Tyramine Calculator for MAOI Users
How This Works
Enter your food choice and quantity to calculate tyramine content. Based on medical guidelines, stay below 6mg for the lowest-risk MAOIs (like selegiline patch), and below 10-25mg for irreversible MAOIs.
When you're taking MAOIs for depression, what you eat isn't just about nutrition-it can be a matter of life or death. Monoamine Oxidase Inhibitors (MAOIs) like phenelzine, tranylcypromine, and isocarboxazid are powerful antidepressants, but they come with a strict rule: avoid foods high in tyramine. This isn't a suggestion. It's a safety requirement backed by decades of clinical evidence and real-world emergencies.
Why Tyramine Is Dangerous with MAOIs
Tyramine is a naturally occurring compound found in aged, fermented, or spoiled foods. Normally, your body breaks it down using an enzyme called monoamine oxidase-A (MAO-A). But MAOIs block this enzyme. When that happens, tyramine doesn't get processed. Instead, it floods into your bloodstream and triggers a sudden, dangerous spike in blood pressure. This is called the tyramine pressor response. Blood pressure can shoot up to 180/120 mmHg or higher. Symptoms include severe headaches, chest pain, rapid heartbeat, nausea, blurred vision, and in extreme cases, stroke or brain hemorrhage. According to the NCBI StatPearls, as little as 10-25 mg of tyramine-roughly the amount in one slice of aged cheese-can cause a crisis in someone on an irreversible MAOI.Which MAOIs Are Riskiest?
Not all MAOIs are the same. The older, irreversible ones-phenelzine, tranylcypromine, and isocarboxazid-bind permanently to MAO enzymes. Your body needs two to four weeks to make new ones. That means dietary restrictions stay in place for the entire treatment and for weeks after you stop. Newer options change the game. The transdermal selegiline patch (Emsam) delivers the drug through your skin, bypassing your gut. At the lowest dose (6 mg/24 hours), it only blocks MAO-B in the brain, not MAO-A in the intestines. That means you can eat most foods without risk. At higher doses (9 mg and 12 mg), restrictions return. Oral selegiline at doses under 10 mg/day also has lower risk. Reversible MAOIs like moclobemide (used outside the U.S.) are safer too. They let tyramine bind to the enzyme temporarily, so it still gets broken down. But these aren't widely available in the U.S. yet.Foods to Avoid: The Real List
Forget vague warnings like "avoid aged cheeses." You need numbers. Here’s what’s dangerous and why:- Aged cheeses: Cheddar, Swiss, blue cheese, parmesan, gouda. One slice (30g) can contain 30-50 mg of tyramine. Fresh mozzarella or cream cheese? Safe. Tyramine builds up during aging-so if it’s been sitting on the shelf for weeks, skip it.
- Dried, cured, or fermented meats: Salami, pepperoni, summer sausage, corned beef. One ounce (28g) can pack 50-100 mg of tyramine. Even smoked salmon can be risky if it’s not fresh.
- Fermented soy products: Soy sauce, miso, tempeh. Traditional soy sauce can have up to 500 mg per 100 ml. Modern commercial versions are lower-around 30 mg-but still too high for MAOI users. One tablespoon (15 ml) of soy sauce = 15 mg. That’s over half the danger threshold in a single spoonful.
- Tap beer and homebrewed beer: These contain live yeast and can have 10-30 mg of tyramine per 100 ml. Bottled or canned beer is usually fine, as pasteurization kills the yeast. Wine is generally safe in moderation (Chianti has 10-20 mg/100 ml), and distilled spirits like vodka or whiskey have almost none.
- Overripe fruits: Bananas, avocados, and figs become risky when they’re brown-spotted or mushy. A ripe avocado has 0.5-3 mg per 100g. An overripe one? Up to 10 mg. One avocado could push you over the limit.
- Yeast extracts: Marmite, Vegemite, and nutritional yeast are concentrated sources. Even a teaspoon can contain 15-20 mg.
- Leftovers and spoiled food: Tyramine builds up in food as it ages. If it’s been in the fridge for more than two days, or smells off, don’t risk it.
What’s Actually Safe?
You don’t have to live on plain rice and chicken. Many foods are perfectly fine:- Fresh meat, poultry, and fish (not cured or smoked)
- Fresh fruits and vegetables (except overripe bananas, avocados, figs)
- Fresh dairy: milk, cottage cheese, ricotta, fresh mozzarella
- Commercially processed breads, cereals, pasta
- Decaffeinated coffee and tea
- Non-alcoholic beer (check labels for yeast content)
- Most bottled and canned beverages
Other Hidden Dangers
It’s not just food. Many over-the-counter medications can trigger the same dangerous reaction:- Decongestants: pseudoephedrine (Sudafed), phenylephrine
- Cough syrups with dextromethorphan
- Weight-loss pills containing stimulants
- Herbal supplements like St. John’s Wort, ginseng, or L-tyrosine
What About After Stopping MAOIs?
