Header warning

FACT: You do not have to change your diet to avoid tyramine-rich foods and drinks at the starting dose of EMSAM of 6 mg/24 hr.

If your dose is increased to the 9 mg/24 hr or 12 mg/24 hr, you must avoid tyramine-rich foods and drinks while taking EMSAM and for 2 weeks after stopping these doses, or after reducing your dose to 6 mg/24 hr from a higher dose.

Some foods and drinks (such as aged cheese and beer from a tap) contain a substance called tyramine. The enzymes in your stomach that break down tyramine are the same ones that are blocked by EMSAM.

This means that consuming foods and drinks that have high levels of tyramine while on EMSAM can cause a sharp increase in blood pressure that can be life-threatening. You must avoid foods and drinks that are high in tyramine with the 9 mg or 12 mg/hr doses of EMSAM. With the 6 mg/hr dose, no change in diet is needed.

For more information on which foods and drinks to avoid, see the charts below.

Click here for a downloadable reference.

Types of foods and drinks containing little or no tyramine Foods and Drinks you can enjoy at any dose
(6 mg/24 hr, 9 mg/24 hr, and 12 mg/24 hr)
Foods and drinks containing little or no tyramine are acceptable at any EMSAM dose.
Meat, Poultry, Fish
Fresh meat, poultry, and fish including fresh processed meats (eg, lunch meats, hot dogs, breakfast sausage and cooked sliced ham)
Foods and drinks containing little or no tyramine are acceptable at any EMSAM dose.
Vegetables
All vegetables other than broad bean pods (fava bean pods)
Foods and drinks containing little or no tyramine are acceptable at any EMSAM dose.
Diary
Processed cheeses, mozzarella, ricotta cheese, cottage cheese, and yogurt
Foods and drinks containing little or no tyramine are acceptable at any EMSAM dose.
Drinks
Bottled and canned beers and wines contain little or no Tyramine.
As with other antidepressants, use of alchohol with Emsam is not recommended.
Foods and drinks containing little or no tyramine are acceptable at any EMSAM dose.
Miscellaneous
Brewer's yeast, baker's yeast, soy milk, and pizzas prepared with cheeses low in tyramine (most pizzas ordered from national pizza chains)


Types of tyramine-rich foods and drinks to avoid Foods and drinks to avoid when using the 2 higher dose patches (9 mg/24 hr or 12 mg/24 hr)
Tyramine-rich foods and drinks are to be avoided at EMSAM 9 and 12 mg/24 hr.
Meat, Poultry, Fish
Air dried, aged and fermented meats, sausages and salami (including cacciatore, hard salami, and mortadella); pickled herring

Any spoiled or improperly stored meat, poultry or fish (eg, foods that have undergone changes in color, odor, or become moldy); spoiled or improperly stored animal livers
Tyramine-rich foods and drinks are to be avoided at EMSAM 9 and 12 mg/24 hr.
Vegetables
Broad bean pods (fava bean pods)
Tyramine-rich foods and drinks are to be avoided at EMSAM 9 and 12 mg/24 hr.
Diary
Aged cheeses
Tyramine-rich foods and drinks are to be avoided at EMSAM 9 and 12 mg/24 hr.
Drinks
All kinds of tap beer and beers that have not been pasteurized
Tyramine-rich foods and drinks are to be avoided at EMSAM 9 and 12 mg/24 hr.
Miscellaneous
Concentrated yeast extract (eg, MarmiteTM); sauerkraut, most soybean products (including soy sauce and tofu); over-the-counter supplements containing tyramine

EMSAM® — INDICATION AND IMPORTANT SAFETY INFORMATION

EMSAM Transdermal System is a skin patch used to treat major depressive disorder.

What is the most important information I should know about EMSAM?

  • Antidepressants may increase suicidal thoughts or actions in children, teenagers and young adults
  • Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts or feelings. This is very important when an antidepressant is started or when the dose is changed
  • Call a healthcare provider right away to report any new or sudden changes in mood, behavior, thoughts, or feelings
  • EMSAM Transdermal System is not approved for use in patients under 18 years of age

Call a healthcare provider right away if you or someone you care for have any of the following symptoms, especially if they are new, worse, or worry you:

Thoughts about suicide or dying; attempts to commit suicide; new or worse depression, anxiety or irritability; feeling very agitated or restless; panic attacks; trouble sleeping; acting aggressive, being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking; other unusual changes in behavior or mood.

