Tyramine reaction: Difference between revisions
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**Tyramine is a dietary amine similar to amphetamine normally metabolized by MAO | **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 | ||
==Clinical Features== | ==Clinical Features== | ||
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**Severe occipital or temporal headache | **Severe occipital or temporal headache | ||
**Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain | **Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain | ||
*Syndrome usually resolves on own over 6 hours | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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
Clinical Features
- Rapid onset (within 15-90 minutes of ingestion) of:
- Severe occipital or temporal headache
- Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain
- Syndrome usually resolves on own over 6 hours
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