Side Effects

Why should people taking MAOIs avoid eating cheese and drinking wine?

Answer: Cheese and wine contain tyramine, an amino acid that could interact with MAOIs to produce high blood pressure.


Monoamine oxidase inhibitors such as Ensam are commonly prescribed to decrease the symptoms of depression. These drugs inhibit the enzyme that breaks down monoamines such as dopamine and serotonin, resulting in elevated monoamine signaling in the synapse. This can increase mood after chronic exposure, usually after a few weeks.

Foods such as cheese and wine contain the amino acid tyramine. In the body, tyramine causes the release of norepinephrine, which acts at the alpha receptors to cause vasoconstriction. Normally, monoamine oxidase in the liver will break down tyramine rapidly.

People who are taking MAOIs will have an elevated blood concentration of tyramine since the amino acid will not be broken down. As a result, they may experience more norepinephrine release, and consequently, increased constriction of blood vessels. This decrease in blood vessel diameter results in elevated blood pressure, which may lead to stroke in some patients.

Because of these side effects and more, MAOIs have often been replaced by other classes of medicines to treat depression.

The Food and Drug Administration in the US currently has approved four different MAOIs for treatment of depression:

Isocarboxazid (Marplan)
Selegiline (Emsam)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Moclobemide is a reversible MAOI that may allow eating cheese while taking the drug.

More information regarding the interactions of cheese and monoamine oxidase inhibitors can be found at in this article, Hypertensive crisis and cheese published by T. S. Sathyanarayana Rao and Vikram K. Yeragani