Psycho-Babble Medication Thread 73614

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MAOI Diet Addendum

Posted by SalArmy4me on August 4, 2001, at 22:53:48

Walker, Scott E. MScPhm. Shulman, Kenneth I. MD, SM, FRCP(C). Tailor, Sandra A.N. PharmD. Gardner, David BScPhm. Tyramine Content of Previously Restricted Foods in Monoamine Oxidase Inhibitor Diets. Journal of Clinical Psychopharmacology. 16(5):383-388, October 1996"

"It has been clearly demonstrated that individuals who are taking MAOIs are more sensitive to the pressor effects of tyramine. [15] A critical issue in dietary restriction relates to the amount of tyramine that will produce an increase in blood pressure. Both Blackwell and Mabbitt [16] as well as Horowitz and associates [17] have observed increases in blood pressure with the ingestion of only 6 mg of tyramine. However, Blackwell and Mabbitt [16] were unable to reproduce these results on rechallenge with 6 mg in the same subject. Bieck and Antonin [15] demonstrated that an 8-mg oral dose of tyramine is sufficient to increase systolic pressure by 30 mm Hg in 50% of subjects receiving tranylcypromine. However, they also demonstrated a wide intra-individual variation in responses in some patients that may be due to variability in both the rate and extent of absorption. Furthermore, many foods have been reported to contain variable amounts of other pressor agents [18-21] that may also increase blood pressure, possibly contributing to variable response. [15,16] Therefore, we have used a conservative upper limit of 6 mg of tyramine as a guideline for safe ingestion. This is identical to the limit that we have used previously. [7,8,11]

Chianti
In this study, we again analyzed an Italian Chianti wine and found no tyramine. This is in agreement with the low or negligible levels reported by others. [8,13] Chianti wine has been widely restricted for many years based on a single report of a tyramine concentration of 25.4 mg/liter. [17] However, case reports of hypertensive crises associated with this or other wines are lacking.

It is of interest to note that in our assay, if we eliminate sodium lauryl sulfate (which acts as a counter ion) from our mobile phase, a compound in Chianti wine coelutes with tyramine. Liquid chromatographic columns can separate this coeluting peak with varying degrees of success. Therefore, it seems possible that the long-standing restriction of Chianti wine may have been due to analytical interference that led to an overestimation of the tyramine content. This points out the need to carefully validate the analytical method before reporting tyramine concentrations.

Cheese
By far, most reported fatal and nonfatal MAOI-related hypertensive reactions have been associated with the ingestion of cheese. [8] The restriction of all aged cheeses is universally accepted. However, not all cheeses should be banned. In this study, we analyzed mozzarella cheese and found extremely low amounts (0.01 mg/g), even when stored at room temperature for 5 days. The content of this part-skim mozzarella cheese is much lower than the 0.16 mg/g observed in our previous report of mozzarella cheese (28% milk fat). [8] Nevertheless, both concentrations would be regarded as safe when less than 30 g of cheese is ingested. Furthermore, the tyramine content provided in the current report is similar to the low concentrations reported for other mild and fresh varieties of cheeses such as cottage cheese, cream cheese, ricotta, and processed cheeses. [8,19,13,16] In this study, we also analyzed the tyramine content of the packaged cheese powder found in a Kraft Macaroni & Cheese Dinner (Kraft Foods, Inc., Glenview, IL) and found no tyramine.

Beer
In this study, we analyzed only one beer, a bottled German beer (Beck's, Brauerei Beck & Co., Bremen, Germany) and found it to contain small amounts of tyramine (1.0 mg/liter). This is in agreement with the results of the analysis of other bottled beers analyzed by our group [8,11] and others. [17,22,23] However, we have previously reported alarmingly high tyramine concentrations of tyramine (27.05-112.91 mg/liter) in four tap beers [11] and suggest that storage and contamination of the hose from the keg to the tap may provide conditions conducive to the production of tyramine. We recommend that tap beers be avoided by patients who are taking MAOIs, and because no bottled or canned beers from North American breweries have been identified as containing dangerous amounts of tyramine, we acknowledge that these can be consumed in moderation.

