Phenelzine Tyramine-rich foods

In practical terms this means that patients taking moclobemide with selegiline should be given the same dietary restrictions for tyramine-rich foods and drinks (see tyramine-rich drinks , (p.l 151) and tyramine-rich foods , (p.l 153)), that relate to the non-selective MAOIs such as phenelzine and tranylcypromine. However, because of the potential risks the manufacturer of moclobemide contraindicate this combination. On the basis of work done on the pig it is suggested that if selegiline is replaced by moclobemide, the dietary restrictions can be relaxed after a wash-out period of about 2 weeks. If switching from moclobemide to selegiline, a wash-out period of 1 to 2 days is sufficient. ... 

Hypertensive reactions have been controlled by intravenous phen-tolamine, phenoxybenzamine, intramuscular chlorpromazine, labetalol or sublingual nifedipine. The manufacturers of phenelzine state that on the basis of present evidence, slow intravenous injection of phentolamine is recommended. However, it is advisable to refer to current guidelines on the management of hypertensive crises for up-to-date advice. See also Importance and Management under MAOIs or RIMAs + Tyramine-rich foods , p.II53. 

An extremely well-documented, well-established, serious interaction. A potentially fatal hypertensive reaction can occur between the irreversible, non-selective MAOIs (see Table 32.1 , (p.ll30)) and tyramine-rich foods. Tranylcypromine is more likely to cause the reaction than phenelzine. The incidence is uncertain, but early estimates of hypertensive reactions to tranylcypromine (before restrictions in its use with indirectly-acting sympathomimetics and foods) range from 0.03% to 20%. Patients taking any of the non-selective MAOIs (isocarboxazid, niaiamide. 

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