How long maoi diet

Skip to main content Skip to main navigation. Home Projects Diet specifications Adult diet specs Drug interactions diets. On this page. Feedback Toggle table only view. We value your feedback. Full name Please provide your name.

Email address Please provide a valid email address. Phone Please provide your phone number. Organisation Please provide your organisation. Role Please provide your role. Comments Please share your feedback. Related Drug interactions diets Diet specifications Adult diet specifications Paediatric diet specifications. Name Please provide your name. Increased information about tyramine content in food has made adhering to a tyramine-restricted diet easier.

The aim of this diet was to make the information about dietary restrictions easier to follow and adhere to. Continued improvements in food packaging and storage have also contributed to a safer food supply. In addition, the mechanism of action or delivery method of newer MAOIs, such as moclobemide and transdermal selegiline, may reduce the risk of hypertensive crisis with tyramine ingestion and, thus, lessen the need for diet modification. Other vasoactive amines. Pressor agents other than tyramine can be present in food.

In addition to reactions with foods, both older and newer MAOIs can negatively interact with sympathomimetic and serotonergic agents Table 2. To avoid mistakenly combining contraindicated medications, clinicians should always tell patients to inform their other physicians about their MAOI regimen.

Further, patients should be counseled to check over-the-counter products for sympathomimetic agents. The most serious, but rare, drug interactions that can result from the combination of sympathomimetic agents or serotonergic agents with MAOIs are hypertensive crisis and serotonin syndrome.

Sympathomimetic agents imitate the effects of sympathetic nervous system neurotransmitters, such as norepinephrine.

Sympathomimetic drugs can act directly or indirectly. Direct-acting sympathomimetics block the breakdown and reuptake of catecholamines and stimulate adrenergic and dopaminergic receptors.

Indirect-acting sympathomimetics provoke the production and release of catecholamines and block norepinephrine transporter activity. The resulting effects of direct and indirect sympathomimetic action include increased cardiac output, vasoconstriction, regulation of body temperature, bronchial dilation, and relaxation of intestinal smooth muscle.

Sympathomimetic drugs can be used in the short-term to treat conditions such as hypotension, myocardial infarction, or congestion. These agents range from stimulants to illicit drugs to over-the-counter medications containing vasoconstrictors, like some cough and cold remedies and weight-reducing preparations see Table 2. When coadministered with MAOIs, sympathomimetics that boost adrenergic stimulation by a mechanism other than MAO inhibition can dangerously elevate blood pressure, causing a hypertensive crisis.

Methylphenidate blocks the reuptake of norepinephrine, and amphetamine inhibits the reuptake of and also releases norepinephrine. Tryptophan is converted into serotonin in the brain by tryptophan hydroxylase and decarboxylase. Part of the antidepressant effect of MAOIs includes inhibiting the MAO enzymes that deactivate serotonin, which in turn, enhances the synaptic availability of serotonin. Serotonin syndrome is characterized by autonomic, neuromotor, and cognitive-behavioral symptoms.

Diarrhea, incoordination, and fever can also occur. Severe hyperthermia with complications such as disseminated intravascular coagulation, rhabdomyolysis, and renal failure can sometimes precede death. Clinicians should be aware that serotonin syndrome has overlapping signs and symptoms with several other hyperthermic states or syndromes such as lethal catatonia, anticholinergic toxicity, malignant hyperthermia, and neuroleptic malignant syndrome.

According to the Hunter Serotonin Toxicity Criteria, 28 serotonin syndrome is present if a serotonergic agent has been taken and 1 of the following conditions is met:. In most cases, the syndrome resolves within 24 hours when the agents are discontinued. When prescribing MAOIs and advising patients about drug interactions, clinicians should remember that patients with several common medical conditions are at particular risk for serotonin syndrome because they may have a reduced ability to metabolize serotonin.

Serotonin syndrome can occur with many MAOI drug combinations, and new contraindications are occasionally added see Table 2. The most toxic combination is an irreversible MAOI with another serotonergic agent. Although dietary restrictions are lessened with low dosages of transdermal selegiline and moclobemide, the drug interaction precautions remain in effect, as with all other MAOIs.

Because of the serious nature of serotonin syndrome, clinicians must prevent unnecessary excess serotonergic activity. Generally, a washout period of at least 14 days is required after discontinuing an MAOI and before beginning a serotonergic agent, and vice versa.

MAOIs with varying mechanisms of action and methods of delivery have become available relatively recently. Oral and transdermal selegiline formulations are selective inhibitors of MAO-B at low doses. Oral selegiline. Adverse reactions in patients treated with oral selegiline and amitriptyline, protriptyline, tricyclic antidepressants TCAs , and SSRIs have also been reported.

With oral selegiline, caution regarding diet should be given and a day washout period for TCAs and SSRIs is advised because the mechanism of action of these combinations is not fully understood. Transdermal selegiline. Transdermal selegiline is indicated for treatment of major depressive disorder MDD. Several double-blind, placebo-controlled studies have established the efficacy of selegiline for MDD.