  1. Do not eat or drink foods and beverages with high amounts of a substance called tyramine while on EMSAM 9 mg/24 hr or 12 mg/24 hr, and for 2 weeks after stopping these doses. Ask your healthcare professional or see the Medication Guide for a complete list of foods and drinks that must be avoided. EMSAM at any dose should not be used in children under 12 even when used with dietary modifications.
    • – Consuming tyramine-rich foods and beverages can lead to a sudden, large increase in blood pressure called “hypertensive crisis.” This is a serious medical condition that may be life-threatening. Seek immediate medical care if you experience any of these symptoms: sudden severe headache, nausea, stiff neck, vomiting, a fast or slow heartbeat or a change in the way your heart beats (palpitations), tight chest pain, a lot of sweating, confusion, dilated pupils, and sensitivity to light
  2. Tell your doctor about all medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Tell all of your healthcare professionals that you are using EMSAM.
    • • Due to the potential for serious and life-threatening side effects, do not use the following medicines while using EMSAM at any dose, and for 2 weeks after stopping EMSAM:
    • – Other medicines to treat depression (antidepressants) including other MAOI medicines; medicines which contain selegiline (such as Eldepryl®);  St. John’s Wort; narcotic pain medicines that contain meperidine e.g., Demerol®; pain medicines tramadol, methadone, or propoxyphene; medicines containing carbamazepine e.g., Tegretol® a seizure medicine and oxcarbazepine, e.g., Trileptal® a seizure medicine; cold / cough preparations, decongestants, over-the-counter diet pills or herbal weight-loss products containing pseudoephedrine, phenylephrine, phenylpropanolamine, dextromethorphan, or ephedrine; herbal or dietary supplements that contain tyramine; Flexeril® (cyclobenzaprine), a medicine used to treat muscle spasms; amphetamines (stimulants or “uppers”); and BuSpar® (buspirone), an anxiety medicine
    • Some of these medicines will have to be stopped for 1 week (or more) before you can start using EMSAM

What should I tell my doctor before starting EMSAM Transdermal System?

  • Tell your healthcare professional about any medical conditions, including if you:
    • – Have or had manic episodes (a mental condition that causes “high” moods)
    • – Have any heart problems
    • – Have or had seizures (convulsions or “fits”)
    • – Tend to get dizzy or faint
    • – Are planning to have surgery
    • – Are or intend to become pregnant
    • – Are breast-feeding

What are the possible side effects of EMSAM Transdermal System?

  • EMSAM may worsen your depression, give you suicidal thoughts, or cause unusual changes in behavior. Call your healthcare professional right away if you feel worse with EMSAM
  • EMSAM may cause mania or hypomania in people who have a history of mania
  • EMSAM may cause low blood pressure. Lie down if you feel dizzy, faint, or lightheaded and change positions gradually
  • The most common side effect of EMSAM is a skin irritation where the patch is placed. Other common side effects with EMSAM include: headache, difficulty sleeping, diarrhea, dry mouth

How should I use EMSAM Transdermal System?

  • Use EMSAM exactly as prescribed and do not stop or change treatment (even if you start to feel better) without talking to your health care professional
  • Use only one patch at a time and change the patch once a day (every 24 hours). If you use more than one EMSAM patch at a time, remove the patches right away and call your doctor or Poison Control at 1-800-222-1222

General advice about EMSAM Transdermal System

  • Avoid exposing the EMSAM application site to direct heat, such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, and prolonged direct sunlight
  • Do not drive or operate hazardous machinery until you know how EMSAM affects you as EMSAM can reduce your judgment, ability to think, or coordination. Avoid drinking alcohol while using EMSAM
  • Do not use EMSAM if you are allergic to anything in EMSAM. See the Medication Guide for a complete list of ingredients in EMSAM
  • If you have any questions about your health or medicines, talk to your healthcare professional

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088

Please see full Prescribing Information, including Boxed Warning and Medication Guide.