The Monoamine Oxidase Inhibitor—Tyramine Interaction

Abstract

Reports of hypertensive reactions from monoamine oxidase inhibitors (MAOI) began to proliferate in the early 1960s. Asatoor did extensive research and found that the combination of an MAOI and a food containing tyramine resulted in the hypertensive interaction ("the cheese reaction"). Because of the risk of intracerebral hemorrhage and death, clinicians were hesitant to use the MAOIs. Although progress on the metabolic effects of MAOIs has been slow, use of clinical information in addition to analysis of bioactive amine content of foods has allowed the formulation of dietary recommendations, which are thought to be useful clinically in the administration of MAOIs. This has resulted in the gradual return to use of these psychotropic compounds.

Azure B and a synthetic structural analogue of methylene blue, ethylthioninium chloride, present with antidepressant-like properties

“…Although no cases have been documented for MB, MAO-A inhibitors may cause tyramine-induced hypertensive crisis when combined with tyramine-rich foods (Brown et al, 1989). Further investigation is necessary to determine if ETC indeed possesses an improved safety profile compared to MB in this regard.…”

“…Although MB possesses a good safety profile, due to its high potency inhibition of MAO-A, MB may precipitate serotonin toxicity (ST) if administered with serotonergic agents (Ramsay et al, 2007;Stanford et al, 2010). Another major disadvantage of MAO-A inhibitors and possibly MB is the concern for development of hypertensive crisis due to the interaction of inhibitors of MAO-A with tyramine and other monoamine releasing compounds (Brown et al, 1989). Despite these concerns, there remains a growing interest in the clinical benefit and utility of MAO-inhibitors in the treatment of depression (Schwartz, 2013;Lum and Stahl, 2012).…”

Mechanisms underlying food–drug interactions: Inhibition of intestinal metabolism and transport

“…For example, vitamin K-rich foods interfere with co-factor function and should be consumed cautiously with the anticoagulant, warfarin, as they can disrupt vitamin K metabolism and increase risk of bleeding or clot formation (Holbrook et al, 2005). Isoniazid and monoamine oxidase inhibitors, used to treat tuberculosis and depression, respectively, inhibit the breakdown of endogenous and dietary amines; a tyramine-rich diet can potentiate a hypertensive crisis (Brown et al, 1989; Self et al, 1999). Foods consumed as beverages account for a very high proportion of dietary antioxidant intake (Pulido et al, 2003).…”

Neurovascular Dissociation With Paradoxical Forearm Vasodilation During Systemic Tyramine Administration

“…This phenomenon inspired many researchers to investigate the effects of tyramine on the cardiovascular system. 1 The hemodynamic effects of tyramine are thought to be related to the release of endogenous norepinephrine from postganglionic sympathetic neurons. 2 Thus, tyramine is often used as a pharmacological tool to evoke "endogenous norepinephrine release" in the belief that its cardiovascular effects mimic those produced by natural sympathetic activation.…”