Tyramine crisis is best treated as a hypertensive emergency with which agent?

• A. Nitroprusside
• B. Fluoxetine
• C. Ondansetron
• D. Haloperidol

Answer: (A)

Tyramine crisis from MAOI use creates a rapid surge of catecholamines, producing a hypertensive emergency with risk of end-organ damage. The goal in this situation is swift, controlled reduction of blood pressure. Intravenous nitroprusside is ideal here because it acts as a potent, titratable vasodilator, lowering both arterial and venous tone within seconds. This allows precise control of blood pressure as you adjust the infusion, which is crucial in a crisis driven by catecholamine excess.

Other options listed do not address the acute hemodynamic goal: they don’t provide the rapid, controllable BP reduction needed in a hypertensive crisis. Fluoxetine is an SSRI, not an antihypertensive; ondansetron is an antiemetic; haloperidol is an antipsychotic. In this emergency context, nitroprusside offers the fastest and most controllable means to reverse the dangerous BP elevation. (Monitor closely for infusion-related risks and cyanide toxicity with prolonged use.)