Comprehensive Nursing Pharmacology Q 290
When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as:
A. Roquefort, cheddar, or Camembert cheese.
B. Grape juice, orange juice, or raisins.
C. Onions, garlic, or scallions.
D. Ground beef, turkey, or pork.
Correct Answer: A. Roquefort, cheddar, or Camembert cheese.
Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid; the other foods are not. Monoamine oxidase inhibitors are responsible for blocking the monoamine oxidase enzyme. The monoamine oxidase enzyme breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. MAOIs inhibit the breakdown of these neurotransmitters thus, increasing their levels and allowing them to continue to influence the cells that have been affected by depression.
Option B: 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 C: 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.
Option D: Examples of high levels of tyramine in food are types of fish, as well as types of meat, including sausage, turkey, liver, and salami. 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.