Tyramine reaction: Difference between revisions
No edit summary |
|||
| Line 17: | Line 17: | ||
==Management== | ==Management== | ||
*Hypertensive | *[[Hypertensive emergency]]: phentolamine is agent of choice | ||
**2.5-5mg IV q5-15min until blood pressure controlled | **2.5-5mg IV q5-15min until blood pressure controlled | ||
**Duration of action <1 hour | **Duration of action <1 hour | ||
Revision as of 15:34, 10 June 2015
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
Differential Diagnosis
Diagnosis
- ECG: monitor for cardiac ischemia
- CT head: if patient has focal neurologic findings or persistent, severe headache
Management
- 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