Dietary Precautions While Taking MAOIs

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Though not nearly as common as they once were, monoamine oxidase inhibitors (MAOIs) are still sometimes prescribed to treat depression, as well as off-label use for Parkinson's disease and anxiety disorders like panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). No matter what condition you may be taking these medications for, there are certain high-protein and aged foods that you should avoid in order to prevent harmful spikes in your blood pressure.

How MAOIs Work

Many people dealing with panic disorder are prescribed medications to treat anxiety, panic attacks, and other panic-related symptoms. Antidepressant medications may sound like they're only designed to treat depression, but antidepressants have increasingly been used to help alleviate the symptoms of panic disorder and other anxiety disorders.

First available to U.S. consumers in the 1950s, MAOIs were one of the earliest antidepressants prescribed. MAOIs work to impact different neurotransmitters, or naturally occurring substances, in the brain that regulate various body functions. In particular, MAOIs are thought to affect the neurotransmitters of serotonin, norepinephrine, and dopamine. These are associated with the regulation of your mood, sleep, energy, and motivation and they're also responsible for balancing the fight-or-flight response, which is linked to how you respond to stress and anxiety.

These days, there are often more effective medications available that have fewer side effects, so MAOIs are usually reserved for cases when other medications haven't done the job. They're a good choice for certain people, however.

Common MAOIs include:

  • Nardil (phenelzine)
  • Parnate (tranylcypromine)
  • Marplan (isocarboxazid)
  • Emsam (selegiline)

Reason for Food Restrictions

Tyramine is a compound that's found in certain foods, beverages, and other substances and has an effect on your blood pressure. Tyramine is regulated by the MAO enzyme, which helps break it down. MAOIs work by restricting the MAO enzyme, which usually results in reducing the symptoms of depression and anxiety.

However, when the MAO enzyme is inhibited, such as when you're taking an MAOI, tyramine can reach dangerously high levels, causing your blood vessels to narrow and resulting in critically high blood pressure.

If you're taking an MAOI, you'll need to avoid foods and beverages that are high in tyramine to prevent potentially fatal blood pressure spikes that can land you in the emergency room.

Foods to Avoid

Protein-rich foods contain higher amounts of tyramine. Additionally, tyramine content rises in these foods as they age. There are a few foods and beverages that are high in tyramine that you should avoid while taking an MAOI, including:

  • Meat products: Foods to avoid include beef liver, chicken liver, fermented sausages like pepperoni and salami, bacon, hot dogs, corned beef, and luncheon meats.
  • Fish products: Stay away from caviar, cured fish, dried or pickled herring, and anything that contains shrimp paste.
  • Milk products: Aged and mature cheeses and other dairy products like sour cream and yogurt are on the list of foods to avoid. You can have cottage cheese, processed cheese like American, cream cheese, ricotta, and part-skim mozzarella.
  • Fruits and vegetables: High-protein produce is also a concern. This includes overripe fruits and avocados, as well as banana peels (not the bananas themselves). Also, try not to eat fava beans, Italian green beans, or snow peas. It's best to stay away from sauerkraut, tofu, pickles, and canned figs as well.
  • Alcohol: Certain fermented alcoholic beverages should be left out of your diet. This includes red wines and Chianti, vermouth, and sherry. A beer that contains yeast should also be avoided, particularly home-brewed or tap beer.
  • Yeast-containing foods: It's recommended that you avoid foods that contain concentrated yeast products and brewer's yeast. Included in this group are items like miso, teriyaki, fermented tofu or bean curd, and soy sauce.
  • Combinations: Snacks or meals that are made with any of these foods also need to be avoided. For example, you shouldn't eat foods that contain cheese such as pizza or lasagna, or foods that contain soy sauce like stir-fry.

You'll also need to avoid high tyramine foods and beverages for two to four weeks after you go off of an MAOI. Your doctor will give you specific instructions.

Other Dietary Considerations

In foods that contain tyramine, the level increases even more during the spoiling or decay process. It's important that you eat only fresh and freshly cooked foods and use proper food safety practices, such as:

  • Check packaged foods for freshness and don't consume products beyond the freshness date.
  • Cook all foods to the proper temperature.
  • Maintain cold foods at the proper temperature.
  • Don't refreeze foods that have been thawed.
  • Avoid leftovers, even if they have been refrigerated.
  • Consume cooked foods promptly, making sure proper food temperature is maintained.

Keep in mind that heat doesn't decrease tyramine, so cooking or heating up food that's high in tyramine won't make any difference.

Symptoms of Hypertensive Crisis

When your tyramine level starts to increase, you may notice symptoms that your blood pressure is quickly rising. When this happens, it's an emergency situation called a hypertensive crisis. Symptoms include:

  • Headache, which will likely be severe
  • Nausea
  • Vomiting
  • Confusion
  • Disturbances in your vision
  • Fast or irregular heart rate
  • Pain in your chest that may be accompanied by shortness of breath
  • Sweating
  • Nosebleeds
  • Severe anxiety
  • Fainting

If you notice any of the symptoms of a hypertensive crisis, and especially if you know you ate food that's high in tyramine, call your doctor or 911, or have someone take you to the emergency room.

Plan Ahead

In the event that your doctor prescribes an MAOI for you, talk to him or her about a complete list of foods and alcohol that you need to avoid. You may also need to avoid certain medications, whether over-the-counter or prescription, so ask about this too. It's also best to make a plan with your doctor about what to do in the event that you have a hypertensive crisis so you know exactly what to do.

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