Blue cheese: the tyramine rule depends on the drug

Blue cheese is the food in the old warning about monoamine oxidase inhibitors, and how much that warning is worth depends on which drug a person takes. In healthy volunteers given phenelzine 15 mg three times daily, selegiline 5 mg twice daily or rasagiline for 14 to 30 days, the tyramine sensitivity factor was 17.3 on phenelzine and 2.5 on selegiline against 1.5 on placebo. That factor comes from a laboratory challenge and measures how much less tyramine it takes to raise blood pressure, and it says nothing about how much cheese is safe. In two double-blind trials in Parkinson disease, tyramine challenges of 50 to 75 mg produced no tyramine reaction in any of the 38 patients on rasagiline monotherapy or the 17 on placebo, at doses far above what a cheese portion delivers. In a second group of the same work, 3 of 22 on rasagiline 0.5 mg and 1 of 21 on placebo had asymptomatic systolic rises of 30 mm Hg or more. Rasagiline is MAO-B selective, so none of this transfers to the older non-selective inhibitors.

The numbers, per 100 g

How much is actually in it

• Imported blue cheese carried the most salt among 612 cheeses surveyed in UK supermarkets at 2.71 g per 100 g, close to five times the 0.55 g per 100 g of cottage cheese. — 612 cheeses on sale in the seven largest UK retailers, surveyed in 2012 (n = 612) Evidence C source
  Imported blue cheese 2.71 plus or minus 0.83 g salt per 100 g, halloumi 2.71 plus or minus 0.34, cottage cheese 0.55 plus or minus 0.14, mean across all cheese 1.7

What your body absorbs

• Tyramine swallowed with a meal reached the blood far less than the same 200 mg dose after a fast, with systemic exposure lower by 53% and peak concentration lower by 72%. — healthy subjects given a single 200 mg oral dose of tyramine after an overnight fast and again during a meal Evidence C source
  Systemic exposure reduced 53% (p < 0.05), maximum concentration reduced 72% (p < 0.05) when taken with food

What cooking and storage change

• A systematic review of 14 studies found tyramine and histamine to be the biogenic amines most often present at high levels in ripening cheese. — 14 studies of cheese ripening published between 2010 and 2024 (n = 14 studies) Evidence C source
  Combined Lactobacillus acidophilus and Lactiplantibacillus plantarum cut total biogenic amines by up to 80%

Safety, limits and interactions

• Tyramine challenges of 50 to 75 mg caused no clinically significant blood pressure reaction in Parkinson patients taking the selective MAO-B inhibitor rasagiline at 0.5 to 2 mg daily. — 72 rasagiline-treated and 38 placebo-treated Parkinson's disease patients at the end of two double-blind trials (n = 110) Evidence B source
  0 of 38 on rasagiline monotherapy and 0 of 17 on placebo showed a tyramine reaction; 3 of 22 on rasagiline 0.5 mg and 1 of 21 on placebo had asymptomatic systolic rises of 30 mm Hg or more
• Sensitivity to dietary tyramine depends on which drug a person takes, with a tyramine sensitivity factor of 17.3 on phenelzine and 2.5 on selegiline against 1.5 on placebo. — healthy volunteers given phenelzine 15 mg three times daily, selegiline 5 mg twice daily or rasagiline 1 to 6 mg daily for 14 to 30 days Evidence B source
  Tyramine sensitivity factor 17.3 (phenelzine), 2.5 (selegiline), 2.0 (rasagiline 1 mg/d), 1.5 (placebo)
• Taking moclobemide and selegiline together raised tyramine pressor sensitivity 8.4-fold in healthy adults, against 2.4-fold and 1.3-fold for each drug alone, so tyramine-rich food stays restricted on that combination. — two parallel groups of 12 healthy men and women treated for 14 days (n = 24) Evidence B source
  Pressor sensitivity enhanced 2.4-fold (moclobemide), 1.3-fold (selegiline) and 8.4-fold (both)
• Meals carrying roughly 400 mg of tyramine from aged cheeses produced no clinically significant cardiovascular change in 12 healthy men wearing a 6 mg per 24 hour selegiline patch. — 12 healthy adult male volunteers after 13 consecutive days of selegiline transdermal treatment (n = 12) Evidence C source
  No pressor response and no hypertensive crisis after about 400 mg of tyramine eaten as aged cheese

What people believe that the data does not support

• The belief that tyramine-rich cheese triggers migraine remains contested, and a review of the headache literature places tyramine among substances that only some patients react to. — review of English language preclinical and clinical studies on food triggers and migraine Evidence E source
  No effect size reported, the authors describe the trigger data as controversial

Who this works differently for

• FDA tells pregnant women to avoid blue-veined cheese unless it is made with pasteurized milk, because soft cheese from unpasteurized milk can carry Listeria monocytogenes. — pregnant women, consumer guidance from the US Food and Drug Administration Evidence E source
  Advice to avoid, with pasteurized milk named as the condition that lifts it

