Dietary restrictions for patients undergoing MAOI therapy

Some foods naturally contain a chemical called tyramine. It's also formed from the breakdown of protein in foods as they age, and by the action of bacteria on protein. This chemical helps your body to control blood pressure. Amounts of tyramine can vary among different brands of a particular food since factors related to its preparation, processing and storage could affect tyramine levels. Mixing tyramine with MAOIs may cause your blood pressure to rise very suddenly. As this can be dangerous, the food and drinks containing tyramine should be avoided. Foods which are suspected of being "off", unfresh, overripe or aged should also be avoided.

Begin this diet on the same day you begin taking the MAOI antidepressant medicine, and continue it for 14 days after you stop taking the medicine.

Rules to Remember:

• Read all labels on all foods.
• Purchase protein-containing foods (meat, poultry, fish, eggs and dairy products) that are properly packaged, refrigerated, frozen or canned. Check labels closely for the freshest date.
• Eat only fresh foods, at all times, avoiding fermented, overripe, unfresh and aged foods. · Be sure to keep foods in appropriate storage facilities (freezer, refrigerator, etc.).
• Go to restaurants that prepare food when it's ordered - not made ahead of time and kept warm. Ask the wait staff or manager if you're unsure.
• When eating out, it is best to avoid soups, gravies, and sauces, and eat the most simply prepared foods possible.
• At home, avoid eating leftovers.

Some doctors also recommend avoiding beverages or foods containing caffeine such as coffee, soft drinks, tea and chocolate.

Talk with your doctor before drinking any alcoholic beverage.

Symptoms of having too much tyramine:
elevation in blood pressure, severe and usually throbbing headache, nausea, neck stiffness, palpitations, profuse perspiration, and confusion.

What to do if you experience these symptoms:
report any severe symptoms to your doctor and follow any other advice given by him.

Foods to avoid:
The chart below can help you to determine foods you can eat and foods to avoid while taking MAOIs. If you have any concerns about whether or not you should eat a particular food, you should contact your doctor before eating it.

DAIRY PRODUCTS
MEAT & FISH
MEAT SUBSTITUTES
STOCKS AND GRAVIES
FRUITS AND VEGETABLES
CEREALS AND CEREAL PRODUCTS
SNACK FOODS
DRINKS
MISCELLANEOUS

FOODS YOU CAN EAT		FOODS TO AVOID
† means the food must be fresh		‡ means "not more than average portion"
‡ means "not more than average portion"
DAIRY PRODUCTS		DAIRY PRODUCTS
cheese †: cottage, curd, Ricotta, Bonbel, Havarti, cream (Philadelphia) ONLY yoghurt † butter, margarine, cooking fats milk eggs - fresh		all cheeses (except those listed in left hand column) cheese spreads
MEAT & FISH		MEAT & FISH
meat †: fresh, frozen, or tinned poultry †: fresh, frozen, or tinned most pâtés ‡ fish †: fresh, frozen, or tinned		ready-made meat pies, especially those in gravy (e.g. meat pies & casseroles) ready-made dishes with cheese sauce (e.g. lasagne) pepperoni, salami, bologna (air dried, smoked, or cured sausage) summer sausage black pudding venison or other game pâté lox pickled, dried, or soused fish (herring) traditionally smoked fish
MEAT SUBSTITUTES		MEAT SUBSTITUTES
unflavoured textured vegetable protein Tofu (unmarinated)		flavoured textured vegetable protein (e.g. Quorn, flavoured soya "meat") fermented soya products (e.g. soya sauce, miso, tempeh) ready-made vegetarian meals or mixes containing cheese or yeast extract
STOCKS AND GRAVIES		STOCKS AND GRAVIES
gravy made with Bisto Original (powder not granules) gravy made with gravy browning most vegetable stock cubes and powders ‡ most vegetable soup powders ‡		most gravy powders all gravy granules most meat stock cubes or powders most meat soup powders all meat extracts (e.g. Oxo, Bovril) all yeast extracts (e.g. Marmite) packet soups containing yeast extracts
FRUITS AND VEGETABLES		FRUITS AND VEGETABLES
all vegetables, including potatoes all fruit and fruit juices		sauerkraut broad bean (fava) pods fava beans banana (skins)
CEREALS & CEREAL PRODUCTS		CEREALS & CEREAL PRODUCTS
bread rice pasta chapatti sweet or plain biscuits cakes breakfast cereal		savoury baked products containing cheese or (e.g. cheese flavoured biscuits, etc.) meat/yeast extract (e.g. Twiglets, etc.)
SNACK FOODS		SNACK FOODS
plain crisps all nuts chocolates sweets toffees		flavoured savoury products (e.g. flavoured crisps)
DRINKS		DRINKS
tea coffee milky drinks fruit squashes and fizzy drinks		red or white wine ‡ (includes Chianti and sherry) beer and lager ‡ non-alcoholic beer ‡ liqueurs vermouth ‡
MISCELLANEOUS		MISCELLANEOUS
If it's not mentioned in "foods to avoid", then it's OK to eat or drink it.		nasal decongestants medicines for colds "slimming" powders

Click here to download a copy of the dietary information card. Requires Adobe Acrobat Reader.

Warning card for patients undergoing MAOI therapy

People taking MAOIs should carry a warning card with them.

The warning card states:

Carry this card with you all the time, in a wallet, purse, or handbag, where it is likely to be found in case of emergency. Show it to any doctor or dentist who may treat you other than the doctor who prescribed this medicine, and to your dentist if you require dental treatment.

Read the following carefully: While taking this medicine, and for 10 days after stopping taking it, you must follow these instructions: Do not eat CHEESE, PICKLED HERRING or BROAD BEAN PODS. Do not eat or drink BOVRIL, OXO, MARMITE or ANY SIMILAR MEAT OR YEAST EXTRACT. Do not take ANY OTHER MEDICINES (including tablets, capsules, nose drops, inhalations or suppositories) whether bought by you or prescribed by your doctor, without first consulting your doctor or your pharmacist. Note: Treatments for coughs and colds, pain relievers and tonics are medicines. Drink ALCOHOL only in moderation, and avoid CHIANTI WINE completely. Notify your surgeon, anaesthetist or dentist well before requiring any treatment which may require an anaesthetic. Report any severe symptoms to your doctor and follow any other advice given by him. This information is adapted from: MAOI: Prepared by the pharmaceutical Society and the British Medical Association on behalf of the Health Departments of the United Kingdom.

 

Click here to download a printable warning card. Requires Adobe Acrobat Reader.