MAOI Dietary Restrictions — MRCPsych Paper B MCQ
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Correct answer: C — Avoid tyramine-rich aged or fermented foods
Phenelzine is an irreversible, non-selective monoamine oxidase inhibitor. Inhibition of intestinal and hepatic monoamine oxidase reduces tyramine metabolism, so tyramine-rich food can produce a marked catecholamine-mediated rise in blood pressure and potentially a hypertensive crisis. Patients must avoid relevant aged, fermented, pickled or otherwise degraded protein foods, including mature cheese, yeast or meat extracts, fermented soya products and dry sausages such as salami. Citrus fruit does not require routine avoidance. Avoidance of all dairy is unnecessarily broad, although particular dairy products such as cheese and yoghurt are listed in the SmPC. Complete caffeine avoidance is not required, although excessive tea and coffee should be avoided. An unrestricted diet is unsafe.
Reference: Neon Healthcare Ltd. Nardil 15 mg film-coated tablets: Summary of Product Characteristics, section 4.5, updated 2025. https://www.medicines.org.uk/emc/product/228/smpc