Abstract

Tranylcypromine (Parnate - SKF, and a constituent of Parstelin - SKF) is a monoamine oxidase (MAO) inhibitor which is useful as an antidepressant. The drug has an unusual side effect: attacks of paroxysmal hypertension and headache occur in a substantial proportion of patients taking it. Intracranial bleeding has occurred in at least 10 cases (W. Dorrell, Lancet Aug. 24, 1963, 414), and a number of deaths have been reported. In some patients the hypertensive attack has been related to the administration of an amphetamine or of imipramine in addition to tranylcypromine, but in most cases no trigger factor could be identified. Now cheese has come under strong suspicion. Many of the attacks have come between half an hour and 2 hours after the patient has eaten cheese (B. Blackwell, ibid.; A. R. Foster and others, ibid. Sept. 14, 1963, 587). In some cases attacks have occurred after only a few doses of the drug, in others after the patient had been taking it for many months. Phenelzine (Nardil - Warner), also an MAO inhibitor, is another drug associated with hypertensive attacks, but whether cheese plays a part in them is not clear. With tranylcypromine an attack has followed the consumption of as little as one ounce of Cheddar cheese. Whether other cheeses or indeed other food can provoke attacks is not yet known.