Bananas
A number of investigators have reported that banana pulp is safe, [8,24] although the peel has been observed to contain moderate to high amounts of several vasoactive substances, including serotonin, dopamine, and noradrenaline in addition to tyramine. [25] In this study, we observed the skin of a blackened banana to contain 2.58 mg of tyramine, whereas the pulp of each of two blackened bananas contained less than half this amount. Both of these bananas had been stored at room temperature for more than 1 week beyond the time when they were a ripened yellow. In our previous study, the tyramine content of a fresh banana was below the limit of detection and one whole peel was observed to have 1.42 mg of tyramine. [8] Although the tyramine content does appear to have increased with storage, this could easily be due to the variability in content between bananas. Furthermore, the bananas tested in this study, even after prolonged storage, did not contain dangerous amounts of tyramine. Therefore, we conclude that the pulp of an overripe banana is safe.

Raspberries
Coffin [24] reported that raspberries contain 0.048 mg/g of tyramine (range: 0.013-0.093 mg/g). Our own analysis of raspberries with different presentations (e.g., stored at room temperature or refrigerated for 4 days, with or without mold, in jam, and frozen) yielded tyramine concentrations ranging from 0 to 0.001 mg/g for berries and 0.021 mg/g for a frozen berry product. Based on our results and those of Coffin as well as the observation that there are no reports linking raspberries to hypertensive episodes, we conclude that raspberries are safe.

Prepared and sliced meat products
Fresh, sliced cold meat and other meat products were analyzed in this study and generally found to contain low amounts of tyramine per 30-g serving. This is in agreement with our previous report. [8] We also chose to analyze some canned meat and pasta products (Chef Boyardee, American Home Products, Inc., Madison, NJ) and found them to contain safe amounts of tyramine per serving.

The freshness of meat, specifically chicken livers, has been identified as a factor affecting the amount of tyramine. [26] In this study, we observed fresh chicken liver to contain very small amounts of tyramine. However, after 9 days' storage at room temperature, the tyramine content had soared to 2.13 mg/g. Although the chicken liver stored for 9 days at room temperature could not have been mistaken as fresh, and would not likely have been prepared and eaten by anyone, it does illustrate a point about freshness. A previous evaluation of chicken liver indicated that storage in the refrigerator for 5 days increased the tyramine concentration from 0 to 0.051 mg/g. [8] The current method adjusted the storage conditions only to create a definitive test of freshness on tyramine in chicken liver.

Sausage
As for cheeses, the degree of aging and variety of cured meats (e.g., salami, mortadella, pastrami) are tremendous and tyramine content can range from low and safe amounts to dangerously high levels. [8,9,21] Of most concern are the air-dried sausages, for example, salami. As sausages dry, an increase in the liberation of free amino acids has been observed to occur. [27] Because sausage can contain microorganisms with decarboxylase activity, [28] tyrosine can be converted to tyramine during the drying process. In this study, we tested a variety of air-dried sausages, analyzing samples taken both from the core and outer rim (next to the skin). In three of the four samples, the sample nearest the skin contained 20 to 360% more tyramine, whereas in the fourth sample the concentration in the center of the sausage was sevenfold higher than the sample taken from the area next to the skin. Of the 10 sausages tested, 2 were observed to contain more than 6 mg of tyramine per 30-g serving, and 2 others were observed to contain between 4 and 6 mg. Therefore, although there are no case reports associating air-dried sausages with hypertensive episodes, we recommend that air-dried sausages continue to be a dietary restriction for patients receiving MAOIs because of the variability in tyramine content among sausages and because of the likelihood that a serving will be greater than 30 g. However, as was pointed out previously, this restriction does not include fresh sliced-meat products, such as sliced cooked ham.

