TYRAMINE-RESTRICTED DIET

Description
Foods containing tyramine and other vascoconstrictive amines are eliminated from the Tyramine-Restricted Diet.

Indications
The Tyramine-Restricted Diet is indicated when patients are receiving monoamine oxidase inhibitors (MAOIs) and the medication Zyvox (Linezolid) (1).  These drugs treat anxiety and depression by inhibiting the inactivation of neurotransmitters.  Therapy with MAOIs is used to prevent the catabolism of dietary tyramine, which normally is metabolized in the gastrointestinal tract.  The result is an increased concentration of tyramine in the body, causing the release of norepinephrine and an elevation of mood.  Increase amounts of tyramine, however, can cause an excess amount of norepinephrine to be released, which may result in a hypertensive crisis.  This is characterized by severe headaches, palpitation, neck stiffness or soreness, nausea or vomiting, sweating, fever, and visual disturbances.

    Many foods normally contain small amounts of tyramine and other vasopressor amines.  Large amounts have been reported only in aged, fermented, pickled, smoked, or bacterially contaminated products.  When fresh foods are stored, especially meat, poultry, fish, and related items such as pâté, gravy, and soup stock, fermentation occurs and the tyramine content of the food increases.  Since heat does not destroy tyramine, all foods should be fresh, fresh frozen, or canned and should be handled, prepared, stored, and served in ways that maximize freshness.

    The consequences of tyramine intake are dose-related.  Therefore, reactions can be prevented without total abstinence from tyramine-containing foods.  A rational approach to diet compliance could best be achieved by emphasizing the most crucial items to avoid.

    Caffeine does not contain tyramine, but excessive amounts may precipitate hypertensive crisis.  Therefore, foods containing caffeine should be ingested with caution.

Nutritional Adequacy
The diet, a variation of the Regular Diet, can be planned to meet the DRIs as outlined in the Statement on Nutritional Adequacy.

Order as “____________________ Diet, Tyramine Restricted.”

Planning the Diet
Guidelines for dietary counseling in MAOI use include the following:

1. Begin nutrition counseling before drug therapy.
2. Monitor patient compliance.
3. Recommend preparation and consumption of only fresh foods.
4. Continue the diet 4 weeks beyond drug therapy.

    Resynthesis of monoamine oxidase occurs slowly, and food interactions may occur up to 3 weeks after withdrawal of some MAOI drugs.  Prudent practice is to start the tyramine-restricted diet when the drug therapy is begun and to continue the diet for 4 weeks after the drug regimen is withdrawn.

Reference
1. Zyvox In:  Drug Library.  Drug Digest. Express Scripts, Inc.@ www.drugdigest.org, accessed October 1, 2005. 

Bibliography
American Hospital Formulary Series (AHFS) Drug Information. Bethesda, Md: American Society of Health System Pharmacists; 1999.
Nursing 2003 Drug Handbook. 23rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003.
Gardner DM, Shulman KI, Walker SE ,Tailor SA.  The making of a user friendly MAOI diet.  J Clin Psych. 1996;52:99-104.
Tyramine-controlled diet.American Dietetic Association Nutrition Care Manual. 2004.  Available at: nutritioncaremanual.org.  Accessed November 14, 2005.

MONOAMINE OXIDASE INHIBITOR (MAOI) DRUGS

Manual of Clinical Nutrition Management                                                     
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