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MAOI food and drug interactions

Posted by Ilene on February 20, 2004, at 17:45:15

In reply to Marplan Diary, posted by Ilene on February 19, 2004, at 8:52:49

I keep reading out of date info about what you can and can't eat while taking MAOIs, so here is what I've gleaned. Most of it comes from Psychotropic Drugs Fast Facts, 3rd edition, some from other reading. It's rather North America-centric; apologies to Babblers from furrin' parts.

1) Eighty percent of hypertensive crises triggered by food are triggered by aged cheese. That's why it's called a "cheese reaction".

2) The substance that causes the cheese reaction is tyramine, a breakdown product of protein that forms during aging or fermentation. A few other substances may cause problems, but see #1. Be wary of meat, fish, poultry, or dairy products that have spent to much time in the fridge.

2) Some of the proscriptions are not only anecdotal, but decades old, such as the one about Chianti. Back in about 1963, someone drank a glass of Chianti and had a problem. Ditto bananas--banana peel, actually, believe it or not.

3) Individual sensitivity to tyramine varies.

4) The tyramine content of naturally fermented foods (e.g. cheeses, soy sauce) varies.

Details:

Aged cheeses are the worst. These include Liederkranz, English Stilton, blue cheese, aged cheddar, brick, mozzarella, Gruyere, Swiss, [I question the mozzarella--good mozzarella is fresh. ]

You can eat fresh cheeses, such as cottage cheese, processed slices (American cheese), ricotta, and cream cheese. Boursin and Bonbel are okay; provolone seems to fall in the middle.

Over 5 mg. tyramine in 4 hours may be risky. This is the best on-line list I can find:
http://www.nationaldairycouncil.org/nutrition/products/dairy.asp?page=3
Scroll down to the link to Table 11 (pdf file)

Don't drink tap or microbrewery beer. Four or fewer US or Canadian beers is okay. I don't have info about other kinds of beer.

Don't eat fava (or "horse") beans (I haven't seen a fava bean in years. The only place you are likely to come across one is an ethnic market or Italian restaurant.)

Don't eat concentrated yeast extracts, esp. Marmite. Beware of powdered protein diet supplements containing yeast extracts. Brewer's yeast is safe.

Beware of pickled herring. (Some sources say avoid entirely, some say you can eat the herring, but not the brine.)

Avoid aged salami, mortadella, air-dried sausage, chicken liver (by day 5). Bologna, pepperoni, summer sausage, fresh chicken liver, corned beef, and liverwurst are safe.

Don't eat sauerkraut.

Soy: Avoid tofu (some sources say fresh tofu is safe, just don't let it sit in the fridge.) Be careful with soy sauce. You should be able to consume up to 4 teaspoons of Kikkoman, for example, but some other brands contain more tyramine. Avoid miso soup. I wouldn't order anything with black bean sauce in a Chinese restaurant.

No shrimp paste.

It's okay to eat:

Chocolate except in very large quantities (I don't know what a "large quantity" is. I've read that dark European chocolate is worse than American milk chocolate.)
Figs, raisins, overripe fruit, avocados, bananas (except for the peel--but when's the last time you ate a banana peel?)
Tea, coffee, cola, and other sources of caffeine. Some sources say keep these under 3 cups/day.
Wine and spirits. Some sources say only up to 3 oz/day. One source says vermouth has a high tyramine content.
Yogurt, unless it is unpasteurized or over 5 days old.
Caviar, snails, canned fish
Canned and powdered soup, unless made from boullion or meat extracts and consumed in quantity.
Aspartame, except in large amounts (e.g. over 10 sodas)
Commercially prepared pizza (beware of gourmet pizza that might contain real cheese or aged sausage)

Drugs

MAOIs interact with an astonishing number of drugs. The reactions include hypertensive crises, serotenerginc reactions, noradrenergic reactions, hypotension, and some other things. Again, the information I can find is contradictory, but here it is.

Prescription drugs

Both serotonergic and noradrenergic ADs can cause problems. This is why you need a several-day washout period between other ADs and MAOIs.

A wide variety of other drugs are can cause reactions. Many MDs aren't familiar with these, so be extra careful with your prescriptions. These include norepinephrine; meperidine (Demerol), which can be fatal; some other opiates; stimulants; anti-asthma drugs; anesthetics; and a raft of others. Make sure your dentist knows you are taking an MAOI, as vasoconstrictors used in local anesthetics may cause a reaction (I found contradictory info. about this.)

OTC Drugs

Be careful with anything for a cough, cold, allergy, or to lose weight. These ingredients are potentially dangerous: Ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine, and dextromethorphan. (No ephedra, either.)


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