MAOIs and Tyramine-rich Foods – Antidepressants (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now, here's the life threating problem. Yeah, you heard me right.

    00:04 Here's the life threating problem.

    00:07 Tyramine is the building block of norepinephrine and it's commonly found in foods that are aged.

    00:15 Okay, so you see the picture we have up there, those are real lunch meats.

    00:18 When I moved to Oklahoma, I missed the real delis that we had, back East and up North.

    00:24 Because a lot of the food is not the same when it comes to deli meats being like really good aged salami or aged deli meat.

    00:33 Not really available in my part of the country now.

    00:36 But truly aged foods like these, aged salamis, really good expensive aged cheese, remember this is not Velveeta.

    00:44 I'm not even sure what Velveeta is except delicious.

    00:49 When you melt it on a cheeseburger, in my mind, or make queso out of it but a really good aged cheese is also gonna contain tyramine, as are wines that are aged.

    00:59 So, tyramine is the building block of norepinephrine.

    01:04 Remember what an MAOI does, it's gonna make more of those neurotransmitters available.

    01:10 So, if a patient is eating food that contains tyramine, in aged food that contains tyramine; and we know that tyramine is the building block of norepinephrine, which, uh-oh, this could be problematic.

    01:22 Now, we might have too much norepinephrine in your body. So, what happens? Well, the MAOIs, we talked about that, inhibit monoamine oxidase and so the body can't get rid of its excess norepinephrine if they're taking this medication.

    01:38 So, what's the result? You have increased levels of norepinephrine.

    01:43 If you take food that has tyramine, the building block of norepinephrine, in it too, this could lead to a hypertensive crisis.

    01:52 So, underline that hypertensive crisis, that's the problem.

    01:57 If the patient's taking an MAOI, they eat a food that's high in tyramine, then they can have a significant hypertensive crisis.

    02:07 So, this involves very clear patient education and making sure that the patient can teach that back to you, can say that back to you.

    02:18 So, they understand the risk of this really strict dietary component of taking an MAOI.

    02:24 Let me give you some examples that maybe you didn't think about.

    02:28 Certain alcoholic beverages like chianti wine or vermouth -- out.

    02:32 Now, this one you might find funny, banana peels.

    02:35 Like, okay, I'm good, I love bananas but not usually the peel.

    02:39 Some places, some cultures, some people actually eat the banana peel, so you don't want to overlook telling patients like you might not know this but tyramine is also in banana peels.

    02:51 Bean curd, which is universally, globally, fairly popular, so you want to make sure they're aware of that.

    02:56 Fava bean pods, they also have dopa, so that's not a good plan.

    03:01 Cheeses that are aged, we talked about, or smoked fish.

    03:04 If your patient loves smoked salmon, they can't do that.

    03:08 Not smoked, fermented, or pickled fishes.

    03:12 Which are very popular parts of a lot of cultures, unique and delicious foods.

    03:17 So, this is not a -- just kinda brush over this point with your patient education.

    03:22 You want to be meticulous about making sure they understand what are the possible foods that could have tyramine and what could happen to them because look at this list.

    03:32 We talked about the aged meats. There's no problem with fresh meat or liver.

    03:37 Like wow, yay, no problem with liver.

    03:41 Except I can't even stand the smell of it, let alone the taste of it, but that's my personal preference. Ginseng is another one.

    03:49 Protein extracts, protein dietary supplements, which a lot of people are into, protein shakes. So keep that in mind.

    03:57 Sauerkraut is out. Shrimp paste, found in Asian foods, certain soups, miso, and yeast in baking is okay.

    04:08 Okay, so, once it's baked, you're okay. But otherwise, that could also be problematic.

    04:12 That is a pretty wide and bizarre list.

    04:17 You can't memorize everything, but you do wanna keep in mind, hey, if a patients on an MAOI, you would look all this up. For testing purposes, remember aged foods.

    04:26 Aged foods are gonna be a problem. As many of these that you can pick up, that would be helpful.

    About the Lecture

    The lecture MAOIs and Tyramine-rich Foods – Antidepressants (Nursing) by Rhonda Lawes, PhD, RN is from the course Central Nervous System (CNS) Medications (Nursing).

    Included Quiz Questions

    1. Tyramine
    2. Choline
    3. Phenylalanine
    4. Glycine
    1. "I should avoid having smoked or fermented fish."
    2. "I can have wine three times a week."
    3. "I should avoid all dairy products."
    4. "I should have bean curd once every day."

    Author of lecture MAOIs and Tyramine-rich Foods – Antidepressants (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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