A patient on a monoamine oxidase inhibitor who consumes tyramine-rich foods is at greatest risk for which complication?

• A. Orthostatic hypotension
• B. Hypertensive crisis
• C. Hypokalemia
• D. Sedation

Answer: (B)

When a patient is taking an MAOI, tyramine from foods isn’t broken down in the gut, so it can enter the bloodstream and trigger a large release of norepinephrine. This indirect sympathomimetic effect causes excessive vasoconstriction and a rapid, dangerous rise in blood pressure—hypertensive crisis. The risk is why tyramine-rich foods must be avoided with MAOIs, and it’s the key reason this scenario is described as the greatest danger. Other choices don’t fit the mechanism: orthostatic changes, electrolyte disturbances, or sedation aren’t driven by this tyramine-MAOI interaction. If severe symptoms occur—sudden very high blood pressure, severe headache, chest pain—seek urgent care.