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MAO inhibitors: what to be careful with

MAO inhibitors block the enzyme that breaks down monoamines such as serotonin, noradrenaline and dopamine, and are used in some depression and, in other forms, in Parkinson's disease.

General information only, and not exhaustive. This is not medical advice, not a full list of interactions, and not a reason to start, stop or change a medicine. Interactions depend on the exact drug, the dose, your other medicines and your own health — a pharmacist or doctor is the one who decides. Always read the leaflet that came with your medicine, and ask your pharmacist before adding anything, including supplements.

Group, not a brandATC N06AF / N06AG / N04BD

Examples in this group: phenelzine, tranylcypromine, isocarboxazid; moclobemide (reversible); selegiline, rasagiline. Interactions usually belong to the whole group, but your own leaflet is brand-specific — always the final word.

Food and drink to be careful with

• Tyramine — the reason this group has a diet sheet. Monoamine oxidase in the gut normally destroys tyramine from food. With the enzyme blocked, tyramine reaches the circulation and can release stored noradrenaline, causing a sharp and dangerous rise in blood pressure. This is the classic "cheese reaction", and it is the reason irreversible MAOIs come with written dietary restrictions.
• Where tyramine is highest. Matured and blue cheeses, cured and fermented meats, yeast extracts such as Marmite and Vegemite, fermented soy products including soy sauce and miso, sauerkraut, broad bean pods, and tap or unpasteurised beer. Tyramine builds up with ageing, fermentation and poor storage, so how old the food is matters as much as what it is.
• Fresh is the general principle. Fresh meat, fresh cheese such as cottage cheese and cream cheese, and freshly cooked food are the low-tyramine side of the list. Leftovers kept for days move the wrong way.
• Not all MAOIs are the same. Moclobemide is a reversible inhibitor and carries far lighter restrictions; low-dose selegiline patches and the medicines used in Parkinson's are also treated differently. Which restrictions apply to you is set by the specific product and by the prescriber, and the written sheet they give you replaces any general list.

Timing around meals

Set by the prescriber. What is different about this group is that the dietary rules continue for a period after stopping, because the enzyme has to be remade.

Alcohol

Beer — particularly tap, cask and unpasteurised beer — and some wines carry tyramine, so alcohol here is a tyramine question as well as an alcohol question. Restrictions are given in writing with the prescription.

Other things to watch

• A sudden severe headache, a pounding heartbeat, neck stiffness, nausea or visual change after eating is the reaction these rules exist to prevent, and it is an emergency.
• Many other medicines are dangerous with MAOIs, including SSRIs and SNRIs, tramadol, pethidine, dextromethorphan in cough remedies, and pseudoephedrine in decongestants — several of which are sold without prescription.
• Washout periods apply both before starting and after stopping. Those intervals are specific and are set by the prescriber.

If anything here does not match what you were told, or you notice a new symptom after starting a medicine, contact your pharmacist or doctor — do not just stop taking it. Stopping some medicines suddenly is more dangerous than any food interaction.

Source: The product's own Summary of Product Characteristics and patient information leaflet, published per medicine by the licensing authority. MAOI prescriptions are normally accompanied by a written tyramine restriction sheet from the prescribing service, which takes precedence over any general list. · checked 2026-09-02

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