Tyramine interaction

The clinical effect of a tyramine interaction Ccheese reactionO is a hypertensive crisis flushing severe throbbing headache severe hypertension tachycardia pallor. There is a risk of cerebral haemorrhage. Treatment is by a 1-adrenoceptor antagonist (phentolamine or chlorpromazine) which is usually given intravenously. 

Doses above f 0 mg/day may increase the risk of hypertensive crisis, tyramine interactions, and drug interactions similar to those of phenelzine and franylcypromine... 

CNS stimulation via metabolism to amphetamine does not cause tyramine interactions. 

Brown C, TaniguchiG, YipK, The monoamine oxidase inhibitor-tyramine interaction. 

Chronic use of these irreversible MAO inhibitors has been associated with life-threatening toxicity, ie, hepatotoxicity and hypertensive crisis. Interactions with tyramine contained in food and other drugs have severely limited use of irreversible MAO inhibitors. These MAO inhibitors are also nonselective, inhibiting both MAO-A and MAO-B isoenzymes. Furthermore, they interfere with the hepatic metabolism of many dmgs. 

As of the mid-1990s, use of MAOIs for the treatment of depression is severely restricted because of potential side effects, the most serious of which is hypertensive crisis, which results primarily from the presence of dietary tyramine. Tyramine, a naturally occurring amine present in cheese, beer, wine, and other foods, is an indirecdy acting sympathomimetic, that is, it potently causes the release of norepinephrine from sympathetic neurons. The norepinephrine that is released interacts with adrenoceptors and, by interacting with a-adrenoceptors, causes a marked increase in blood pressure the resultant hypertension may be so severe as to cause death. 

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). 

If the patient is prescribed an MAOI, it is critical that the nurse give the patient a list of foods containing tyramine. When teaching the patient, the nurse emphas zesthe importance of not eating any of the foods on the list. (See Home Care Checklist Avoiding Drug-Food Interactions With MAOIs)... 

Because of their lack of selectivity and their irreversible inhibition of MAO, the first MAOIs to be developed presented a high risk of adverse interactions with dietary tyramine (see Chapter 20). However, more recently, drugs which are selective for and, more importantly, reversible inhibitors of MAO-A (RIMAs) have been developed (e.g. moclobemide). These drugs are proving to be highly effective antidepressants which avoid the need for a tyramine-free diet. 

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... 

Ethanol DOES NOT interact with MAOIs however, tyramine may be a component of some aged alcoholic drinks, such as red wines or tap beers if a reaction occurs, hypertension and a pounding headache are the most likely symptoms usually white wine is fine (in moderation) and most widely available domestic canned beers do not contain significant amounts of tyramine. 

C. Helene, T. Montenay-Garestier, and J. L. Dimicoli, Interactions of tyrosine and tyramine with nucleic acids and their components. Fluorescence, nuclear magnetic resonance, and circular dichroism studies, Biochim. Biophys. Acta 254, 349-365 (1971). 

The main limitation to the clinical use of the MAOIs is due to their interaction with amine-containing foods such as cheeses, red wine, beers (including non-alcoholic beers), fermented and processed meat products, yeast products, soya and some vegetables. Some proprietary medicines such as cold cures contain phenylpropanolamine, ephedrine, etc. and will also interact with MAOIs. Such an interaction (termed the "cheese effect"), is attributed to the dramatic rise in blood pressure due to the sudden release of noradrenaline from peripheral sympathetic terminals, an event due to the displacement of noradrenaline from its mtraneuronal vesicles by the primary amine (usually tyramine). Under normal circumstances, any dietary amines would be metabolized by MAO in the wall of the gastrointestinal tract, in the liver, platelets, etc. The occurrence of hypertensive crises, and occasionally strokes, therefore limited the use of the MAOIs, despite their proven clinical efficacy, to the treatment of atypical depression and occasionally panic disorder. 

Predictable interactions occur between the MAOIs and any amine precursors, or directly or indirectly acting sympathomimetic amines (e.g. the amphetamines, phenylephrine and tyramine). Such interactions can cause pronounced hypertension and, in extreme cases, stroke. 

Drug/Lab test interactions Thiazides may decrease serum PBI levels without signs of thyroid disturbance. Thiazides also may cause diagnostic interference of serum electrolyte, blood, and urine glucose levels (usually only in patients with a predisposition to glucose intolerance), serum bilirubin levels, and serum uric acid levels. In uremic patients, serum magnesium levels may be increased. Bendroflumethiazide may interfere with the phenolsulfonphthalein test due to decreased excretion. In the phentolamine and tyramine tests, bendroflumethiazide... 

Drug/Food interactions Warn all patients against eating foods with a high tyramine content. Hypertensive crisis may result (see Warnings). 

Drug/Food interactions Large quantities of foods or beverages with high tyramine content should be avoided while taking linezolid. Quantities of tyramine consumed should be less than 100 mg per meal. 

Not long after their introduction, it was discovered that MAOIs could have serious and sometimes fatal interactions with other medications and foods that have high levels of tyramine. Tyramine is found in foods like cheese, wine, beer, liver, and even chocolate, and can increase blood pressure. MAOIs interact with certain medications and foods, raising blood pressure so much that fatal results can occur. To be used safely, these drugs must be taken with a restricted diet. 

If type A inhibitors eventually prove to be as efficacious as other MAOIs and non-MAOIs, there is no doubt that some clinicians will prescribe them with increasing frequency. In addition, if there is minimal risk of adverse interactions with tyramine and other substances (e.g., sympathomimetics), medical and legal concerns about their use will be appreciably reduced. 

Hypertensive crisis often occurs as a result of the interaction of two or more drugs acting via different mechanisms to potentiate the cardiovascular effects of NE. It can also occur as a result of a drug-food interaction involving MAOIs and tyramine-containing foods. Like the serotonin syndrome, hypertensive crisis can be fatal. Prodromal symptoms include the following ... 

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