Newer research shows that foods have lower levels of tyramine than originally believed.
Patients can benefit from MAO-Inhibiting medications like Marplan while consuming almost all of the foods and beverages that they like - including a number of foods that were incorrectly thought to be 'off-limits'1-8.
More recent information about tyramine
It is well known that, in the gut, MAO-Inhibitors can cause an increase in levels of tyramine. Tyramine also is present in some foods and beverages, particularly if those foods and beverages have been aged or fermented.
Since serum levels of MAO-Inhibitors in the presence of tyramine may yield a pressor effect, there is a potential risk of severe hypertension among MAO-I-treated patients who consume tyramine-containing foods or beverages.
Newer Findings: Less Restrictive Dietary Guidelines
When Marplan was first introduced, nutritionists didn't have advanced ways to measure tyramine in foods and beverages. So, to be as safe as possible, diets restricting foods containing tyramine were developed. These highly restrictive diets were hard for patients to adhere to, since, at the time, many popular foods were incorrectly thought to be 'off limits'.
There still are some foods and drinks patients should avoid - or consume only in moderation. But, using the newest analytical techniques, we now know that many foods that were once restricted, in actuality, have very little or no tyramine, and thus can be considered safe to consume while patients are taking Marplan.
The key is fresh foods
When instructing your patients about diet, the key is to emphasize that they eat fresh foods. Fresh dairy, fresh poultry, fresh fish, and fresh packaged or processed meats are all safe food choices for patients taking Marplan.
So they can go right ahead and enjoy a burger or a hot dog at the barbecue. Nearly all fruits and vegetables are OK too.
However, you'll want to counsel them to avoid any aged cheeses, fermented/dry/aged meats such as salami, most soy products, and any foods that haven't been stored properly or have gone beyond their expiration dates.
Of course, it is best to avoid Alcohol
When taking any antidepressant, it is unwise to drink alcohol, since it may aggravate the symptoms of the depression. However, if your patient chooses to drink alcoholic beverages, the Menu for a new beginning we've provided for you as a patient education resource lists alcoholic beverages to avoid.
The best diet news is that--with your guidance--patients can receive the benefits of Marplan therapy for Treatment-Resistant Depression - AND enjoy a varied, healthful diet that's easy for them to adhere to.
For more details please click here to View and Download the Full Prescribing Information for Marplan tablets.
Avoiding medication interactions
Because some medications can interact with Marplan and cause unwanted adverse effects, you'll want to encourage your patients to fully report all medications they are taking, including OTC products and herbal supplements prior to prescribing Marplan.
Below is a list of medication combinations that should be avoided:
- Marplan should be administered with caution to patients receiving Antabuse® (disulfiram)
- The use of Marplan in combination with other psychotropic agents is not recommended without your doctor's knowledge, because one product can potentially magnify the effects of the other.
The MAO-Inhibiting effects of Marplan can persist for a substantial period after it has been discontinued, so it is best to wait at least 10 days before taking any other psychotropic medication.
Marplan should not be used with:
- other MAO-Inhibitors, tri-cyclic medications (dibenzazepine-related and other); Wellbutrin® (buproprion); SSRI antidepressants; Buspar® (buspirone)
- sympathomimetic drugs, including amphetamines, and over-the-counter cold, hay fever or weight-reducing preparations containing vasoconstrictors (decongestants); tryptophan;
- Demerol® (meperidine); the cough-preventive dextromethorphan; anestheic agents; blood pressure drugs, including thiazide diuretics; excessive amounts of caffeine; central nervous system depressants such as narcotics, barbiturates, and alcohol.
References:
- Gardner DM, et al. The making of a user friendly MAOI diet. J Clin Psychiarty. 1996;57:99-104.
- McCabe B, Tsuang MT. Dietary consideration in MAO inhibitor regimens. J Clin Psychiatry. 1982;43:178-181
- Shulman, et al. Dietary restriction, tyramine, and the use of monamine oxidase inhibitors. J Clin Psychopharmaol. 1989;9:397-402
- Shulman KI, Walker SE. Refining the MAOI die: tyramine content of pizzas and soy products. J Clin Psychiatry. 1999;60:191-193.
- Sullivan EA, Shulman, KI. Diet and monamine oxidase inhibitors: a re-examination. Can J Psychiatry. 1984;29:707-711.
- Tailor SA, et al. Hypertensive episode associated with phenelzine and tap beer - a reanalysis of the role of pressor amines in beer. J Clin Psychopharmacol. 1994;14:5-14.
- Walker SE, et al. Tyramine content of previously restricted foods in monamine oxidase inhibitor diets. J Clin Psychopharmacol. 1996;16:383-388.
- Rappaport MH. Dietary restriction and drug intersactions with monoamine oxidase inhibitors: The state of the art. J Clin Psychiatry. 2007;68[suppl 8]:42-46.
Please see Full Prescribing Information including BOXED WARNINGS regarding increased risk of suicidality in children and adolescents. MAO-Inhibitors are contraindicated with certain drugs. Potential hypertensive crises may occur with foods that contain tyramine. As with all antidepressants, patients should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment.
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