The bottom line

Salt is the everyday number. A survey of 612 cheeses on sale in the seven largest UK retailers in 2012 put the mean at 1.7 g of salt per 100 g, with cottage cheese lowest at 0.55. Imported blue cheese sat at the top of that list at 2.71 g per 100 g, level with halloumi. Those are label values from one country in one year, and salt varies widely inside a single cheese type. Risk concentrates where drugs are combined. In two parallel groups of 12 healthy men and women treated for 14 days, moclobemide and selegiline together raised tyramine pressor sensitivity 8.4-fold, against 2.4-fold and 1.3-fold for each drug alone, with the tyramine given intravenously, which bypasses the gut barrier. That barrier is measurable. A single 200 mg oral dose of tyramine taken during a meal gave 53 percent lower systemic exposure and a 72 percent lower peak concentration than the same dose after an overnight fast (p < 0.05), using encapsulated pure tyramine rather than tyramine inside cheese. In 12 healthy men wearing a 6 mg per 24 hour selegiline patch for 13 days, meals carrying about 400 mg of tyramine from aged cheeses produced no clinically significant cardiovascular change, an open-label study at a dose many times a normal serving. Migraine is the belief that has never been settled. A review of the headache literature calls the food trigger data controversial and places tyramine among substances that only some patients react to, with no effect size of its own, so it carries the reading of its authors and no new measurement. Ripening is what builds the amine. A systematic review of 14 cheese ripening studies published between 2010 and 2024 found tyramine and histamine the amines most often reported at high concentrations, with strains, cheese types and methods differing enough that the authors did not pool their numbers. Who should take care. The FDA tells pregnant women not to eat blue-veined cheese unless it is made with pasteurized milk, because soft cheese from unpasteurized milk can carry Listeria monocytogenes, a position that covers soft cheese as a class rather than blue cheese measured on its own. Anyone taking a non-selective inhibitor such as phenelzine, or more than one of these drugs at once, is the person the numbers above are about. We found no measurement of how much tyramine a portion of blue cheese actually holds, and no study of Listeria in blue cheese itself.

Sources

1. bluc-r3-06 · cross-sectional survey
   Salt content in cheese was high with a mean (±SD) of 1.7±0.58 g/100 g...cottage cheese (0.55±0.14 g/100 g) contained the lowest amount of salt.
   BMJ Open, 2014 · checked 2026-09-24
2. bluc-r3-05 · pharmacokinetic study
   Systemic exposure to tyramine was reduced by 53% (p < 0.05), and the maximum concentration of tyramine was reduced by 72% (p < 0.05) when the dose was administered during a meal.
   J Clin Pharmacol, 2003 · checked 2026-09-24
3. bluc-r3-07 · systematic review of laboratory studies
   Among the identified biogenic amines, tyramine and histamine were most frequently reported at high concentrations...a maturation period of 3-4 months, enhanced the efficiency of probiotic interventions.
   J Food Prot, 2026 · checked 2026-09-24
4. bluc-r3-01 · randomised controlled trial
   In the first study involving 55 patients with early PD on rasagiline monotherapy, no patients randomized to rasagiline (1 mg/2 mg; n = 38) or placebo (n = 17) developed systolic BP (SBP) or heart rate changes indicative of a tyramine reaction.
   Mov Disord, 2006 · checked 2026-09-24
5. bluc-r3-02 · randomised controlled trial
   TSF was highest with phenelzine (17.3) and lowest with placebo (1.5). TSF with selegiline was 2.5...These data allowed removal of dietary tyramine restriction from rasagiline US labeling.
   J Clin Pharmacol, 2010 · checked 2026-09-24
6. bluc-r3-03 · randomised controlled trial
   Tyramine pressor sensitivity during moclobemide, selegiline and moclobemide + selegiline treatment was enhanced, on average, by 2.4-, 1.3- and 8.4-times, respectively...the supra-additive potentiation of the tyramine pressor effects means that dietary restriction of tyramine intake will be necessary during such combination therapy.
   Eur J Clin Pharmacol, 1996 · checked 2026-09-24
7. bluc-r3-04 · open-label challenge study
   Ingestion of tyramine-enriched meals following 13 consecutive days of treatment with the STS 6 mg/24 hr (pharmacokinetic steady-state) produced no clinically significant changes in cardiovascular vital signs in 12 healthy adult male subjects.
   CNS Spectr, 2007 · checked 2026-09-24
8. bluc-r3-08 · narrative review
   Although the data surrounding the role of certain foods and substances in triggering headaches is controversial, certain subsets of patients may be sensitive to phenylethylamine, tyramine, aspartame, monosodium glutamate, nitrates, nitrites, alcohol, and caffeine.
   Clin J Pain, 2009 · checked 2026-09-24
9. bluc-r3-09 · agency guidance
   pregnant women should not eat soft cheeses, such as Feta, Brie, Camembert, "blue-veined cheeses," or "queso blanco," "queso fresco," or Panela - unless they're made with pasteurized milk.
   FDA, Fact or Fiction: Food Safety for Moms-to-Be · checked 2026-09-24