The MAOI phenelzine is contraindicated with stimulants, decongestants, most antidepressants and aged or fermented foods
Nardil's label bars stimulants, decongestants, L-dopa and tryptophan for hypertensive crisis; SSRIs and other serotonergic drugs for "serious, sometimes fatal, reactions"; and aged cheese, cured meat, beer, wine and yeast extract.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: The food list is old and broad; Gillman 2011 (this wave) argues tyramine content in modern foods is lower and the hypertension risk lower than the label era assumed. That is a dispute about the food rules, not about the drug contraindications.
Monoamine oxidase inhibitors are the antidepressants with the longest interaction list, and the only class where the list includes dinner.
Significant findings
NARDIL (phenelzine) prescribing information (Pfizer, June 2025), Contraindications: "The potentiation of sympathomimetic substances and related compounds by MAO inhibitors may result in hypertensive crises. Therefore, patients being treated with NARDIL should not take sympathomimetic drugs (including amphetamines, cocaine, methylphenidate, dopamine, epinephrine, and norepinephrine) or related compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine, and phenylalanine)."
On food: "Hypertensive crises during NARDIL therapy may also be caused by the ingestion of foods with a high concentration of tyramine or dopamine. Therefore, patients being treated with NARDIL should avoid high protein food that has undergone protein breakdown by aging, fermentation, pickling, smoking, or bacterial contamination. Patients should also avoid cheeses (especially aged varieties), pickled herring, beer, wine, liver, yeast extract (including brewer's yeast in large quantities), dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna), pods of broad beans (fava beans), and yogurt. Excessive amounts of caffeine and chocolate may also cause hypertensive reactions."
On other antidepressants, Drug Interactions: "In patients receiving nonselective monoamine oxidase (MAO) inhibitors in combination with serotoninergic agents (e.g., dexfenfluramine, fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, venlafaxine) there have been reports of serious, sometimes fatal, reactions. Because NARDIL is a monoamine oxidase (MAO) inhibitor, NARDIL should not be used concomitantly with a serotoninergic agent". Other labels in this wave require 14 days between an MAOI and an SSRI in either direction; the stimulant label requires the same gap.
Worth asking
People on an MAOI usually know the food list. The interactions that catch them are the cold remedy with pseudoephedrine, the ADHD stimulant prescribed by a different clinician, and the surgical or dental anaesthetic with epinephrine. The Gillman 2011 row in this wave argues the food risk is smaller than the label's era assumed; the drug risks are not in dispute. If you take an MAOI, every new prescription and every over-the-counter product is a pharmacist question first.
Source
NARDIL (phenelzine sulfate) tablets: FDA-approved prescribing information, Contraindications and Drug Interactions — Parke-Davis Division of Pfizer Inc; US Food and Drug Administration (2025)
Regulator or national health body
How this was scored
- Study design
- Regulatory safety determination
- Funding
- Industry funded
- Published in
- Regulator or national health body
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 57 out of 100 on our published rubric. One caveat travels with that badge: The food list is old and broad; Gillman 2011 (this wave) argues tyramine content in modern foods is lower and the hypertension risk lower than the label era assumed. That is a dispute about the food rules, not about the drug contraindications. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
NARDIL (phenelzine sulfate) tablets: FDA-approved prescribing information, Contraindications and Drug Interactions — Parke-Davis Division of Pfizer Inc; US Food and Drug Administration (2025). Published in: Regulator or national health body. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Regulatory safety determination. Funding: Industry funded. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.