Maoi hypertensive crisis

Severe and often unpredictable side effects, due to drug-food and drug-drug interactions, limit the widespread use of MAOIs. For example, tyramine, which is contained in certain foods, such as aged cheeses and meats, chicken liver, pickled or smoked fish (such as anchovies or herring), and red wines, is normally inactivated by MAO in the gut. Individuals receiving a MAOI are unable to degrade tyramine obtained from the diet. Tyramine causes the release of large amounts of stored catecholamines from nerve terminals, resulting in what is termed a “hypertensive crisis,” with signs and symptoms such as occipital headache, stiff neck, tachycardia, nausea, hypertension, cardiac arrhythmias, seizures, and, possibly, stroke. Patients must, therefore, be educated to avoid tyramine-containing foods. Phentolamine and prazosin are helpful in the management of tyramine-induced hypertension. [Note: Treatment with MAOIs may be dangerous in severely depressed patients with suicidal tendencies. Purposeful consumption of tyramine-containing foods is a possibility.]