Tyramine reaction

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