HealthInfo Aoraki South Canterbury

MAOIs and a low tyramine diet

Monoamine oxidase inhibitors (MAOIs) are medications used to treat depression.

If you are prescribed a MAOI medication such as tranylcypromine (Parnate) or phenelzine (Nardil), you will need to follow a low tyramine diet.

Tyramine is a natural compound found in certain foods, especially foods that are fermented, aged or spoiled.

For most people, our body can process tyramine and there is no harm in eating foods that contain it. But when you take a MAOI, your body cannot process tyramine very well. This can cause your blood pressure to rise suddenly. If this happens you may notice:

• a headache
• a stiff neck
• nausea
• chest pain
• shortness of breath.

You will need to start a low tyramine diet on the same day you start your MAOI medication. You should stay on the low tyramine diet while taking the medication and for two weeks after stopping.

If you have an unpleasant reaction after having a food or drink, speak to your general practice team.

Tips for following a low tyramine diet

• Eat, cook or freeze fresh foods within 24 hours of buying.
• Eat frozen and canned food straight after opening or cooking.
• Avoid foods that are overripe, spoiled or past their best before or use by date.
• Eat leftovers within 48 hours of cooking or freeze them.
• Limit alcohol. If you do have alcohol, make sure you have had something to eat first and have no more than two standard drinks a day. A standard drink is a 330 ml bottle of beer, a 100 ml glass of wine or a 30 ml nip of spirits. Avoid craft beers and home brewed beer or wine.

Use the following table for foods you should avoid and foods to include.

Food group	Foods to avoid	Foods to include
Meat, chicken, seafood, eggs, nuts, seeds and legumes (cooked dried beans, split pea and lentils)	Spoiled or improperly stored meat, chicken and seafood. Aged, dried or cured meats. For example, salami, pepperoni and jerky. Pickled or smoked fish. Tempeh or fermented tofu. Soybeans.	Fresh, frozen or canned meat, chicken and seafood. Processed meat. For example, fresh ham, deli meats or sausages that have been stored and handled correctly. Fresh eggs. Regular tofu. All other legumes. Plain nuts and seeds.
Milk & milk products	Aged or strong cheese. For example, Brie, Camembert, Cheddar, Edam, Gouda, Gruyere and Parmesan. Probiotic drinks. For example, Yakult and Activate.	Cottage cheese, cream cheese and ricotta cheese. Fresh pasteurised milk, yoghurt, custard and ice cream. Non-fermented soy products. For example, soy milk, soy yoghurt and soy cheese.
Grain foods	Sour dough bread. Bread or baked products containing cheese or yeast extracts. For example, cheese biscuits and Marmite scrolls.	Bread, breakfast cereal, pasta, rice, plain biscuits and cake.
Vegetables & Fruit	Dried, overripe or spoiled vegetables and fruit. Broad beans, edamame beans and snow peas. Banana peel.	All other fresh, frozen or canned vegetables and fruit.
Fats & oils	None.	All.
Spreads, sauces & fermented foods	Yeast extracts. For example, Bovril, Marmite, Promite and Vegemite. Meat stock cubes and powders. Fish sauce. Soy sauce, hoisin sauce, tamari and teriyaki sauce. Kefir, kimchi, kombucha, miso, sauerkraut and shrimp paste.	Jam, honey and peanut butter. Most vegetable stock cubes and powders. All other sauces.
Alcohol	Craft beer and home brewed beer. Homemade wine.	All other beer. Red or white wine. Fortified wine. For example, port and sherry. Spirits. For example, gin, rum and vodka.

  HealthInfo recommends the following pages

• Sunnybrook Health Sciences Centre – MAOI diet recipe book

  This 76-page recipe book has information about the low tyramine diet. It also has recipes that are safe for someone on a low tyramine diet.

Written by HealthInfo clinical advisers. Page created December 2023.

Sources

Page reference: 1293504

Review key: HIMMH-215644