A patient on carbidopa-levodopa and selegiline attending a party should avoid which item due to potential interaction?

• A. Smoked cheese
• B. Smoked fish
• C. Sourdough bread
• D. Smoked meat

Answer: (B)

When selegiline is used, it inhibits monoamine oxidase in the gut, which normally breaks down tyramine. Tyramine then can cause a surge of norepinephrine, leading to a dangerous rise in blood pressure (hypertensive crisis). Foods high in tyramine should be avoided.

Smoked fish is commonly high in tyramine due to preservation and aging processes, making it a prime trigger for this interaction with selegiline. The other options generally have lower tyramine levels, so they pose a lesser risk in this context.