Drug interactions diet - tyramine low - for MAOI
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To prevent adverse reactions such as severe headache, tachycardia and hypertension in patients taking monoamine oxidase inhibitor (MAOI) medications by restricting the tyramine content of the diet.
Characteristics
Mainly freshly prepared food, and eliminates foods that are high in tyramine, including soy sauce, yeast and meat extracts, fermented foods and mature cheeses. However, many foods once thought to be dangerous for patients on MAOIs are now allowed. A tyramine content of less than 6mg per serving is generally considered safe. Foods that have been unnecessarily restricted previously include bananas, beef / chicken bouillon, chocolate, fresh and mild cheeses, monosodium glutamate, peanuts, properly stored pickled or smoked fish, and raspberries.
Indications
Patients prescribed MAOI drugs (e.g. Parnate, Nardil). The diet should continue for two to three weeks after MAOI medication has ceased.
Nutritional adequacy
Nutritionally adequate.
Precautions
None.
Paediatrics
Suitable for use in paediatrics when combined with an age-appropriate diet.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | Plain cooked meat, poultry, fish and eggs | Any dishes containing cheese, e.g. cheese omelettes, lasagne, spaghetti bolognese, mornays, quiches, crepes Fermented sausages, e.g. salami, pepperoni, mortadella Any dishes made with beer or red wine, meat or yeast extracts, or shrimp paste Soybean products, including textured vegetable protein (TVP), soy sauce, tamari |
| Sauces, gravies | Sauces prepared without meat or yeast extracts or soy sauce Portion-control tomato sauce | Many commercial gravies and sauces Soy sauce |
| Starchy vegetables / pasta / rice | All others | Any prepared with cheese sauce |
| Vegetables | All others | Any prepared with cheese sauce, e.g. cauliflower cheese Sauerkraut, snow peas, broad beans |
| Soups | None | All |
| Sandwiches | All others | Cheese, Vegemite™, avocado Salami, mortadella and other processed meats |
| Salads, dressings | All others Portion-control mayonnaise | Avocado Salami, mortadella and other processed meats |
| Breads, cereals | All | |
| Spreads | All others | Vegemite™, Marmite™ |
| Hot breakfast choices | All | |
| Fruit | All, including banana | Avocado |
| Yoghurt | All | |
| Desserts | All | |
| Milk and cheese | All milk Fresh cottage cheese or ricotta | All matured and aged cheeses |
| Beverages | All | |
| Biscuits | All | |
| Miscellaneous | Nuts, monosodium glutamate (MSG), chocolate | Bonox® |
References
- American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. [accessed 17 March 2010].
- Rapaport MH. Dietary restrictions and drug interactions with monoamine oxidase inhibitors: the state of the art. J Clin Psychiatry. 2007;68 Suppl 8:42-6.
- Fiedorowicz JG, Swartz KL. The role of monoamine oxidase inhibitors in current psychiatric practice. J Psychiatr Pract 2004;10(4):239-48.
- Dilsaver SC. Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology. Acta Psychiatr Scand 1988;78:1-7.