Tyramine reaction: Difference between revisions
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==Background== | ==Background== | ||
*Occurs when a | *Occurs when patient taking a monoamine oxidase inhibitor (MAO-I) ingests tyramine | ||
** | **Tyramine is a dietary amine similar to amphetamine normally metabolized by MAO | ||
**Found in preserved meat, fish, cheese, alcohol | **Found in preserved meat, fish, cheese, alcohol | ||
* | *Syndrome usually resolves on own over 6 hours | ||
==Clinical Features== | ==Clinical Features== | ||
*Rapid onset (within 15- | *Rapid onset (within 15-90 minutes of ingestion) of: | ||
**Severe occipital or temporal headache | **Severe occipital or temporal headache | ||
**Sympathomimetic effects: | **Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain | ||
==Management== | ==Management== | ||
*ECG | *ECG: monitor for cardiac ischemia | ||
*CT head: if patient has focal neurologic findings or persistent, severe headache | |||
*CT head | *Hypertensive Emergency: phentolamine is agent of choice | ||
**2.5-5mg IV q5-15min until blood pressure controlled | |||
*Hypertensive Emergency | **Duration of action <1 hour | ||
*Beta-blockers '''contraindicated''' | |||
==Disposition== | ==Disposition== | ||
*Discharge home if asymptomatic after | *Discharge home if asymptomatic after 4 hours of observation | ||
==Source== | ==Source== | ||
Revision as of 02:49, 23 August 2013
Background
- Occurs when patient taking a monoamine oxidase inhibitor (MAO-I) ingests tyramine
- Tyramine is a dietary amine similar to amphetamine normally metabolized by MAO
- Found in preserved meat, fish, cheese, alcohol
- Syndrome usually resolves on own over 6 hours
Clinical Features
- Rapid onset (within 15-90 minutes of ingestion) of:
- Severe occipital or temporal headache
- Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain
Management
- ECG: monitor for cardiac ischemia
- CT head: if patient has focal neurologic findings or persistent, severe headache
- Hypertensive Emergency: phentolamine is agent of choice
- 2.5-5mg IV q5-15min until blood pressure controlled
- Duration of action <1 hour
- Beta-blockers contraindicated
Disposition
- Discharge home if asymptomatic after 4 hours of observation
Source
- Tintinalli