A pharmacology review argues MAOI interaction risks are "less than previously believed," partly because food has changed
Gillman, 2011: "The adverse effects and difficulties with monoamine oxidase inhibitors are less than previously believed or estimated, including a lower risk of hypertension, because the tyramine content in foods is now lower."
Weak or heavily disputed. Treat as a question, not an answer. how we score evidence
Caveat on this rating: A single-author narrative review from an author who has long argued MAOIs are underused. The tyramine claim is plausible and widely cited but rests on food-content surveys not read for this row. The label contraindications stand regardless.
The phenelzine label's food list dates from an era of different cheese. This review, by a long-standing advocate of the class, is the counter-reading.
Significant findings
Gillman (2011) reviewed the pharmacology and interactions of the irreversible non-selective MAOIs phenelzine and tranylcypromine. On enzyme interactions: "Their effect on CYP 450 enzymes is less than many newer drugs. Tranylcypromine only inhibits CYP 450 2A6 (selectively and potently). Phenelzine has no reported interactions, but, like isoniazid, weakly and irreversibly inhibits CYP 450 2C19 and 3A4 in vitro."
On phenelzine's own effects: it "commonly causes pyridoxal deficiency, weight gain, sedation, and sexual dysfunction, but only rarely causes hepatic damage and failure, or neurotoxicity."
The central claim: "The adverse effects and difficulties with monoamine oxidase inhibitors are less than previously believed or estimated, including a lower risk of hypertension, because the tyramine content in foods is now lower. Potent norepinephrine reuptake inhibitors have a strong protective effect against tyramine-induced hypertension." And the conclusion: "Monoamine oxidase inhibitors are not used to an extent proportionate with their benefits; medical texts and doctors' knowledge require a major update to reflect the evidence of recent advances."
Worth asking
Read this beside the Nardil label, not instead of it. The review is one author's synthesis, and its argument is about the size of the food risk and the reputation of the class, not about the drug contraindications, which it does not dispute. If you take an MAOI and find the diet unmanageable, this is the paper to bring to the prescriber when asking which foods on the list actually matter at the amounts you eat.
Source
Advances pertaining to the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors — Gillman PK (2011)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1097/JCP.0b013e31820469ea
DOI: 10.1097/JCP.0b013e31820469ea
How this was scored
- Study design
- Narrative review
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- 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 "contested". Weak or heavily disputed. Treat as a question, not an answer. It scores 33 out of 100 on our published rubric. One caveat travels with that badge: A single-author narrative review from an author who has long argued MAOIs are underused. The tyramine claim is plausible and widely cited but rests on food-content surveys not read for this row. The label contraindications stand regardless. 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?
Advances pertaining to the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors — Gillman PK (2011). Published in: Reputable peer-reviewed journal. DOI: 10.1097/JCP.0b013e31820469ea. 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: Narrative review. Funding: Funding not disclosed. 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.