Bovril and moclobemide: a novel therapeutic strategy for central autonomic failure

Lancet. 1994 Nov 5;344(8932):1263-5. doi: 10.1016/s0140-6736(94)90752-8.


The consumption of tyramine-containing foods is contraindicated in patients on classic monoamine oxidase (MAO) inhibitors. We report successful therapeutic use of moclobemide (a MAO-A selective inhibitor) plus controlled amounts of Bovril (a tyramine-rich yeast-extract available as a food) in a patient with pure central autonomic failure who was rendered bed-bound by severe postural hypotension. Standing blood pressure is now at least 90/45 mm Hg. The selectivity of moclobemide allows about a tenth of ingested tyramine to reach nerve endings and thus the modest hypertensive effect of this combination re-established day-to-day function by restoring normotension.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Autonomic Nervous System Diseases / complications
  • Autonomic Nervous System Diseases / diagnosis
  • Autonomic Nervous System Diseases / drug therapy*
  • Benzamides / pharmacology
  • Benzamides / therapeutic use*
  • Blood Pressure / drug effects
  • Blood Pressure Monitoring, Ambulatory
  • Drug Therapy, Combination
  • Female
  • Heart Rate / drug effects
  • Humans
  • Hypotension, Orthostatic / diagnosis
  • Hypotension, Orthostatic / etiology*
  • Hypotension, Orthostatic / physiopathology
  • Middle Aged
  • Moclobemide
  • Monoamine Oxidase Inhibitors / pharmacology
  • Monoamine Oxidase Inhibitors / therapeutic use*
  • Treatment Outcome
  • Tyramine / pharmacology
  • Tyramine / therapeutic use*
  • Yeast, Dried / pharmacology
  • Yeast, Dried / therapeutic use*


  • Benzamides
  • Monoamine Oxidase Inhibitors
  • marmite
  • Moclobemide
  • Tyramine