Maois Interactions

Fermented foods accumulate tyramine through microbial decarboxylation of tyrosine during fermentation, and MAOIs block the monoamine oxidase enzyme that normally clears tyramine from the gut and bloodstream. Unmetabolized tyramine then triggers massive norepinephrine release, which can produce a hypertensive crisis with systolic blood pressure spiking above 180 mmHg.

Yerba mate contains caffeine plus trace monoamine oxidase inhibitor-like compounds, but its bigger risk with prescription MAOIs (phenelzine, tranylcypromine, isocarboxazid, selegiline) is its sympathomimetic load: caffeine, theobromine, and modest tyramine content can amplify the pressor response in patients with inhibited MAO. Combining the two can trigger hypertensive crisis or serotonergic adverse effects.

Nutmeg contains myristicin, which has weak monoamine oxidase inhibitor (MAOI) activity. Combining nutmeg supplements or large culinary doses with prescription MAOIs can theoretically precipitate hypertensive crisis or serotonin syndrome through additive MAO inhibition.

Raw, unroasted cacao (often sold as ceremonial cacao or raw cacao paste) contains higher levels of tyramine, tryptamine, and phenylethylamine than processed chocolate. With irreversible MAOIs in the system, these vasoactive amines can drive a hypertensive reaction and, theoretically, contribute to serotonin syndrome.