Sauerkraut
In this study, sauerkraut was observed to have a significant tyramine content per serving, (0.031 mg/g). This amount is lower than previously reported by Shulman and colleagues [8] (0.055 mg/g) but still within the range (0.020-0.095 mg/g) reported by Lovenberg [25] and Da Prada and associates. [9] All of these reports suggest a potentially dangerous tyramine content per serving, yet there are no case reports linking sauerkraut to hypertensive episodes. It is possible that the tyramine in sauerkraut may not be completely bioavailable or that the rate of absorption of tyramine from sauerkraut is slow, producing little change in blood pressure. However, in view of the confirmed high tyramine concentration per serving of sauerkraut, we recommend that it be restricted in patients on a regimen of MAOIs.

Storage
Improperly stored or spoiled food can create an environment where tyramine concentrations may increase. These foods must have either free tyrosine or tyrosine liberated on storage, which is then converted to tyramine by microorganisms with decarboxylase enzymes. [27] This was shown to occur with the chicken livers stored at room temperature for 9 days and is the postulated mechanism for production of tyramine in air-dried sausages and tap beers. [11] However, for a number of other foods (raspberries, mozzarella cheese, and bananas), improper or prolonged storage did not increase the tyramine content to unsafe levels. In these later cases, although conditions of growth were present, it is likely that either tyrosine was not liberated, was liberated in only small quantities, or decarboxylation activity was lacking.

Chocolate
Our analysis of a single chocolate bar (Toblerone, Kraft General Foods Canada Inc., Don Mills, Ontario, Canada; 35-g bar) failed to demonstrate measurable quantities of either tyramine or phenylethylamine, yet we did observe significant quantities of theobromine (2.78 mg/g) and caffeine (1.07 mg/g). The choice of a Toblerone chocolate bar arose from a case in which a young woman maintained on tranylcypromine (Parnate, SmithKline Beecham Pharmaceuticals, Oakville, Ontario, Canada) reported symptoms of dizziness, light-headedness, blurred vision, and headache 45 min after ingesting an unspecified amount of a Toblerone chocolate bar. The patient arrived at a hospital emergency department and was found to have normal blood pressure and heart rate, although she demonstrated slurred speech and pallor. We believe that many case reports, with only subjective findings that are not validated by objective measures, have led to the restriction of many foods. Headaches, which can occur for a variety of reasons, can also occur with chocolate ingestion in patients who are not taking MAOIs. In these cases, the cause does not appear to be related to either tyramine or phenylethylamine. We would suggest that this reaction may have been due to the stimulant effects of the methylxanthines (theobromine and caffeine).

Soy
Soy sauce and other soy bean preparations have been found to contain tyramine in significant concentrations, [9,10,29] whereas others have reported low concentrations. [8,13] From an analysis of Far Eastern cuisine, Da Prada and Zurcher [10] reported tyramine concentrations of 293 mg/liter and 878 mg/liter in two samples of soy sauce. Similarly, high concentrations (941 mg/liter) of tyramine were observed in the single soy product tested in this study. As with some other foods, the variation in tyramine content reported in various studies and between different soy sauce products creates a potential hazard. We recommend that soy sauce be avoided by patients taking MAOIs but acknowledge that patients may be able to ingest some brands without serious consequences...."

 

Re: MAOI Diet Addendum

Posted by Elizabeth on August 5, 2001, at 8:35:11

In reply to MAOI Diet Addendum, posted by SalArmy4me on August 4, 2001, at 22:53:48

I have a copy of this article somewhere. Thanks for posting it; I'm very grateful to this group of researchers for their work on updating the MAOI dietary restrictions.

And yes, I did drink Chianti (and several other wines, both red and white) while taking Parnate. :-) (Don't let me get started about the amount of chocolate I consumed when I was on Nardil. Yikes.)

The following passage deserves particular emphasis:

"We believe that many case reports, with only subjective findings that are not validated by objective measures, have led to the restriction of many foods. Headaches, which can occur for a variety of reasons, can also occur with chocolate ingestion in patients who are not taking MAOIs. In these cases, the cause does not appear to be related to either tyramine or phenylethylamine. We would suggest that this reaction may have been due to the stimulant effects of the methylxanthines (theobromine and caffeine)."

