PsychoTropical Research - Dr Ken Gillman, Serotonin Syndrome, Mirtazapine, Dual Action Drugs. MAOIs - Dietary principles.

PsychoTropicalResearch, serotonin and serotonin syndrome research.

MAOIs - Dietary principles

MAOIs - Dietary principles

Date Created: 01/09/1999   Last Modified: 06/10/2002   Last Checked: 17/04/2004

The diet that is advisable with MAOIs is aimed at avoiding foods which contain greatly elevated quantities of tyramine. High concentrations of tyramine only occur in foods as a result of the action of micro-organisms. Foods which have not been subjected to such action from micro-organisms can confidently be stated always to be safe. The term micro-organisms includes various bugs and I do not think it is known precisely which ones do, or do not, produce tyramine as a byproduct of their metabolism. Excess tyramine is associated with food 'spoilage' and measurement of tyramine in food provides an index of 'freshness' that can be used for the quality control of food production. The practical admonition 'do not eat food if it does not smell fresh' may therefor be the best simple guide for patients on MAOIs.

The classical prohibitions with MAOIs are cheeses and meat or vegetable extracts such as 'Marmite', 'Vegemite', 'Promite' and any other similarly prepared substances (eg Soy sauce, and anything prepared from fermented bean curd eg miso soup, tofu).

It seems that avoiding the above limited number of foods removes a great proportion of the risk of a hypertensive reaction. The risk benefit ratio of treatment with these drugs will vary with each case. A basic written guide of dietary advice for each patient is almost always advisable, but the mere provision of this is not always sufficient education and instruction for all patients. Hence printed lists of instruction are only part of the patient education process. Most patients require periodic reinforcement of the dietary advice including the reminder that getting away with occasional lapses does not alter the fact that one day they may find a piece of really strong cheese and learn what the expression 'the mother of all headaches' really means.

It is useful to make it clear to patients that providing they seek prompt medical attention, should tyramine be ingested, then there is little or no risk of morbidity. It is the patient who sits around wondering why they have got such a bad headache who is at most risk.

The update note 'Brief information for patients' may be printed for your patients.

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