FOOD AND MAOIS

A potentially life-threatening hypertensive crisis can develop in patients taking non-selective MAOIs who eat tyramine-rich food (e.g. cheeses, salami, yeast extracts, pickled herrings) and drinks (e.g. some beers and wines) or young broad bean pods, which contain dopa. Fatalities have occurred.
As little as 20 mg of tyramine can raise the blood pressure by 30 mmHg in patients taking tranylcypromine. However, because tyramine levels vary so much it is impossible to guess the amount of tyramine present in any food or drink. Old, over-ripe strong smelling cheeses with a salty, biting taste, or those with characteristic holes due to fermentation should be avoided, as they generally contain high levels of tyramine. Fresh cheeses made from pasteurised milk tend to have lower levels of tyramine. The tyramine-content can even differ significantly within a single cheese between the centre, with lowest levels of tyramine, and the rind, containing the most. There is no guarantee that patients who have uneventfully eaten these hazardous foodstuffs on many occasions may not eventually experience a full-scale hypertensive crisis, if all the possible variables conspire together. Therefore tyramine-rich foods should be avoided. Fermented or aged foods, such as cheeses, sausages and beer, or smoked meats tend to be the most common tyramine-rich foods.