In other words, people sometimes just get headaches for no particular reason, even people on MAOIs.

-elizabeth

 

Re: MAOI Diet Addendum

Posted by may_b on August 6, 2001, at 13:14:16

In reply to Re: MAOI Diet Addendum, posted by Elizabeth on August 5, 2001, at 8:35:11

Hi Elizabeth

Am also glad for the posting re diet restriction and MAOI. Have not been able to locate a definitive list, which alas cost me dearly.

I had a hypertensive crisis after consuming one bottle of a local micro brewery beer. (Per my research, one beer, fresh, should have been ok.) The hypertensive crisis was exactly as described in the literature -- very scary. Tried to tell the emerg team about Nifedipene but they believed nothing of what I said. Because I could not speak very loudly, the Doc declared I made no sense. Eventually, he ordered intravenous Ativan, Gravol, and morphine.

The whole emergency experience was condescending and punitive -- this at a place and time where the impact of such bigotry is most damaging.

[Did you experience HC on MAOIs? I faintly remember a posting of yours dealing with emerg teams.]

Thanks, Elizabeth, for your thoughts re grogginess and parnate. I talked to the Doc who recommended Cytomel and upped the Parnate to 20 mg, [10 mg 2x day.] Now I am wondering if this lowered my threshold for HC. Before upping the dose of Parnate and adding Cytomel, I had been able to drink 1 canned beer without incident or reaction. I note there are occurrences of spontaneous HC in the research I did this a.m. (under MAOIs in high doses and with stimulants, www.dr-bob/tips).

Do you have any thoughts on this? Thanks as always,
may_b

 

Re: MAOI Diet Addendum may_b

Posted by Elizabeth on August 7, 2001, at 9:07:17

In reply to Re: MAOI Diet Addendum, posted by may_b on August 6, 2001, at 13:14:16

> I had a hypertensive crisis after consuming one bottle of a local micro brewery beer.

How high was your blood pressure?

> I talked to the Doc who recommended Cytomel and upped the Parnate to 20 mg, [10 mg 2x day.] Now I am wondering if this lowered my threshold for HC.

Parnate does potentiate the pressor response to tyramine more than Nardil does, and occasionally someone will experience significant rises in BP on Parnate alone (i.e., without any food interaction). My experience has been that this is best avoided by splitting the dose (taking no more than 10 mg in a single dose).

I can also easily see how adding stimulant-like drugs (such as thyroid hormones) could increase the risk of hypertension.

-elizabeth

 

Re: MAOI Diet Parnate-users Elizabeth

Posted by may_b on August 8, 2001, at 9:22:50

In reply to Re: MAOI Diet Addendum may_b, posted by Elizabeth on August 7, 2001, at 9:07:17

Hi Elizabeth

> How high was your blood pressure?

I was way too sick to ask for this information -- it was nearly impossible to talk (too weak)-- it took immense concentration. Later the doctor involved said the blood pressure was not high enough to use nifedipine (my brother was with me and reported this to me the next day). I was alternately vomitting and agitated or too weak to speak or move.

> Parnate does potentiate the pressor response to tyramine more than Nardil does, and occasionally someone will experience significant rises in BP on Parnate alone (i.e., without any food interaction). My experience has been that this is best avoided by splitting the dose (taking no more than 10 mg in a single dose).

I had taken 10 mg twice, one at 8 am and one at 3 pm for two days when this happened.

> I can also easily see how adding stimulant-like drugs (such as thyroid hormones) could increase the risk of hypertension.

I had guessed Cytomel would expand blood vessels rather than constrict?

Sorry to go back to your emerg experience, but were the interventions similar?

