Handouts · Medications
MAO Inhibitors (MAOIs)
Includes phenelzine, tranylcypromine, isocarboxazid, and selegiline. Powerful antidepressants that require a special diet and careful drug avoidance.
What This Group Is
MAOIs are strong antidepressants, often used when other medicines haven’t worked.
They require a special diet and strict attention to other medications, so they are reserved for people who can follow these rules carefully.
The Tyramine Diet (Very Important)
MAOIs react with tyramine, a substance in aged and fermented foods, which can cause a dangerous blood-pressure spike.
Avoid: aged cheeses, cured/smoked meats, tap or unpasteurized beer, soy sauce, sauerkraut, and other fermented foods. Your prescriber will give you a full list.
Black Box Warning
Like all antidepressants, MAOIs carry a small risk of increased suicidal thoughts in people under 25. Watch closely early in treatment.
Common (Usually Mild) Side Effects
- Dizziness on standing (low blood pressure).
- Trouble sleeping.
- Weight gain.
- Sexual side effects.
Serious — Seek Care Now
- Hypertensive crisis: sudden pounding headache, stiff neck, sweating, nausea — a medical emergency.
- Serotonin syndrome: from combining with SSRIs, SNRIs, tramadol, triptans, and many others.
- Fainting from low blood pressure.
Alcohol & Drug Interactions
Avoid alcohol, especially tap beer and red wine (tyramine).
Never combine with other antidepressants, decongestants (pseudoephedrine), stimulants, meperidine, or tramadol. A washout period (up to 2 weeks, or 5 weeks after fluoxetine) is required before switching.
Monitoring
We check your blood pressure and review your diet and medications at each visit.
Keep an up-to-date list and tell every provider (including dentists and ER staff) that you take an MAOI.