7 Foods to Consider Avoiding If You’re Taking an MAOI
Key takeaways:
Tyramine is a naturally occurring substance in certain foods. In most people, there’s no harm in consuming tyramine-containing foods. But if you’re taking a monoamine oxidase inhibitor medication, getting too much tyramine from your diet can be dangerous.
Foods high in tyramine include aged cheeses, aged meats, and fermented foods. It’s best to avoid these products, or consume small amounts if your prescriber says it’s OK.
Most research on tyramine-rich foods is from many years ago. But recent research shows that improved food storage and production have decreased the amount of tyramine in many foods. It’s a good idea to talk with your prescriber about your diet before you change anything.
Access savings on related medications
Table of contents
Monoamine oxidase inhibitors (MAOIs) were some of the first medications used to treat depression. Examples include rasagiline (Azilect), phenelzine (Nardil), and selegiline (Zelapar, Emsam).
But MAOIs have several side effects, drug interactions, and food interactions. Newer, safer antidepressants are on the market today, so MAOIs aren’t commonly used for depression anymore. Still, they may be a good option for some people with treatment-resistant depression, bipolar disorder, Parkinson’s disease, and other conditions.
MAOIs can interact with several foods, especially those containing a protein called tyramine. This is because MAOIs block the enzyme (protein) in the body called monoamine oxidase (MAO), which breaks down tyramine. If you take an MAOI and eat tyramine-rich foods, tyramine levels can get too high and cause a severe rise in blood pressure, called a hypertensive crisis. This is a medical emergency because it can lead to a heart attack, a stroke, or organ damage.
Read more like this
Explore these related articles, suggested for readers like you.
If you take an MAOI, your prescriber may recommend following a low-tyramine diet. Here, we’ll cover seven foods to consider avoiding and what you can replace them with.
Do you really have to avoid certain foods with MAOIs?
If you look online, you can find several lists of tyramine-rich foods to avoid with MAOIs. But there are a few things to keep in mind:
How recent the cited research is. There are several decades of research on tyramine-containing foods. But food storage and production methods have evolved over time. Proper food handling and storage can significantly limit the tyramine content in foods, and older studies may incorrectly report high tyramine levels in foods that have been improved by current food standards.
Different brands can produce the same item with different levels of tyramine. The tyramine content in foods depends on where it comes from, how it was manufactured, and more. This is why studies show large differences in the amount of tyramine in a single food.
Individuals may respond to tyramine differently. Some people may be more sensitive to tyramine, which means they may experience a greater increase in tyramine levels than someone else.
We don’t know exactly how much tyramine is too much. Some experts recommend limiting the amount of tyramine to 6 mg per meal, but there’s no standard amount of tyramine that is recommended to everyone.
Knowing these points, it’s hard to say whether people taking an MAOI should completely avoid foods containing tyramine. But we do know that it’s best to limit your tyramine intake if you’re taking an MAOI and for 14 days after stopping one.
Talk to your prescriber about your diet if you’re taking an MAOI. If you take several tyramine-rich foods on a daily basis, they may ask you to cut back. If your diet includes only one or two foods high in tyramine, and you eat them in small amounts, you may not need to make any drastic changes.
1. Dried, cured, and aged meat and fish products
Fresh and frozen meat products typically have low tyramine levels if they’re stored correctly. But some dried, cured, and aged meats have higher tyramine levels. So can smoked meat and fish. Examples include:
Dry-cured ham
Salami
Sausages, such as chorizo and sobrasada
Smoked salmon
Dry-salted fish, including tuna roe and shrimp
Preserved anchovies
To minimize your risk of consuming large amounts of tyramine with meat and fish products, make sure you store your fresh and frozen meat and fish products properly. These are typically safe to consume. You can also safely consume canned meat and fish products, such as tuna.
2. Fermented and aged dairy products
In general, commercially available, pasteurized cheese products have low levels of tyramine. But aged cheese products may have larger amounts of tyramine. Examples include aged cheddar, Gouda, and Parmesan.
Fresh milk and cheeses have low tyramine. But similar to meat and fish, make sure you store them correctly. Fermented milk products, such as kefir, can also have larger amounts of tyramine. Buttermilk (which is fermented) may also have more tyramine than fresh dairy products.
To avoid getting too much tyramine from dairy products, stick to cheeses that are pasteurized and aren’t aged. Dairy products like milk and yogurt are also typically OK.
3. Processed and fermented soy products
Some processed and fermented soy products may have high tyramine levels. Examples include:
Soybean paste
Miso-containing foods, such as miso soup and miso paste
Soy sauce
Tempeh
Fresh soy products are less likely to have high amounts of tyramine. This includes tofu and soy milk. But it’s best to consume these products quickly after purchasing them, since some research shows that the tyramine level in tofu increases several days after purchase, even in the refrigerator.
Keep in mind that although soy sauce and miso paste contain tyramine, they’re usually used in small amounts in cooking. Ask your prescriber about whether they’re OK to use.
4. Fermented condiments
Several fermented condiments contain tyramine. This includes:
Fish sauce
Worcestershire sauce
Concentrated yeast products (such as Marmite and Vegemite)
Tomato paste
Similar to soy sauces, some of these products are used in small amounts during cooking. So they may be safe to consume. But some brands of these products may contain a lot of tyramine, even in one serving. Unless you know the tyramine content of the fermented condiment you’re using, it may be safer to avoid it.