Tho I went back to the dose of 10 mg of Parnate only once a day at 8 am, and stopped the Cytomel, I have had a variable but continuous low grade headache since the HC--worse if I lean over. Much as I think Parnate is already helping me with depression, I feel extremely nervous about triggering another episode. The headache is worse after each meal, even though I am adhering to a very restrictive MAOI diet.

When you were on Parnate, did you carry an emergency supply of nifedipine or nitrosprusside?

[I know you were able to tolerate a more reasonable diet. I thought I had saved a copy of your posting on this subject but cannot find it in my Harddrive.]

Although I have not had migraines too often in the last year, I have a history of them since childhood (am now 48). So I am wondering if this makes me a poor Parnate candidate.


I appreciate any comments you'd care to make; thanks as always for your thoughts.

[I am following your desiprimine trial with interest. All the best wishes for success,]

may_b


 

Parnate questions (Elizabeth?)

Posted by may_b on August 9, 2001, at 9:53:15

In reply to Re: MAOI Diet Parnate-users Elizabeth, posted by may_b on August 8, 2001, at 9:22:50

> Hi Elizabeth
>
> > How high was your blood pressure?
>
> I was way too sick to ask for this information -- it was nearly impossible to talk (too weak)-- it took immense concentration. Later the doctor involved said the blood pressure was not high enough to use nifedipine (my brother was with me and reported this to me the next day). I was alternately vomitting and agitated or too weak to speak or move.
>
> > Parnate does potentiate the pressor response to tyramine more than Nardil does, and occasionally someone will experience significant rises in BP on Parnate alone (i.e., without any food interaction). My experience has been that this is best avoided by splitting the dose (taking no more than 10 mg in a single dose).
>
> I had taken 10 mg twice, one at 8 am and one at 3 pm for two days when this happened.
>
> > I can also easily see how adding stimulant-like drugs (such as thyroid hormones) could increase the risk of hypertension.
>
> I had guessed Cytomel would expand blood vessels rather than constrict?
>
> Sorry to go back to your emerg experience, but were the interventions similar?
>
> Tho I went back to the dose of 10 mg of Parnate only once a day at 8 am, and stopped the Cytomel, I have had a variable but continuous low grade headache since the HC--worse if I lean over. Much as I think Parnate is already helping me with depression, I feel extremely nervous about triggering another episode. The headache is worse after each meal, even though I am adhering to a very restrictive MAOI diet.
>
> When you were on Parnate, did you carry an emergency supply of nifedipine or nitrosprusside?
>
> [I know you were able to tolerate a more reasonable diet. I thought I had saved a copy of your posting on this subject but cannot find it in my Harddrive.]
>
> Although I have not had migraines too often in the last year, I have a history of them since childhood (am now 48). So I am wondering if this makes me a poor Parnate candidate.
>
>
> I appreciate any comments you'd care to make; thanks as always for your thoughts.
>
> [I am following your desiprimine trial with interest. All the best wishes for success,]
>
> may_b

 

Re: MAOI Diet Parnate-users may_b

Posted by Elizabeth on August 9, 2001, at 10:21:44

In reply to Re: MAOI Diet Parnate-users Elizabeth, posted by may_b on August 8, 2001, at 9:22:50

> > How high was your blood pressure?
>
> I was way too sick to ask for this information -- it was nearly impossible to talk (too weak)-- it took immense concentration. Later the doctor involved said the blood pressure was not high enough to use nifedipine (my brother was with me and reported this to me the next day). I was alternately vomitting and agitated or too weak to speak or move.

That's surprising if your BP wasn't high enough that it would normally warrant nifedipine. I wonder if there was something else going on too.

> I had guessed Cytomel would expand blood vessels rather than constrict?

Not sure offhand, but in any case that isn't the only factor affecting blood pressure. (There are a lot of things that have to be taken into account; that's why treatment of essential hypertension is so complicated.)

> Tho I went back to the dose of 10 mg of Parnate only once a day at 8 am, and stopped the Cytomel, I have had a variable but continuous low grade headache since the HC--worse if I lean over. Much as I think Parnate is already helping me with depression, I feel extremely nervous about triggering another episode. The headache is worse after each meal, even though I am adhering to a very restrictive MAOI diet.

