Core56: Drug-induced adverse reaction: cheese reaction

🧀 High-yield / 要点：Cheese reaction = MAO inhibitor + tyramine-rich food → norepinephrine surge → hypertensive crisis.

Definition / 定義

• Cheese reaction is a drug-food interaction causing hypertensive crisis.
• Causative drugs:
  • MAO inhibitors / MAOIs.
• Trigger:
  • Tyramine-containing foods.

Mechanism / 機序

• MAO normally metabolizes norepinephrine and tyramine-related amines.
• MAOI inhibits metabolism of norepinephrine.
• Tyramine promotes catecholamine/norepinephrine release.
• Result:
  • Norepinephrine increases sharply.
  • Blood pressure rises severely.

Triggers / 誘因

MAOI drugs	Tyramine-rich foods
Isocarboxazid, phenelzine, tranylcypromine, selegiline	Beer, cheese, wine, pickles, smoked meat, smoked fish

Symptoms / 症状

• Headache: main symptom.
• Dizziness.
• Sweating.
• Palpitations.
• Tremor.
• Severe hypertension, e.g. BP >180/120 mmHg.

Hypertensive crisis / 高血圧クリーゼ

Type	Meaning
Hypertensive emergency	Severe hypertension with organ damage: brain, heart, kidneys, or blood vessels
Hypertensive urgency	Severe hypertension without signs of organ damage

Complications / 合併症

• Hemorrhage.
• Hemiplegia.
• Intracranial hemorrhage.
• Cardiac arrhythmias.
• Cardiac failure.
• Pulmonary edema.
• Death.

Treatment / 治療

• Emergency management of hypertensive crisis.
• Rapidly acting IV α-blocker:
  • Phentolamine
  • Prazosin or chlorpromazine were listed in the lecture context.

Remember / 覚え方

• MAOI + cheese/wine/smoked foods = hypertensive crisis
• Tyramine → norepinephrine release
• Main symptom = headache