5. Fruits
Most fresh fruit has low tyramine levels. Some fruits have higher levels, including avocados, bananas, and raspberries. Still, fresh fruits are generally considered safe to eat.
Fermented or pickled fruits, such as cucumbers, tomatoes, and peppers, may have higher tyramine levels.
6. Vegetables
Fresh vegetables have low tyramine levels. But spoiled vegetables may have increased levels. Consuming fresh vegetables quickly after buying them will help limit tyramine intake.
Fava beans (also called broad beans) are known to have higher amounts of tyramine. So are fermented or pickled vegetables, such as sauerkraut and kimchi. So it’s best to stick to fresh or frozen vegetables.
7. Certain beverages
Most commercially available beer, wine, and sake have low amounts of tyramine. But draft beers (served from the tap) may have higher levels of tyramine. And drinking any beer or wine on an empty stomach can lead to higher amounts of tyramine being absorbed.
Regardless of tyramine content, consuming alcohol while taking an MAOI isn’t recommended. This is because alcohol and MAOIs can cause similar side effects, including drowsiness. The combination could make this worse, leading to slowed breathing in severe cases.
Other beverages containing caffeine, such as coffee and tea, can also interact with MAOIs. This isn’t because of tyramine, though. Caffeine can also block MAO. When taken with MAOIs, your risk of high blood pressure and other side effects may be increased.
Tips for avoiding tyramine if you’re taking an MAOI
There are several things you can do to limit tyramine levels in foods. Some tips include:
Storing foods correctly and avoiding spoilage. If a food looks or smells overripe or spoiled, don’t eat it.
Cook or freeze fresh foods within a few days of purchase.
Eat cooked foods that are stored in the refrigerator within a day or two.
Eat canned and frozen foods immediately after opening or cooking.
What are signs of a tyramine and MAOI interaction?
The main risk of getting too much tyramine while taking an MAOI is elevated blood pressure and a hypertensive crisis. That’s why it’s important to know how to check your blood pressure at home. Before you start taking an MAOI, ask your prescriber how often they want you to check your blood pressure. A blood pressure over 120/80 mmHg is considered high and should be discussed with a healthcare professional.
An extremely high blood pressure is anything over 180/120 mmHg. This requires emergency care. Signs and symptoms of a hypertensive crisis include:
Severe headache
Vision changes
Confusion
Chest pain
Trouble breathing
Nausea and vomiting
Severe anxiety
If you have a high blood pressure and you’re experiencing any of these symptoms, seek emergency care.
What else should you avoid while taking MAOIs?
It’s also important to avoid any tyramine-containing nutritional supplements or vitamins if you take an MAOI. If you have a question about whether something is safe for you, talk to your healthcare team. Additionally, other medications and supplements may also interact with MAOIs and increase your risk of side effects. Examples include:
Some opioids, such as tramadol (Conzip, Qdolo) and methadone (Methadose)
Stimulants, such as mixed amphetamine salts (Adderall) and methylphenidate (Ritalin)
Selective serotonin reuptake inhibitors, such as sertraline (Zoloft) and fluoxetine (Prozac)
Serotonin and norepinephrine reuptake inhibitors, such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
Mirtazapine (Remeron)
Bupropion (Wellbutrin)
Dextromethorphan (Delsym)
Always let your prescriber and pharmacist know what medications you’re taking so they can determine if MAOIs are safe for you.
The bottom line
If you’re taking a monoamine oxidase inhibitor (MAOI), it may be a good idea to avoid eating tyramine-rich foods. Getting too much tyramine while taking an MAOI can increase your blood pressure rapidly and lead to serious problems, such as increased risk for a heart attack, stroke, or other organ damage. Examples of tyramine-rich foods include aged cheeses like aged cheddar, cured meats like sausage, and fermented soy products such as miso and soy sauce.
If you take an MAOI, talk to your prescriber about your diet. Be sure you know the signs and symptoms of high blood pressure and how to check your blood pressure at home.
Why trust our experts?
References
Andersen, G., et al. (2019). Food sources and biomolecular targets of tyramine. Nutrition Reviews.
Boulaamane, Y., et al. (2022). In silico studies of natural product-like caffeine derivatives as potential MAO-B inhibitors/AA2AR antagonists for the treatment of Parkinson’s disease. Journal of Integrative Bioinformatics.
Burns, C., et al. (2022). Biochemistry, tyramine. StatPearls.
European Food Safety Authority Panel on Biological Hazards. (2011). Scientific Opinion on risk based control of biogenic amine formation in fermented foods. EFSA Journal.
Fiedorowicz, J. G., et al. (2004). The role of monoamine oxidase inhibitors in current psychiatric practice. Journal of Psychiatric Practice.
McCabe, B. J., et al. (2003). Handbook of food-drug interactions. CRC Press.
Sub Laban, T., et al. (2023). Monoamine oxidase inhibitors (MAOI). StatPearls.
Van den Eynde, V., et al. (2022). The prescriber’s guide to the MAOI diet—thinking through tyramine troubles. Psychopharmacology Bulletin.
