Question

Ms. Jones has been taking MAO inhibitors for several weeks when she calls the clinic because she has developed a severe headache, heart palpitations, dilated pupils, tachycardia, chest pain, and sweating after attending a wine and cheese tasting event.

1. These symptoms are common in what adverse condition in patients taking MAO inhibitors? What type of immediate treatment is required?
2. What adverse drug–food interactions involving MAO inhibitors can occur?

Answer 1

Monoamine oxidase inhibitor inhibits monoamine oxidase enzyme A and monoamine oxidase enzyme B and is prescribed in various neuropsychiatric disorders.
When a food interferes with the action of the drug this is know as drug food interaction.
a. Substances such as cheese and alcoholic beverages are known to interact with MAOI and cause hypertensive crisis. The treatment includes infusion of iv fluids. If the respiratory failure symptoms are seen provide endotracheal intubation. To control the blood pressure short-acting antihypertensive agent, such as nitroprusside, nitroglycerin, or phentolamine are recommended. Benzodiazepines help control seizure and reduce blood pressure.
b. Cheese and alcoholic beverage contains tyramine. Tyramine metabolism is inhibited by MAOI which results in increased epinephrine release. This causes elevated blood pressure and vasoconstriction resulting in hypertensive crisis.