If you have entered the site at this page you may wish to look at the home page and my publications (via menus at the top of the page), so that you appreciate my expertise and pre-eminence in this field. This advice and info is up to date, expert and comprehensive. You will not find better.

There are two versions:

1) The abbreviated version: title – ‘V.abbrev 3.1 2016’ which has been updated in line with the full monograph (pdf from the menu on left of this screen).

2) The full monograph- as below and now freely available to all as a pdf file from menu on the left of this screen (I would hope those who use it would give a donation to recognise its worth and to help PTR). This is the latest (and significantly updated) version of what I have been posting here for some time.

A donation of only $5 helps, a large portion of the help we get is from people who can only manage to give a little.

The abstract and some of the myths laid to rest are below, the full paper download is in the menu on L of this screen.

 

Monoamine Oxidase Inhibitors: a Review Concerning Dietary Tyramine and Drug Interactions

Abstract

This comprehensive monograph surveys original data on the subject of both dietary tyramine and drug interactions relevant to Monoamine Oxidase Inhibitors (MAOIs), about which there is much outdated, incorrect, and incomplete information, in the medical literature and elsewhere.

Fewer foods than previously supposed have problematically high tyramine levels because international food hygiene regulations have improved both production and handling. Cheese is the only food that has, in the past, been associated with documented fatalities from hypertension, and now almost all ‘supermarket’ cheeses are perfectly safe in healthy-sized portions. The variability of sensitivity to tyramine between individuals, and the sometimes unpredictable amount of tyramine content in foods, means a little knowledge and care are still advised.

The interactions between MAOIs and other drugs are now well understood, are quite straightforward, and are briefly summarized here (by a recognised expert). MAOIs have no pharmaco-kinetic interactions, and the only significant pharmaco-dynamic interaction, other than the ‘cheese reaction’ (caused by indirect sympatho-mimetic activity [ISA], is serotonin toxicity ST (aka serotonin syndrome) which is now well defined and straightforward to avoid by not co-administering any drug with serotonin re-uptake inhibitor (SRI) potency. There are no therapeutically used drugs, other than SRIs, that are capable of inducing serious ST with MAOIs. Anaesthesia is not contra-indicated if a patient is taking MAOIs.

Most of the previously held concerns about MAOIs turn out to be mythical: they are either incorrect, or over-rated in importance, or stem from apprehensions born out of insufficient knowledge.

Some Common Myths

The diet is difficult

People cannot have cheese or red wine

MAOIs have many dangerous interactions with other drugs

One cannot give an anaesthetic 

It is difficult to swap to and from other drugs 

One cannot combine them with tricyclic anti-depressants (TCAs)

They have a lot of side effects

MAOIs cause hypertension/should not be given to hypertensive patients

Tyramine reactions need urgent treatment

Patients should be given nifedipine sub-lingually

Adrenaline cannot be used