You can’t just quit the pill and go back to your old diet. MAO enzymes take 2-4 weeks to regenerate after stopping irreversible MAOIs. That means you must keep avoiding high-tyramine foods for at least 14 days after your last dose-sometimes longer. And if you’re switching to another antidepressant? The wait is non-negotiable. Combining MAOIs with SSRIs like fluoxetine or sertraline-even after stopping-can cause serotonin syndrome, a potentially fatal condition. The 14-day washout period isn’t a suggestion. It’s a rule backed by case reports where patients died because they didn’t wait.
How to Stay Safe
Here’s what works in real life:- Keep a food journal. Write down everything you eat and when.
- Ask your pharmacist for a printed list of safe and unsafe foods. Many clinics give these out.
- Carry an MAOI alert card in your wallet. Emergency responders need to know immediately.
- Always tell every doctor, dentist, or nurse you see that you’re on an MAOI.
- When dining out, ask how food is prepared. No aged cheeses. No soy sauce. No cured meats.
- Use apps like MyTherapy or Medisafe to track your meds and food intake.
Why This Still Matters Today
MAOIs make up only about 2% of antidepressant prescriptions in the U.S. But they’re often the last option for people who haven’t responded to other treatments. With better understanding, fewer people are being scared off by myths. The transdermal selegiline patch has made MAOIs more accessible than ever. And modern guidelines now focus on exact tyramine thresholds-not just "avoid aged cheese." The bottom line? If you’re on an irreversible MAOI, your diet matters as much as your pills. Don’t guess. Don’t assume. Know the numbers. Know the risks. And don’t let a slice of blue cheese or a spoonful of soy sauce become your last mistake.Can I drink wine while on MAOIs?
Yes, in moderation. Most wines, including Chianti, contain 10-20 mg of tyramine per 100 ml. One glass (150 ml) is generally safe. Avoid red wines that are unfiltered or home-brewed, as they may have higher levels. Distilled spirits like vodka, gin, or whiskey are even safer-they contain almost no tyramine.
Is soy sauce always dangerous?
Traditional fermented soy sauce can have up to 500 mg of tyramine per 100 ml-extremely dangerous. But most commercial brands in supermarkets are pasteurized and contain around 30 mg per 100 ml. One tablespoon (15 ml) equals about 15 mg, which is above the 6 mg safety threshold. So, avoid it entirely unless your doctor confirms your specific MAOI allows small amounts.
What if I accidentally eat high-tyramine food?
If you feel a sudden headache, pounding heartbeat, or chest tightness after eating, seek emergency help immediately. Don’t wait. Call 911 or go to the nearest ER. Tyramine reactions can escalate in minutes. Bring your medication list with you. Emergency teams need to know you’re on an MAOI.
Can I take a break from MAOIs to eat my favorite foods?
No. Stopping MAOIs to eat high-tyramine foods is dangerous and ineffective. The enzyme inhibition lasts for weeks. Even if you skip a dose, the enzyme is still blocked. You must follow the full 14-day washout before switching to another antidepressant. There’s no safe shortcut.
Are there any new MAOIs without dietary restrictions?
Yes. The transdermal selegiline patch (Emsam) at 6 mg/24 hours has minimal dietary restrictions because it avoids gut metabolism. A new extended-release selegiline formulation approved in 2021 reduces risk further. Researchers are also testing a reversible MAO-A inhibitor called befloxatone, which in Phase III trials shows no tyramine interaction. These are promising, but not yet widely available.
Next Steps: What to Do Now
If you're on an MAOI:- Get a printed food list from your psychiatrist or pharmacist.
- Check your fridge and pantry. Toss anything aged, fermented, or cured.
- Set a reminder to avoid OTC cold meds and supplements.
- Carry your MAOI alert card.
- Ask your doctor if switching to the selegiline patch could reduce your restrictions.
- Ask if the transdermal patch is an option.
- Discuss your lifestyle. Can you commit to a strict diet?
- Ask about alternatives like SSRIs or ketamine therapy if dietary restrictions seem too hard.
bobby chandra
December 3, 2025 AT 07:34Let me tell you something-MAOIs aren’t just meds, they’re a lifestyle upgrade. I was on phenelzine for eight months, and yeah, I had to say goodbye to my beloved blue cheese board. But guess what? My depression lifted like a fog after a hurricane. No more crying in the shower. No more canceling plans because my brain felt like wet concrete. This isn’t about deprivation-it’s about reclaiming your life. And if you think that’s harsh, try living with untreated depression. The cheese was never the enemy. The silence was.
Archie singh
December 4, 2025 AT 18:16Stop romanticizing MAOIs. You people act like avoiding soy sauce is some heroic sacrifice. It’s not. It’s basic pharmacology. You’re not a martyr. You’re just someone who didn’t do their homework before accepting a prescription that requires a PhD in food science. The fact that you’re even asking if wine is okay means you shouldn’t be on it. This isn’t a diet. It’s a minefield. And you’re walking through it with blindfolded optimism.
Chloe Madison
December 6, 2025 AT 05:53If you’re on an MAOI and you’re reading this-you’re already doing better than you think. I’ve been there. I remember staring at a block of cheddar in the grocery store, crying because I didn’t know if it was safe. But here’s the thing: you don’t have to be perfect. You just have to be aware. Keep the list in your phone. Ask your pharmacist. Tell your waiter. One slip-up doesn’t erase your progress. You’re not failing-you’re learning. And that’s brave.
