Tyramine foods and MAOIs
If you take a monoamine oxidase inhibitor (MAOI), the tyramine in aged, cured and fermented foods can push your blood pressure up sharply — a hypertensive crisis. This is the food list, taken from the MAOI drug labels themselves — and, just as important, the drugs and doses that don’t need it.
The part people get wrong
Not every MAOI needs the strict diet. It is essential on the non-selectiveMAOIs — phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) — and on the higher-dose selegiline patch (Emsam 9 mg and above). The Parkinson’s MAO-B drugs — rasagiline (Azilect), low-dose selegiline (Eldepryl, Zelapar) — and the lowest-dose Emsam patch carry far less restriction. Know exactly which one you take before you either panic or ignore this. And a sudden, severe “pounding” headache after eating on an MAOI is an emergency — do not wait it out.
Avoid — high, unpredictable tyramine
Aging, fermentation, curing and spoilage all build tyramine. The riskiest foods are the most aged/fermented — and the same food can be fine fresh and dangerous aged, so 'it was OK last time' is not a safe guide.
- Aged cheeses (cheddar, blue, Swiss, parmesan, Camembert, Roquefort)
- Cured, dried and fermented meats (salami, pepperoni, aged sausage, mortadella)
- Fermented soy — soy sauce, miso, tempeh, fermented bean curd
- Sauerkraut and kimchi
- Draft/tap and unpasteurised beer, and 'homebrew'
- Marmite, Vegemite and other concentrated yeast extracts
- Fava (broad) bean pods
- Any spoiled, over-ripe or improperly stored high-protein food
Limit — moderate, in moderation only
Fresh and in small amounts these are usually tolerated on a non-selective MAOI, but they climb as they age — buy fresh, eat promptly, and keep portions small.
- Bottled/canned beer and red wine (small amounts; avoid on the strictest advice)
- Ripe avocado and over-ripe bananas (the peel especially)
- Yogurt and sour cream
- Processed/smoked fish
- Chocolate in large amounts
Generally safe — low tyramine
Fresh, properly stored foods are low in tyramine. Freshness is the whole game.
- Fresh meat, poultry and fish (eaten fresh, not aged or cured)
- Fresh cheeses — cottage cheese, ricotta, cream cheese, fresh mozzarella
- Eggs, milk
- Most fresh fruit and vegetables
- Bread, grains, pasta, rice
MAOIs in our catalog
Each carries its own FDA label — check yours for the exact dietary instruction, which depends on the drug and the dose.
Frequently asked questions
What happens if you eat tyramine on an MAOI?
Monoamine oxidase normally breaks tyramine down in your gut. A non-selective MAOI blocks that enzyme, so tyramine passes into the blood and forces the release of stored noradrenaline. That can spike blood pressure suddenly — a hypertensive crisis — with a severe, often 'pounding' headache, neck stiffness, sweating, nausea, a racing or irregular heartbeat, and in the worst cases stroke. A sudden severe headache after eating on an MAOI is an emergency: get medical help.
Do all MAOIs need the tyramine diet?
No — this is the part that matters most. The strict diet is for NON-selective MAOIs: phenelzine (Nardil), tranylcypromine (Parnate) and isocarboxazid (Marplan). The selegiline transdermal patch (Emsam) needs it at higher doses (its label requires the diet at 9 mg/24h and above, not at the lowest 6 mg/24h dose). The MAO-B-selective drugs used for Parkinson's — rasagiline (Azilect) and low-dose oral selegiline (Eldepryl, Zelapar) — carry far less dietary restriction at their usual doses. Always confirm which category your drug and dose fall into with your prescriber.
How long after stopping an MAOI is tyramine safe again?
The enzyme has to be remade by the body, which takes about two weeks after stopping a non-selective MAOI. Most labels advise keeping to the tyramine restrictions for roughly two weeks after the last dose — confirm the exact window with your prescriber.
Where does this list come from?
The foods to avoid are taken from the FDA labels of the MAOIs themselves — the phenelzine (Nardil) and selegiline patch (Emsam) prescribing information both carry a dietary-tyramine warning and food list. Tyramine content varies enormously with aging, fermentation and storage, which is why this is a tiered 'avoid / limit / safe' guide rather than a table of exact milligrams.
Sources
- Phenelzine (Nardil) — FDA label, dietary tyramine warning (DailyMed) ↗
- Selegiline transdermal (Emsam) — FDA label, tyramine & dose-dependent diet (DailyMed) ↗
General information, not medical advice, and not a complete list — tyramine content varies with aging and storage. Follow the specific diet your prescriber gives you for your exact MAOI and dose, and treat a sudden severe headache as an emergency.