A 32-year-old man with treatment-resistant depression is prescribed phenelzine, an irreversible MAO inhibitor. The patient is counselled on dietary restrictions. Which food combination poses the GREATEST risk of a hypertensive crisis for this patient?
- A Boiled rice and fresh vegetables
- B Fresh milk and boiled eggs
- C Aged cheddar cheese and red wine ✓
- D Fresh chicken and plain bread
Correct answer: C. Aged cheddar cheese and red wine
Explanation
MAO inhibitors block intestinal and hepatic MAO-A that normally metabolises dietary tyramine. Foods rich in tyramine — aged cheeses, cured/fermented meats, red wine, and yeast extracts — cause massive catecholamine release from adrenergic nerve endings when MAO is blocked, producing a potentially fatal hypertensive crisis (the cheese reaction). Fresh, unfermented foods contain negligible tyramine and are safe. Aged cheese and red wine together are the classic highest-risk combination, as both are high in tyramine.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.