Psychiatric Medications Q 66
Tranylcypromine sulfate (Parnate) is prescribed for a depressed client who has not responded to the tricyclic antidepressants. After teaching the client about the medication, Nurse Marian evaluates that learning has occurred when the client states, “I will avoid:
A. Citrus fruit, tuna, and yellow vegetables.”
B. Chocolate milk, aged cheese, and yogurt”
C. Green leafy vegetables, chicken, and milk.”
D. Whole grains, red meats, and carbonated soda.”
Correct Answer: B. Chocolate milk, aged cheese, and yogurt’”
These high-tyramine foods, when ingested in the presence of an MAO inhibitor, cause a severe hypertensive response. MAOIs prevent the breakdown of tyramine found in the body as well as certain foods, drinks, and other medications. Patients that take MAOIs and consume tyramine-containing foods or drinks will exhibit high serum tyramine level. A high level of tyramine can cause a sudden increase in blood pressure, called the tyramine pressor response.Even though it is rare, a high tyramine level can trigger a cerebral hemorrhage, which can even result in death.
Option A: Also, certain fruits can contain tyramine like overripe fruits, avocados, bananas, raisins, or figs. Further examples are cheeses, alcohol, and fava beans; all of these should be avoided even after two weeks of stopping MAOIs. Anyone taking MAOIs is at risk for an adverse hypertensive reaction, with accompanying morbidity.
Option C: Tyramine occurs naturally in small amounts in protein-containing foods. As these foods age, the tyramine levels increase. Tyramine amounts can vary among foods due to different processing, storage, and preparation methods. You can’t reduce the amount of tyramine in food by cooking it.
Option D: Eating foods with high tyramine can trigger a reaction that can have serious consequences. Patients should know that tyramine can increase with the aging of food; they should be encouraged to have foods that are fresh instead of leftovers or food prepared hours earlier. Examples of high levels of tyramine in food are types of fish, as well as types of meat, including sausage, turkey, liver, and salami.