Master Monoamine Oxidase Inhibitor (MAOI) Contraindications

Wine and aged cheese are foods containing tyramine, which can lead to hypertensive crisis when ingested with MAOIs. Tyramine is metabolized by monoamine oxidase, and when foods high in tyramine are combined with therapy that inhibits MAO, excess stored monoamines (serotonin, NE and dopamine) are released. Patients taking MAOIs should avoid aged cheeses, red wine, beer, soy products, over-ripened bananas, and cured, smoked, aged, or pickled meats.

Combining excess amounts of wine and cheese, or other tyramine-containing foods with MAOI therapy leads to hypertensive crisis. This is characterized by a severe blood pressure increase which can lead to stroke.

Caution should be taken with multiple drug therapy, as the use of SSRIs, TCAs, meperidine, and dextromethorphan are contraindicated in a patients taking MAOIs. When combined, there is a profound risk of serotonin syndrome.

This is a rapidly progressive, potentially life-threatening syndrome which can be caused by a drug interaction. It has a wide range of clinical findings, where patients may display hyperthermia, hypertension, myoclonus, mydriasis, overactive bowels, and mental agitation. This syndrome should not be confused with neuroleptic malignant syndrome, which is associated with the use of antipsychotic drugs.