Makenzie Keely
December 6, 2025 AT 08:25Wait-did you know that soy sauce isn’t even the worst offender? I once ate a slice of aged gouda that had been sitting in my fridge for 3 weeks-just because I thought "it looked fine"-and my blood pressure spiked to 198/112. I thought I was having a panic attack. Turns out, it was tyramine. I ended up in the ER. They gave me nitroprusside. I’ve never been so scared. So now? I label everything. I write dates on my cheese. I freeze leftovers immediately. And I never, ever trust "artisanal" anything. If it’s been sitting longer than 48 hours, it’s not worth it. Not even close.
Francine Phillips
December 8, 2025 AT 06:08So… can I eat bananas? I mean, the yellow ones? Not the brown ones. Just… the normal ones?
Katherine Gianelli
December 9, 2025 AT 05:09I’m so proud of you for even researching this. I know how overwhelming it feels-like you’re being handed a 50-page manual on how to survive your own life. But you’re not alone. I’ve been on selegiline patch for a year now, and honestly? It’s changed everything. I can eat sushi. I can have a glass of wine with friends. I can go to dinner without Googling every ingredient. It’s not magic-it’s science. And if your doctor hasn’t mentioned the patch? Ask. Again. And again. You deserve to live, not just survive.
Joykrishna Banerjee
December 9, 2025 AT 10:55Typical Western medical reductionism. You treat the symptom (depression) with a blunt instrument (MAOI), then blame the patient for not being a perfect little robot who never eats anything with microbial life. In Ayurveda, we understand that fermentation is prana-it’s life force. You’re not poisoning yourself with cheese. You’re resisting the industrial pharmaceutical monoculture. You should be taking probiotics, not avoiding fermented foods. This is cultural imperialism disguised as safety.
Myson Jones
December 11, 2025 AT 03:21Look. I get it. You’re trying to help. But the real issue here isn’t tyramine-it’s that we’re still treating mental health like it’s a math problem. You take X pill, avoid Y food, and boom-you’re fixed. But depression isn’t solved by a checklist. It’s solved by connection. By being seen. By someone saying, "I’m here." Not by memorizing how many milligrams of tyramine are in a slice of salami. Maybe we need to stop focusing on the food… and start focusing on the person.
parth pandya
December 12, 2025 AT 08:45hey i was on isocarboxazid for 6 months and i totally forgot about the soy sauce thing and had a big bowl of ramen with shoyu and i was fine lol. maybe its just me? i think the whole thing is overblown. also i think the patch is just a money grab. why pay more for a sticker?
Albert Essel
December 13, 2025 AT 15:15I’ve been on tranylcypromine for three years. I’ve had two near-misses-one with a homemade kimchi, one with a miso soup I thought was "low-sodium." Both times, my heart felt like it was trying to escape my chest. I didn’t go to the hospital either time. I sat down. I breathed. I waited. And I lived. But I won’t make that mistake again. I keep a printed list taped to my fridge. I call my pharmacist before trying anything new. I don’t trust labels. I don’t trust restaurants. I don’t trust myself. But I trust the process. And that’s what keeps me alive.
Charles Moore
December 14, 2025 AT 11:58One thing no one talks about: the loneliness of this diet. You’re not just avoiding cheese-you’re avoiding birthday parties, family dinners, cultural traditions. I had to skip my grandmother’s funeral lunch because her homemade bologna was aged. I didn’t eat for three days after. That’s the hidden cost. The meds save your mind. But your heart? That’s on you. Find your people. The ones who bring you safe food. The ones who don’t judge. They’re out there.
Gavin Boyne
December 16, 2025 AT 03:22So we’ve turned a life-saving medical protocol into a TikTok diet trend. "Avoid aged cheese like it’s the devil’s snack." Meanwhile, people are dying from SSRIs because no one talks about serotonin syndrome. We’re terrified of a slice of blue cheese but will down 10 Advil like candy. The real danger isn’t tyramine-it’s the myth that medicine is simple. It’s not. It’s messy. It’s terrifying. And it requires more than a list. It requires humility. And maybe, just maybe, a little less performative caution.
Rashi Taliyan
December 17, 2025 AT 22:20I’m so sorry you’re going through this. I’ve been there. I know how it feels to sit across from someone you love and say, "I can’t eat that." And see the hurt in their eyes. But you’re not being difficult. You’re being brave. And if anyone tells you it’s too much? Tell them you’re not asking for permission to live-you’re demanding it. And you deserve every single bite of safety you can get.
Kara Bysterbusch
December 18, 2025 AT 01:36One thing I wish the article mentioned: the emotional toll of the 14-day washout. It’s not just about avoiding cheese-it’s about waiting. Waiting to feel normal again. Waiting to trust your body. Waiting to stop wondering if that headache is a reaction or just stress. I did the washout before switching to sertraline. I cried every day for two weeks because I felt like I was losing the only thing that had ever helped me. But I did it. And now I’m here. So if you’re in that limbo? You’re not broken. You’re becoming. And that’s worth every second.