The headache might be unrelated to blood pressure.

> When you were on Parnate, did you carry an emergency supply of nifedipine or nitrosprusside?

Nifedipine, yes.

-elizabeth

 

Re: MAOI Diet Elizabeth

Posted by may_b on August 9, 2001, at 10:58:33

In reply to Re: MAOI Diet Parnate-users may_b, posted by Elizabeth on August 9, 2001, at 10:21:44


Hi Elizabeth

Thanks for your response.

> That's surprising if your BP wasn't high enough that it would normally warrant nifedipine.

Meaning that you think it probably was high enough? (I felt like I was going to have a heart attack or more likely a stroke. The whole episode took six hours to resolve enough for me to leave the hospital.) Or that there should have been little risk to the Nifedipine intervention given that (he said) the blood pressure was "not high enough"?

> I wonder if there was something else going on too.

Do you mean from their end or mine? Their attitude was condescending and invalidating. Even my brother felt it necessary to say: "Listen to her; she DOES know what she's talking about." I felt like I was being punished for asking for a certain intervention. The nurse asked me if I was trying to kill myself! The doctor actually said "What is the generic name for nifedipene?" so I wondered if it he was just out of his league.

> The headache might be unrelated to blood pressure.

Like intolerance for Parnate? Damage caused by the hypertensive crisis?

> > When you were on Parnate, did you carry an emergency supply of nifedipine or nitrosprusside?
>
> Nifedipine, yes.

This experience has left me feeling very alone. I liked Parnate but feel utterly gun-shy and never want to trust another emerg team if I can do anything to avoid it.

Thanks very much for your helpful info. It means a lot to be able to check in with folks who have been there.

may_b

 

Re: MAOI Diet may_b

Posted by Elizabeth on August 9, 2001, at 17:05:34

In reply to Re: MAOI Diet Elizabeth, posted by may_b on August 9, 2001, at 10:58:33

> > That's surprising if your BP wasn't high enough that it would normally warrant nifedipine.
>
> Meaning that you think it probably was high enough?

I don't know; I don't have enough information. The way you describe the symptoms, though, makes it sound like your BP must have been quite high *or* there might have been something else going on that contributed.

Using nifedipine can be risky under some circumstances, and there really isn't any particular blood pressure that's generally agreed to be an indication for nifedipine. So it might be expected that a doctor (in particular, a medical doctor who didn't have much experience with MAOIs) would want to be conservative about it.

> (I felt like I was going to have a heart attack or more likely a stroke. The whole episode took six hours to resolve enough for me to leave the hospital.)

That's a little odd -- my impression has been that MAOI-associated hypertensive episodes usually last much shorter than that.

> Do you mean from their end or mine? Their attitude was condescending and invalidating.

I just expect that sort of behaviour from doctors, nurses, paramedics, pharmacists, et al. It sounds like you ended up with some especially incompetent ones.

> > The headache might be unrelated to blood pressure.
>
> Like intolerance for Parnate? Damage caused by the hypertensive crisis?

I'm not clear whether it was a hypertensive crisis or not, but people do get vascular headaches for reasons other than MAOI interactions. I doubt that there was any real damage done, BTW. If you're still having symptoms, I'd recommend reporting them to your pdoc, who can refer you for testing if necessary.

> This experience has left me feeling very alone. I liked Parnate but feel utterly gun-shy and never want to trust another emerg team if I can do anything to avoid it.

I understand completely.

> Thanks very much for your helpful info. It means a lot to be able to check in with folks who have been there.

I'm glad I could be of help. Take care.

-elizabeth

 

Re: MAOI Diet

Posted by may_b on August 10, 2001, at 2:24:14

In reply to Re: MAOI Diet may_b, posted by Elizabeth on August 9, 2001, at 17:05:34

Hi Elizabeth

> The way you describe the symptoms, though, makes it sound like your BP must have been quite high *or* there might have been something else going on that contributed.

