A 45-year-old patient on sertraline develops a hypertensive crisis after eating aged cheese. The explanation for this interaction involves:
- A Sertraline inhibits MAO-A, preventing tyramine metabolism in the GI wall and liver
- B SSRIs can cause mild MAO inhibition at high doses, but tyramine interaction is primarily seen with non-selective MAOIs, not sertraline ✓
- C Sertraline inhibits CYP2D6, increasing tyramine bioavailability
- D Sertraline blocks norepinephrine reuptake, sensitizing adrenoceptors to tyramine
Correct answer: B. SSRIs can cause mild MAO inhibition at high doses, but tyramine interaction is primarily seen with non-selective MAOIs, not sertraline
Explanation
SSRIs like sertraline do not inhibit monoamine oxidase and therefore do not cause the tyramine ('cheese') reaction; the tyramine interaction is specific to non-selective MAOIs (phenelzine, tranylcypromine) and irreversible MAO-A inhibitors because they prevent first-pass intestinal and hepatic tyramine degradation. This question scenario as described is not pharmacologically consistent with sertraline. If this interaction occurred, it would indicate inadvertent MAOI co-administration or an MAOI being mistakenly prescribed.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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