Participants observed a tyramine-restricted diet. Patients were not advised to adhere to a tyramine-restricted diet, and no significant differences in blood pressure occurred. A flexible-dose trial 40 of the selegiline patch allowed use of the 2 higher doses if response was insufficient in patients with MDD over 8 weeks. No dietary restrictions were imposed, and no hypertensive crises resulted.

Because moclobemide reversibly inhibits MAO-A, the need for dietary restrictions and the risk for hypertensive crisis are substantially lessened with this MAOI. Meta-analyses 17 , of studies in patients with depression have found moclobemide to be more effective than placebo and to be comparable to TCAs and SSRIs. Rasagiline is a selective inhibitor of MAO-B at recommended doses of 0.

Selectivity is lost progressively as dosage increases. Rasagiline carries warnings for serotonin syndrome and hypertensive crisis. Foods containing high levels of tyramine and contraindicated drugs should clearly be avoided see Tables 1 and 2.

Future Directions: Personalized Treatment for Depression. A large armamentarium of medications is available to treat depression, including MAOIs. One goal for the future in medicine is to be able to predict which patients are most likely to respond to particular agents, that is, personalizing therapy.

In the past, when the armamentarium of depression treatments was beginning to grow, one way to personalize therapy was to determine the subtype of depression; for patients with atypical depression, MAOIs were believed to have superior efficacy.

Developing a predictive panel of pharmacogenetic biomarkers may eventually be able to guide the stratification of depression therapy for particular patients, which should improve their treatment outcomes and quality of life.

The study did identify single nucleotide polymorphisms associated with response and remission that deserve further research. Further, although the number of pharmacogenetic tests for cancer has grown in recent years, the same cannot be said for neuropsychiatric disorders. Monoamine oxidase inhibitors are effective treatments for depression, but due to dietary restrictions and drug interactions, they are relatively underused.

Despite the restriction of dietary tyramine, many foods are permitted with MAOIs, and some foods once thought to contain tyramine have been discovered to have no or little tyramine. Additionally, the need for a tyramine-restricted diet depends on the MAOI and its dosage. For example, transdermal delivery and MAO reversibility may avoid the need for dietary modifications. Although some MAOIs reduce the risk of dietary interactions, all MAOIs can have serious drug interactions with sympathomimetics, serotonergic agents, and other medications, potentially leading to hypertensive crisis or serotonin syndrome.

In the future, a greater understanding of pharmacogenomics may assist clinicians in personalizing depression therapy and selecting the most effective antidepressant for individual patients. Disclosure of off-label usage: The author has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration-approved labeling has been presented in this article.

Treatment of depression with atypical features: a meta-analytic approach. Psychiatry Res. PubMed doi Any drug that works as a serotonin reuptake inhibitor SRI is potentially dangerous possibly fatal if combined with an MAOI, including: sertraline, fluoxetine, paroxetine, fluvoxamine, citalopram, escitalopram, clomipramine or imipramine, or SNRIs like milnacipran, venlafaxine, desvenlafaxine, duloxetine.

No washout is required for TCAs other than clomipramine and imipramine , or mirtazapine, mianserin, trazodone or reboxetine, because they are safe taken together with MAOIs.

The risk is that of serotonin toxicity ST , because some act as weak SRIs, as explained in detail in my papers, pethidine aka meperidine tramadol, tapentadol, especially, are a significant risk for anyone on MAOIs.

Dextromethorphan, dextro propoxyphene and pentazocine are also best avoided. Other opioids are safe. This advice on diet and possible interacting drugs should be followed for a minimum of two weeks six weeks in some situations after ceasing MAOIs between one and three days in the case of moclobemide. Gillman, P. Journal of Clinical Psychopharmacology, CNS Spectr, p. Feinberg, and L. Fochtmann, Revitalizing monoamine oxidase inhibitors: A call for action.

CNS spectrums, p. Search for:. MAOI Menu 1. New review of TCP 2. MAOI updates Clarifications concerning pharmacology and terminology 4. The risk of harm from acute tyramine-induced hypertension: how significant?

MAOIs and anaesthesia 8. Treatment of hypertension resulting from tyramine ingestion MAOIs: swapping and combining MAOIs for psychotic depression Tranylcypromine Parnate : A History. Dr P Ken Gillman V 3. Concentrations are given as milligrams mg of tyramine per kilogram kg or litre L. There are two main reasons for BP monitoring: 1 variation in the population: some people will get more marked reactions of BP elevation with relatively smaller doses of tyramine.

It will tell you if you are tyramine sensitive and alert you to the need to be careful about diet 2 BP drop on standing is the best measure of the effectiveness of a given dose and essential to optimal speed of adjustment to the final effective dose see info re an App for mobiles that makes a graph of your BP readings. Tyramine Tyramine formation in foods requires the presence of micro-organisms with amino acid decarboxylase enzyme activity.