I am sure it was very high.

> Using nifedipine can be risky under some circumstances,

but not in emerg, where this could have been monitored (theoretically)?

>and there really isn't any particular blood pressure that's generally agreed to be an indication for nifedipine. So it might be expected that a doctor (in particular, a medical doctor who didn't have much experience with MAOIs) would want to be conservative about it.

I think you are absolutely right -- he seemed utterly unfamiliar with parnate and had no knowledge of nifedipine.
>
> > (I felt like I was going to have a heart attack or more likely a stroke. The whole episode took six hours to resolve enough for me to leave the hospital.)
>
> That's a little odd -- my impression has been that MAOI-associated hypertensive episodes usually last much shorter than that.
>
With or without treatment? They took no intervention for well over an hour, according to my brother. (It felt much longer than that.)

> > Their attitude was condescending and invalidating.
>
> I just expect that sort of behaviour from doctors, nurses, paramedics, pharmacists, et al. It sounds like you ended up with some especially incompetent ones.

< wry smile > For now, further risk seems inadvisable. I have discontinued Parnate and any foodstuff identified on any maoi restriction list anywhere. It's pretty unworkable but I guess Parnate should clear out of my system in a month. I will talk to the Doc and if I can get some control over my situation, (ie, a prescription for nifedipine or some other such drug) it would be worth continuing. Aside from this catastrophe, it was a very effective drug for depression. Parnate parted the fog. Hate to give that up...

thanks again for your ideas and reactions,
may_b

 

Re: MAOI Diet may_b

Posted by Elizabeth on August 10, 2001, at 15:37:30

In reply to Re: MAOI Diet , posted by may_b on August 10, 2001, at 2:24:14

> > The way you describe the symptoms, though, makes it sound like your BP must have been quite high *or* there might have been something else going on that contributed.
>
> I am sure it was very high.

Have you ever had a sudden rise in blood pressure before? If not, how would you know? Some people are much more symptomatic to relatively small rises in blood pressure than others are. I would definitely notice something if my systolic pressure got up to 140 or so, yet there are some people for whom 140 is baseline.

If you can get your medical records from this incident, it might be worthwhile to see what your measured BP was.

> > Using nifedipine can be risky under some circumstances,
>
> but not in emerg, where this could have been monitored (theoretically)?

They wouldn't want to do something that could cause much more serious complications ("do no harm" and all) if your BP isn't (in their judgment) really dangerously high.

> I think you are absolutely right -- he seemed utterly unfamiliar with parnate and had no knowledge of nifedipine.

I think that it's typical for a non-psychiatrist to be unfamiliar with MAOIs. Immediate-release nifedipine isn't used much anymore, although ProCardia XL is a fairly common antihypertensive (for people with sustained hypertension).

> > That's a little odd -- my impression has been that MAOI-associated hypertensive episodes usually last much shorter than that.
>
> With or without treatment?

Either. Even if there is a hemorrhage or something like that, a typical MAOI hypertensive event subsides on its own pretty quickly (within an hour, perhaps two hours).

> < wry smile > For now, further risk seems inadvisable. I have discontinued Parnate and any foodstuff identified on any maoi restriction list anywhere.

The food lists are silly. I used evidence-based dietary rescrictions, rather than basing my food selections on what amounts to rumour.

> It's pretty unworkable but I guess Parnate should clear out of my system in a month.

MAO takes about a week to return to normal; the conservative washout period is 2 weeks. I hope you don't get any withdrawal symptoms; they can be pretty bad.

best,
-elizabeth

 

Re: MAOI Diet Elizabeth

Posted by may_b on August 12, 2001, at 13:19:15

In reply to Re: MAOI Diet may_b, posted by Elizabeth on August 10, 2001, at 15:37:30

Hi Elizabeth

> If you can get your medical records from this incident, it might be worthwhile to see what your measured BP was.

