Tyramine reaction
Revision as of 15:34, 10 June 2015 by Rossdonaldson1 (talk | contribs)
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