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Diet during therapeutic use of monoamine oxidase inhibitors

Food	Allowed (not allowed if spoiled or improperly stored)*	Minimize intake^¶	Not allowed
Beverages	Decaffeinated beverages (eg, coffee, tea, soda); milk	Caffeine-containing drinks Clear alcoholic spirits (eg, gin, vodka, rum) Red or white wine (no more than two 4-ounce servings per day) Bottled/canned beer, including nonalcoholic (no more than two 12-ounce servings per day) Soy milk	Tap (draft) beer, Korean beer, vermouth
Breads, cereals, crackers	Commercial yeast breads, hot and cold cereals, most crackers (ie, containing no aged cheese)	None	Sourdough bread; crackers and breads that contain aged cheese
Dairy, eggs, cheeses	Butter, cottage cheese, eggs, farmers or pot cheese, cream cheese, ricotta cheese, pasteurized milk, pasteurized cream, ice cream, pudding, yogurt	American processed cheese, mozzarella, parmesan, Romano, sour cream (limit these to one serving of ½ cup)	All aged cheeses are absolutely not allowed^Δ, including: Blue/bleu, camembert, cheddar, gorgonzola, gouda, gruyere, provolone, Roquefort, Stilton, Swiss
Meat, fish, and poultry	All fresh packaged, fresh frozen, or fresh processed (not aged or smoked) meats, fish, and poultry; fresh breakfast sausage	Pepperoni, hot dogs, bologna	All aged, smoked, pickled, or cured meats/fish/poultry are absolutely not allowed, including: Aged, smoked, pickled or dried meats (eg, bacon, aged or dried sausage, all types of salami, Genoa, mortadella, corned beef, pastrami); aged chicken and beef liver; dried, pickled or smoked fish (eg, pickled herring, lox, smoked salmon, smoked trout, shrimp paste); liverwurst; meat extracts; meat alternatives that contain soy product (eg, meatless hot dogs made from tofu)
Starches – potatoes/rice	Potatoes, rice, noodles, pasta, and most stuffings	None	Soy products (eg, tofu, tempeh)
Vegetables and beans	Most fresh, frozen, canned, or dried vegetables, leafy salad greens, lentils, and beans (except fava and soy beans); most veggie burgers (ie, containing no soy product)	Chili peppers	Fava or broad beans (Italian green beans) and their pods, Kim chee (Kimchi), sauerkraut, snow peas, soy beans, bean pastes, edamame beans
Fruit and fruit juices	Most fresh, frozen, or canned fruits and fruit juices	Avocado (not over-ripened), canned figs, raspberries	Avocado (over-ripened), banana (over-ripened), banana peel, dried fruit, any kind of fruit that is over-ripened
Soups, gravies, casseroles, pizza	Home prepared (not prepackaged) soups, gravies, casseroles that contain no aged cheese, bouillons, flavoring cubes, or meat extracts	Occasional consumption of one to two slices of pizza from large chain commercial outlets appears safe (ie, generally made with low tyramine cheese); avoid: larger quantities, extra cheese, or pizzas containing aged cheese	Soups, gravies, casseroles, pizzas that contain aged cheese; soups or casseroles with flavoring meat extracts (eg, flavor cubes, bouillon), miso, broad or fava beans and their pods, tofu, tempeh, soy products (eg, soy sauce, teriyaki sauce) or yeast extracts
Fats and oils	Butter, cream cheese, margarine, mayonnaise, olive oil, vegetable oils	Moderate amount (eg, 2 to 4 ounces) of peanut butter is considered safe	Fats and oils included in fermented, aged, cured, smoked, pickled, or other foods that are not allowed
Snacks	Potato chips, popcorn, most nuts, most crackers (ie, containing no aged cheese)	Moderate consumption of peanuts is considered safe	Snack foods containing aged cheeses
Sweets	Sugar, hard candy, honey, molasses, syrups	One serving of chocolate (eg, 2 ounces) is considered safe	None
Desserts	Cakes, cookies, gelatin, pastries, pies, sherbets, sorbets	One serving of chocolate-containing dessert (eg 4 ounces) is considered safe	None
Condiments and miscellaneous	Ketchup, mustard, mayonnaise, non-cheese salad dressings, salt, spices, herbs, Worcestershire sauce	None	All aged or fermented soy and yeast products (eg, soy sauce, teriyaki sauce, soy paste, Thai or Vietnamese fish sauce, marmite/vegemite and other concentrated yeast extracts), sauerkraut

Foods and beverages listed as "not allowed" often contain significant amounts of tyramine that can interact with nonselective MAOIs, or potentially with selective MAOI-b inhibitors at high doses, and may result in elevated blood pressure or hypertensive crisis.
The ingredients of all foods and beverages (including those listed in this table as "allowed") should be reviewed prior to consumption to confirm they do not also include ingredients that are not allowed.
Tyramine avoidance should be continued for two weeks following discontinuation of an MAOI.

MAOI: monoamine oxidase inhibitor.
* No leftover, improperly stored, handled, or spoiled foods of any type should be consumed. It is important to purchase and consume only fresh meats, poultry, and fish that are properly wrapped and stored under refrigeration and eaten the same day or frozen right away. Fresh produce should be consumed within 48 hours of purchase and not eaten if overripe. Use canned or frozen foods immediately upon opening or thawing.
¶ Eat these foods occasionally; no more than one serving (eg, ½ cup) of one to three of these foods or beverages each day.
Δ The majority of cases of food-related hypertensive crisis during treatment with MAOIs are associated with consumption of aged cheeses.

Data from:

Hirsch M, Birnbaum RJ. An Approach to psychopharmacological treatment. In: The Ten-Minute guide to psychiatric diagnosis and treatment, Stern TA (Ed). New York: Professional Publishing Group, Ltd, 2005. p.355. Copyright © 2005 Castle Connolly Graduate Medical Publishing, Ltd.
McCabe-Sellers BJ, Staggs CG, and Bogle ML. Tyramine in foods and monoamine oxidase inhibitor drugs: A crossroad where medicine, nutrition, pharmacy and food industry converge; J Food Comp Anal. 2006; 19:S58.

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