyramine “Cheese” reaction are HYPERTENSION + SEVERE HEADACHE (occipital or temporal), palpitations, nausea and vomiting. Any tyramine that comes from your diet is “extra,” and can easily accumulate in your body and overload the system. This is known as the “Cheese effect”!!! Your healthcare provider will provide a list of foods to avoid while you’re using any type of MAOI to treat depression or another condition. MAO-B preferentially deaminates phenethylamine and certain other trace amines; in contrast, MAO-A preferentially deaminates other trace amines, like tyramine MAOIs can interact with foods that contain tyramine and cause a dangerous increase in blood pressure. Many physicians also stopped prescribing MAO-Is. Fermented and pickled foods such as sauerkraut, kimchi, miso, pickles, pickled vegetables, Asian fish sauce, soy sauce, fermented bean curd (tofu). Tyramine is a naturally occurring substance that is present in a number of foods and drinks. Levels of monoamines are regulated by an enzyme found throughout the body called monoamine oxidase, or MAO. For a It is naturally found in some foods, plants, and animals. Tyramine buildup in the body has been associated with migraine headaches and life-threatening blood pressure spikes in people taking MAOI antidepressants. A lot of foods contain the amino acid “tyramine”. If the patient is taking a MOA inhibitor, Tyramine accumulates in the bloodstream; it has indirect sympathomimetic action causing the release of stored catecholamines. Indian Journal of Psychiatry. Aged, fermented, pickled and air-dried meats, poultry and fish. Remedy Health Media & PsyCom do not provide medical advice, diagnosis or treatment. To include salami, dried sausages such as mortadella, jerky, aged chicken livers, smoked salmon (lox), caviar, and pickled herring, as well as any animal foods that have spoiled or have been improperly stored. This is especially the case in people w… (Canned and bottled beers have been pasteurized, which prevents further fermentation and production of tyramine.) Oranges, grapefruit, lemons, limes, and pineapple contain small amounts of tyramine and should be limited to no more than 1/2 cup per day. Drug-Nutrient Task Force. Monoamine oxidase (MAO) is an enzyme found in nerve endings, gastrointestinal tract, the liver, and brain. When Patients (Disastrously) Go Off Their Psych Medications, Finally, A New Drug for Postpartum Depression, What to Know if You're Curious about Magic Mushrooms, Tell Me All I Need to Know About Postpartum Depression, 5 Things You Need to Stop Telling Yourself if You Want to Improve Your Mental Health, The Mindfulness Guide for People Too Busy to Meditate, How to Improve Sleep: 5 Ways to Find a Sleep Strategy That Works, Work Anxiety: 10 Tips to Manage Anxiety at Work, What You Need To Know About Cocaine and Crack. Tyramine is a monoamine (a compound that is a neurotransmitter). How Does DNA Testing for Medication Work? MECHANISM: Tyramine is a byproduct of Tyrosine metabolism by MAO in the liver. In peripheral tissues, MAO is involved in the oxidative catabolism of amines and prevent the penetration of dietary amines (such as tyramine from cheese and fermented drinks) into the circulation [21]. My interest in tyramine and MAOIs started after I had a severe migraine attack. However, if the MAO enzyme is inhibited, tyramine can reach dangerously high levels in … Ramachandraih CT, Subramanyam N, Bar, KJ, Baker G, Yeragani VK. One of the usual jobs this enzyme performs is to remove certain neurotransmitters (chemical messengers such as serotonin, norepinephrine and dopamine) from your brain, in order to maintain a normal flow. Mayo Clinic. The newer reversible MAOI medicine, moclobemide is less likely to cause a severe reaction with tyramine containing foods but large quantities of food containing tyramine should be avoided. Check the ingredient list for any form of tyramine, including L-tyramine, N-Methyl-L-Tyramine HCL and N-Methyltyramine HCL. In fact, because they are so effective, some mental health experts are calling for wider consideration of MAOIs for difficult-to-treat depressive conditions, and for more training of new physicians on how to use them. As MAO is an intraneuronal enzyme, which is bound to the mitochondrial