Tyramine is a decarboxylation product of tyrosine that can be formed during fermentation or in the gastrointestinal tract. A patient receiving a monoamine oxidase (MAO) inhibitor may develop potentially serious symptoms if exposed to high levels of tyramine or to sympathomimetic drugs.


Monoamine oxidase inhibitors may be found in:

(1) antidepressants (isocarboxazid, phenelzine, selegiline, tranylcypromine)

(2) antihypertensive (Pargyline)

(3) furazolidone (a nitrofuran antibiotic)

(4) procarbazine (antineoplastic agent)

(5) some herbal products, like St John's Wort


Symptoms (usually 30-60 minutes after eating, allowing for oral absorption):

(1) nausea and vomiting

(2) headache

(3) vomiting

(4) diarrhea

(5) hypertensive crisis


Proposed mechanism: In a patient taking an MAO inhibitor, absorbed tyramine may be transported and stored in adrenergic nerve terminals. It can result in a massive release of norepinephrine which causes the symptoms.


Restriction is started as soon as the exposure to MAO inhibitors are started and for 4 weeks after it is discontinued.


High tyramine products:

(1) fermented or "aged" cheeses (Cheddar, Stilton, Camembert, Emmenthaler, Boursault, Brie)

(2) fermented sausages (pepperoni, salami)

(3) fermented (pickled herring) or dried fish, caviar

(4) fermented alcoholic beverages, nondistilled (beer, ale, wine, sherry)

(5) yeast

(6) beef or chicken liver

(7) meat tenderizers

(8) soy sauce miso (fermented soybean paste)

(9) yogurt, sour cream, buttermilk and acidophilus milk

(10) bouillon

(11) canned or processed meats, hot dogs, bologna, liverwurst

(12) avocado, overripe

(13) figs

(14) eggplant

(15) broad beans, especially if overripe (fava beans, Chinese pea pods, lima beans)

(16) saurerkraut

(17) sourdough bread, homemade yeast bread

(18) bananas

(19) raisins


The tyramine content of food increases with storage or if fruits and vegetables are allowed to become overripe. Perishable food should be eaten fresh.


Products containing vasopressors that should be avoided:

(1) chocolate (phenylethylamine)

(2) coffee, tea, cola (caffeine) – no more than 2 servings a day

(3) nose drops, cold drops, some allergy medications or decongestants (phenylephrine, other)


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