Dietary guidelines for nonselective MAOIs

Tyramine is an indirectly acting sympathomimetic metabolised by monoamine oxidase enzymes. The irreversible nonselective monoamine oxidase inhibitors (MAOIs), phenelzine and tranylcypromine, may cause significant hypertension when combined with foods containing large amounts of tyramine; see Tyramine reaction. For foods to avoid when taking irreversible nonselective MAOIs, see Irreversible nonselective monoamine oxidase inhibitor dietary guidelines.

Interactions with tyramine-containing foods are unlikely at recommended doses of moclobemide, a reversible inhibitor of monoamine oxidase type A (MAO-A), as tyramine is also metabolised by monoamine oxidase type B (MAO-B). Risk of interaction is further minimised by taking moclobemide after meals. However, when used at higher than recommended doses, moclobemide also inhibits MAO-B and dietary restrictions are warranted (see Irreversible nonselective monoamine oxidase inhibitor dietary guidelines).

Table 1. Irreversible nonselective monoamine oxidase inhibitor dietary guidelines
This table should be used as a guide only. All food should be fresh or freshly frozen, stored properly and eaten soon after purchase. Avoid food that is fermented or possibly ‘off’.
There is no way of knowing for certain the tyramine content of food or drink without appropriate product analysis.
Food types	Permitted	Avoid [NB1] [NB2]
cheese and other milk products	fresh cottage, cream and ricotta cheese; processed cheese slices; all fresh milk products that have been stored correctly (eg fresh cream, yoghurt, ice cream)	matured, aged or out-of-date cheese
meat, fish, poultry and eggs	all permitted except those listed opposite as avoid	liver products (eg pâté); fermented, matured or aged meat (eg salami, pepperoni, mortadella); pickled herring; improperly stored or spoilt meat, fish, poultry or eggs
fruit and vegetables	all permitted except those listed opposite as avoid	fava or broad bean pods (not beans), banana peel (not pulp), sauerkraut, fermented soya beans
alcoholic drinks	spirits, moderate quantities [NB3] of bottled or canned beer (including nonalcoholic beer), moderate quantities [NB3] of wine (except Chianti wine made by the governo process) red wine may cause a headache unrelated to a rise in blood pressure	all tap and home-brewed beers [NB4], Chianti wine made by the governo process
miscellaneous	brewer’s yeast; soy milk; commercial soup bases, packet soups and tinned soups if used before their expiry date	yeast extracts (eg Vegemite, Promite, Marmite, Bovril); protein extracts; soy sauce and other soybean products (eg miso, tofu); banana chips and banana-flavoured dessert (banana peel is used in flavouring)
Note: NB1: These foods are known to contain large amounts of tyramine; however, any food high in aromatic amino acids can become high in tyramine if spoilage occurs or after storage. Cooking does not inactivate tyramine. NB2: Wait for 14 days after stopping phenelzine or tranylcypromine before eating any of these foods to allow new monoamine oxidase enzymes to be synthesised. NB3: Moderate quantities: beer, 2 × 340 mL glasses; wine, 2 × 110 mL glasses. NB4: Avoid home-brewed alcoholic drinks because they have highly variable tyramine concentrations.