Tyramine, drug reaction with

Procarbazine may potentiate the effects of tranquilizers and hypnotics. Hypertensive episodes can result if procarbazine is administered simultaneously with adrenomimetic drugs or with tyramine-containing foods. Rarely, a reaction to alcohol similar to that provoked by disulfiram may occur. 

Administered as a single, daily dose on an empty stomach Monoamine oxidase inhibitors drug-food interactions with tyramine-rich foods such as red wines, dark beers, aged cheeses, yogurt may precipitate hypertensive crisis drug interactions tricyclic antidepressants and SSRIs, sympathomimetics disulfiram-like reaction with alcohol... 

One serious adverse reaction associated with the use of the MAOIs is hypertensive crisis (extremely high blood pressure), which may occur when foods containing tyramine (an amino acid present in some foods) are eaten (see Home Care Checklist Avoiding Drug Food Interactions With MAOIs). 

M AO Is. The MAOIs are not widely used because of their potential for serious adverse reactions. Fhtients receiving MAOIs require strict dietary control because foods containing tyramine should not be eaten because of the danger of a hypertensive crisis. (See Home Care Checklist Avoiding Drug-Food Interactions With MAOIs). 

The main problems with early, irreversible MAOIs were adverse interactions with other drugs (notably sympathomimetics, such as ephedrine, phenylpropanolamine and tricyclic antidepressants) and the infamous "cheese reaction". The cheese reaction is a consequence of accumulation of the dietary and trace amine, tyramine, in noradrenergic neurons when MAO is inhibited. Tyramine, which is found in cheese and certain other foods (particularly fermented food products and dried meats), is normally metabolised by MAO in the gut wall and liver and so little ever reaches the systemic circulation. MAOIs, by inactivating this enzymic shield, enable tyramine to reach the bloodstream and eventually to be taken up by the monoamine transporters on serotonergic and noradrenergic neurons. Fike amphetamine, tyramine reduces the pH gradient across the vesicle membrane which, in turn, causes the vesicular transporter to fail. Transmitter that leaks out of the vesicles into the neuronal cytosol cannot be metabolised because... 

A newer class of MAO inhibitors, which has entered clinical practice for the treatment of depression, is known as reversible inhibitors of MAO A (RIMAs). This is a very welcome development in new drug therapeutics for depression, because it has the potential of making MAO A inhibition for the treatment of depression much safer. That is, the suicide inhibitors are associated with the dangerous hypertensive episodes mentioned above, which are caused when patients eat food rich in tyramine (such as cheese). This so-called cheese reaction occurs when the tyramine in the diet releases norepinephrine and other sympathomimetic amines (Fig. 5—23). When MAO is inhibited irreversibly, the levels of these amines rise to a dangerous level... 

Reboxetine seems to be an antidepressant that has negligible interference with the pharmacokinetics of other drugs thus, fewer drug-drug interactions are expected. It also may be possible to use reboxetine in combination with MAOIs, because it has no inhibitory effect on this enzyme, which would avoid tyramine-induced hypertensive reactions. 

A 77-year-old woman with hiatus hernia, who had been taking cimetidine 400 mg four times daily for 3 years, experienced a severe frontal headache and hypertension, which appeared to be related to the ingestion of a cup of Bovril and some English cheddar cheese, both of which can contain substantial amounts of tyramine. Although the authors point out the similarity between this reaction and that seen in patients on MAOIs who eat tyramine-rich foods (see MAOIs or RIMAs + Tyramine-rich foods , p. 1153), there is no satisfactory explanation for what occurred. They note that she was also taking salbutamol (another sympathomimetic) but rule out any contribution from this drug. 

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