A client taking monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is instructed by nurse to avoid which foods and beverages?

Correct Answer: A. Aged cheese and red wine

Aged cheese and red wines contain the substance tyramine which, when taken with an MAOI, can precipitate a hypertensive crisis. Monoamine oxidase inhibitors (MAOIs) were first introduced in the 1950s. They are a separate class from other antidepressants, treating different forms of depression as well as other nervous system disorders such as panic disorder, social phobia, and depression with atypical features. MAOIs prevent the breakdown of tyramine found in the body as well as certain foods, drinks, and other medications. Patients that take MAOIs and consume tyramine-containing foods or drinks will exhibit high serum tyramine level.

• Option B: These are foods rich in iron. A high level of tyramine can cause a sudden increase in blood pressure, called the tyramine pressor response. Even though it is rare, a high tyramine level can trigger a cerebral hemorrhage, which can even result in death. Eating foods with high tyramine can trigger a reaction that can have serious consequences. Patients should know that tyramine can increase with the aging of food; they should be encouraged to have foods that are fresh instead of leftovers or food prepared hours earlier.
• Option C: Carbonated beverages are unhealthy and tomato products are high in sodium. Eating foods with high tyramine can trigger a reaction that can have serious consequences. Patients should know that tyramine can increase with the aging of food; they should be encouraged to have foods that are fresh instead of leftovers or food prepared hours earlier. Examples of high levels of tyramine in food are types of fish, as well as types of meat, including sausage, turkey, liver, and salami.
• Option D: Lean red meats are rich in protein and fruit juices are rich in fiber. Also, certain fruits can contain tyramine like overripe fruits, avocados, bananas, raisins, or figs. Further examples are cheeses, alcohol, and fava beans; all of these should be avoided even after two weeks of stopping MAOIs. Anyone taking MAOIs is at risk for an adverse hypertensive reaction, with accompanying morbidity.