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Journal of Neural Transmission

, Volume 125, Issue 11, pp 1707–1717 | Cite as

A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths

  • Peter Kenneth GillmanEmail author
Psychiatry and Preclinical Psychiatric Studies - Review Article

Abstract

This review appraises over 150 recent original papers reporting data that demonstrate the greatly reduced tyramine content of modern-day ‘foods’, about which the medical literature has a paucity of information. It discusses the cardiovascular pharmacology of tyramine and the characteristics, extent, risks, and treatment of the blood pressure increases that sometimes result from tyramine ingestion (the pressor response). In past decades, cheese was the only food associated with documented fatalities resulting from hypertension. Today, few foods contain problematically high tyramine levels, which is a result of changes in international food production techniques (especially the use of starter cultures), and hygiene regulations. Nowadays, even ‘matured’ cheeses are usually safe in healthy-sized portions. The mechanism by which tyramine may be produced in foods (by certain micro-organisms) is explained and hundreds of recent estimations of cheeses are reviewed. Numerous other previously inadequately documented foods are reviewed, including fish and soy sauces, salami-type sausages, dried meats, beers, wines, and various condiments. Evidence that the risk of harm from the pressor response has previously been overstated is reviewed, and the iatrogenic harms from hasty and aggressive treatment of hypertensive urgency are re-evaluated. Evidence now suggests that MAOIs are of comparable safety to many newer drugs and are straightforward to use. Previously held concerns about MAOIs are misplaced and some are of over-estimated consequence. The variability of pressor sensitivity to tyramine between individuals means that the knowledge and judgement of doctors, and some care, are still required.

Keywords

Monoamine oxidase inhibitors Hypertension Decarboxylating enzymes Biogenic amines Tyramine Hypertensive urgency Hypertensive emergency 

Notes

Funding

This manuscript was produced without any support, financial or otherwise, from anybody other than the author.

Compliance with ethical standards

Conflict of interest

The author declares that he has no conflict of interest.

Supplementary material

702_2018_1932_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 37 KB)

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.PsychoTropical ResearchBucasiaAustralia

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