Posted by SLS on June 4, 2001, at 9:58:36
In reply to Re: MAOIs » SLS, posted by Elizabeth on June 3, 2001, at 21:18:38
> > *** including those with double pepperoni ***
> Yup. It's bizarre. I think it's because the pepperoni on pizzas from chain restaurants is so, you know, lame. < g > There were also other factors that might have contributed in your case.
> > Here is a good example of how elusive this whole MAOI diet thing is.
> It is elusive. That's why you have to consider *both* measured tyramine content in foods and well-documented case reports. (And be careful not to get all worked up over badly-documented case reports!)
> > I suffered a robust MAOI-food reaction when I accidentally ate one and one-half (1½) thin slices of pepperoni at the end of a slice of pizza. I was taking Parnate 60mg combined with desipramine 125mg at the time.
> Some thoughts:
>
> * Where did the pizza slice come from?It was a local pizzaria, not part of any chain or franchise.
> * Parnate potentiates tyramine at clinically used doses to a much greater degree than other MAOIs, and 60 mg is a fairly high dose.
Why do you suppose that is? Are Parnate or its metabolites amphetamine-like? Are they catecholamine releasers?
> * Although MAOI-TCA combinations are generally safe (exception: clomipramine), desipramine is a pretty selective NE reuptake inhibitor, and 125 mg is within the therapeutic dose range (for normal metabolisers) even by itself
I am not sure if I am a rapid-metabolizer of desipramine or not. When I was being treated by W. Harrison and F. Quitkin at Columbia in 1982, they had me take 450mg of imipramine, claiming that my blood work indicated that this was necessary to achieve a therapeutic level. However, my blood level of nortriptyline is towards the upper end of its therapeutic level when taking a modest dosage of 100mg. I guess the two tricyclics follow different routes of elimination, or perhaps the assays used in 1982 were unreliable. I have taken a combination of Parnate 150mg and desipramine 300mg (along with Lamictal). I ate plenty of pizza during this period of time. In fact, I had no problem with pizza when I was taking Parnate 120mg + desipramine 200mg + Dexedrine 15mg + Synthroid.
> * Although by your description you clearly had an elevation in blood pressure, it's not known how high your blood pressure got. Different people have different levels of sensitivity to BP elevation.
I guess you are a good example of that.
You'll have to forgive my fuzzy memory, but I think I encountered something that indicated that the pounding headache produced during the MAOI-food reaction is not exclusive or dependant upon a significant rise in blood pressure. I don't know. I would think that for me it was, given that the magnitude of the throbbing pain changed with posture.
> So there were multiple contributing factors, and we don't know how bad the reaction was (although I'm assuming you didn't suffer any major hemorrhaging).
Well, I don't know. I did see red when I became angry at myself for being so careless.
> > I used the term "MAOI-food reaction" because it might not have been dependent exclusively upon tyramine.
> You're right. There are other biogenic amines that have pressor effects. Fava bean pods, for example, contain DOPA, a direct precursor to dopamine. It's possible that other amines, such as putrescine and cadaverine (I swear I didn't make those names up!), occur in certain meats in the presence of certain bacteria.
LOL
That explains it. I am surely brain-dead.
:-)
- Scott
poster:SLS
thread:64764
URL: http://www.dr-bob.org/babble/20010530/msgs/65336.html