Fact sheetDiet specifications

Published on 1 Nov 2011


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 dishesPlain 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 / riceAll othersAny prepared with cheese sauce
VegetablesAll others

Any prepared with cheese sauce, e.g. cauliflower cheese

Sauerkraut, snow peas, broad beans

SoupsNoneAll
SandwichesAll others

Cheese, Vegemite™, avocado

Salami, mortadella and other processed meats

Salads, dressingsAll others

Portion-control mayonnaise

Avocado

Salami, mortadella and other processed meats

Breads, cerealsAll  
SpreadsAll othersVegemite™, Marmite™
Hot breakfast choicesAll 
FruitAll, including bananaAvocado
YoghurtAll  
DessertsAll 
Milk and cheeseAll milk

Fresh cottage cheese or ricotta
All matured and aged cheeses
BeveragesAll  
BiscuitsAll 
MiscellaneousNuts, monosodium glutamate (MSG), chocolateBonox®

References

  1. American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. [accessed 17 March 2010].
  2. 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.
  3. Fiedorowicz JG, Swartz KL. The role of monoamine oxidase inhibitors in current psychiatric practice. J Psychiatr Pract 2004;10(4):239-48.
  4. Dilsaver SC. Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology. Acta Psychiatr Scand 1988;78:1-7.
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