When MAOI Inhibitors were introduced as the first antidepressants in the early 50’s, they came in pill form. The pills were processed in part by the liver and this caused severe side effects in people who had ingested food containing Tyramine.
The Food and Drug Administration pulled MAOIs from the market until they figured out what was going on. Later the FDA relented, so long as people were warned not to eat aged cheese, processed meats, draft beer, and a host of other common foods.
In 2006, a new delivery system was released, an MAOI patch called Emsam. This enabled the drug to bypass the liver on the way to the brain. Clinical trials of the 6 MG patch found no food interaction. Unfortunately, it usually takes a higher dose to achieve the antidepressant effect.
In a rush to market, the makers of the Emsam patch did not seek FDA approval for higher doses, so a patch for greater than 6 MG carries dire warnings about ingesting foods laden with Tyramine.
I wore a 12 MG (i.e., over the limit) patch during a recent two-week trip through Alsace, Bavaria, and Hungary during which I stuffed myself with smelly cheese, tap beer, cured pork, sauerkraut, goulash, foie gras, and other Tyramine-rich foods.
Mylan, the manufacturer of the Emsam patch, should run trials with patches stronger than 6 MG. The current guidelines unnecessarily restrict the dining pleasure of people on higher doses.
Your mileage may vary.