A number of patients have developed severe behavioural and neurological signs of
toxicity (some similar to serotonin
syndrome) after taking
MAOIs with tryptophan, and fatalities have occurred.
It has been recommended that patients taking
MAOIs should start treatment with a low dose of
tryptophan (500 mg). This should be gradually increased while monitoring the patient for changes suggesting hypomania, and neurological changes, including
ocular oscillations and upper motor neurone signs.