outer membrane, tyramine molecules within the axoplasm are susceptible to enzymatic destruction by MAO. A certain amount of tyramine is not a problem for our system. It belongs to a category called monoamines. Reports of hypertensive reactions from monoamine oxidase inhibitors (MAOI) began to proliferate in the early 1960s. MAOIs currently approved for treating depression include oral phenelzine (brand name Nardil), tranylcypromine (Parnate), and isocaroxazid (Marplan), and the transdermal patch form of selegiline (EMSAM).1,2, “When researchers looked at how MAOIs were being used in the 1980s, they were commonly being prescribed for people with bipolar disorder,” recalls psychiatrist Matthew Edlund, MD, MOH, director of the Center for Circadian Medicine in Sarasota, Florida. Protein supplements and supplemental products, especially those promoted for weight loss and body-building. Other fruits are fine but avoid any that are overripe. MAOIs block an enzyme called monoamine oxidase, which breaks down excess tyramine in the body. MAO-A preferentially deaminates serotonin, melatonin, epinephrine, and norepinephrine. Ingesting foods high in tyramine can cause a pressor response in a patient with MAO-A and MAO-B inhibition, which is an increase in systolic blood pressure of 30 mm Hg or more. Tyramine and foods to avoid One downside to MAOIs is that they come with dietary restrictions because of the elevated tyramine levels in the blood. also prevent this enzyme from doing another one of its usual jobs, which is to metabolize, or break down, tyramine to a form that is easily eliminated from your body. Do SSRIs (Antidepressants) Cause Weight Gain? MAOIs prevent the breakdown of tyramine, and a build up of this substance can result in dangerous increases in blood pressure (hypertensive crisis). A question arose in my mind if there are foods out there that can inhibit tyramine degradation similar to MAOI drugs. Culpepper L. Reducing the burden of difficult-to-treat major depressive disorder: revisiting monoamine oxidase inhibitor therapy. Fava beans, broad beans (and their pods), snow peas, and most soybean products (with the exception of soy beverages). Cause of Pericardial Effusion in Pulmonary Hypertension: Pathogenesis, Difference between Mycophenolate Mofetil vs. Mycophenolate Sodium, Macrophage activation syndrome vs. Hemophagocytic lymphohistiocytosis,  CHAPTER 9: Adrenoceptor Agonists & Sympathomimetic Drugs. April-June 2011; 53(2): 180-182. The identification of the interaction between tyramine and MAO-I interaction led to many changes. Tyramine has an effect on blood pressure and is regulated by the enzyme monoamine oxidase. (1) Certain foods should be avoided while on this class medication-specifically tyramine containing foods. There are two isoforms of monoamine oxidase, MAO-A and MAO-B. Frank LoVecchio. So while you are taking MAOIs for depression, Dr. Edlund explains, your body is already working harder to process naturally occurring tyramine. Kathrynne Holden, MS, RD. When blood pressure shoots up high enough, there is the possibility of a hypertensive crisis, which can be deadly. Important Drug and Food Information. Always consult your doctor about your medical conditions. The way to prevent these side effects is to avoid eating foods that are high in tyramine throughout the period of time you are taking MAOIs and for several weeks after you stop the medication, to allow all traces of the drug to to be eliminated from your body. • Some foods contain greater amounts of tyramine than others. Asatoor did extensive research and found that the combination of an MAOI and a food containing tyramine resulted in the hypertensive interaction ("the cheese reaction"). Primary Care Companion CNS Disorders. MAOIs prevent the breakdown of tyramine, and a build up of this substance can result in dangerous increases in blood pressure (hypertensive crisis). Therefore, a small proportion of people may get a measurable, but not problematic, blood pressure elevation with only 10 mg of tyramine, but most people need to have 25-50 mg (in a meal) to get a significant rise in BP. MAOI medicines; the older types (isocarboxazid, phenelzine and tranylcypromine) can provoke a more severe reaction with tyramine containing foods.