Tyramine reaction

Revision as of 23:07, 31 December 2011 by Jswartz (talk | contribs) (Created page with "==Background== *Occurs when a pt on MAOIs ingests tyramine **Dietary amine (similar to amphetamine) normally metabolized by MAO **Found in preserved meat, fish, cheese, alcohol *...")
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Background

  • Occurs when a pt on MAOIs ingests tyramine
    • Dietary amine (similar to amphetamine) normally metabolized by MAO
    • Found in preserved meat, fish, cheese, alcohol
  • Usually resolves on own over 6hr

Clinical Features

  • Rapid onset (within 15-90min of ingestion) of:
    • Severe occipital or temporal headache
    • Sympathomimetic effects:
      • HTN, diaphoresis, mydriasis, palpitations, chest pain

Management

  • ECG
    • Monitor for cardiac ischemia
  • CT head
    • Obtain if pt has focal neuro findings or persistent, severe HA
  • Hypertensive Emergency
    • Phentolamine is agent of choice
      • 2.5-5mg IV dose q5-15min until BP is controlled
      • Duration of action is <1hr
    • Beta-blockers are contraindicated

Disposition

  • Discharge home if asymptomatic after 4hr of observation

Source

  • Tintinalli
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