Saw the Doc and debriefed re HC -- we are requesting data from ER to evaluate. She, like you, Elizabeth, thought there MUST be something else going on.

> They wouldn't want to do something that could cause much more serious complications ("do no harm" and all) if your BP isn't (in their judgment) really dangerously high.

You and my Doc see eye to eye on this. :-)

> The food lists are silly. I used evidence-based dietary rescrictions, rather than basing my food selections on what amounts to rumour.

You had a modified list, which you posted once. Would you mind posting it again? Do you think you are one of the folks who is less affected by diet? I read individuals vary on their tolerance to tyramine, just like everything else, I guess.


> MAO takes about a week to return to normal; the conservative washout period is 2 weeks. I hope you don't get any withdrawal symptoms; they can be pretty bad.

Thanks. I had a recurrent headache at mid afternoon and roughly twelve hours after, waking about 2 or 3 each night feeling headache-y and weird. Nothing like as horrendous as Paxil withdrawal. Worst thing ever.

Cheers, thanks for yours,

may_b

 

Re: MAOI Diet may_b

Posted by Elizabeth on August 15, 2001, at 18:19:11

In reply to Re: MAOI Diet Elizabeth, posted by may_b on August 12, 2001, at 13:19:15

> Hi Elizabeth

Hi :)

> You and my Doc see eye to eye on this. :-)

Jeez, I'm already thinking like one of them. < g >

> You had a modified list, which you posted once. Would you mind posting it again?

Let me see if I can dig it up. I've been quite tired lately (accumulated sleep deprivation, maybe?), which is why I haven't been posting.

> Do you think you are one of the folks who is less affected by diet? I read individuals vary on their tolerance to tyramine, just like everything else, I guess.

Oh, no; I had some pretty bad reactions, including a pulmonary hemorrhage once. When I started using the modified diet (the "short list"), things got a lot better, although I never was able to take stimulants with MAOIs.

> Thanks. I had a recurrent headache at mid afternoon and roughly twelve hours after, waking about 2 or 3 each night feeling headache-y and weird. Nothing like as horrendous as Paxil withdrawal. Worst thing ever.

YMMV, as they say! I'm glad it hasn't been too bad for you.

-elizabeth

 

Re: MAOI Diet

Posted by elanor roosevelt on July 14, 2006, at 21:34:37

In reply to Re: MAOI Diet , posted by may_b on August 10, 2001, at 2:24:14

Can we get back to the topic of MAOI diet restrictions?
i don'u understand the meat tenderizer thing
something in it or the breakdown of the meat?
is it alright to use lime to marinate?

 

Re: MAOI Diet

Posted by Ms_Princess on July 24, 2006, at 22:06:27

In reply to Re: MAOI Diet, posted by elanor roosevelt on July 14, 2006, at 21:34:37

Hello,
My dad was recently put on selegiline. They have told him what he cannot eat. But my mother and I are more interested in sample items he can eat.
IF u have any suggestions or resources I would love it if you would pass them on.

Ms_Princess

 

Re: MAOI Diet Ms_Princess

Posted by SFY on July 25, 2006, at 14:42:00

In reply to Re: MAOI Diet, posted by Ms_Princess on July 24, 2006, at 22:06:27

> Hello,
> My dad was recently put on selegiline. They have told him what he cannot eat. But my mother and I are more interested in sample items he can eat.
> IF u have any suggestions or resources I would love it if you would pass them on.
>
> Ms_Princess

The list of things that CAN be eaten is a lot longer than the list of things that CAN'T be eaten while on a MAOI. It's difficult to know where to start. Your best bet is to come up with a list of foods that your dad would like and check then against the restricted list.

What dosage of selegiline is your dad taking? At the typical dose (about 5 to 10 mg. per day) there are no dietary restrictions?

 

Re: MAOI Diet

Posted by Ms_Princess on July 26, 2006, at 19:34:15

In reply to Re: MAOI Diet Ms_Princess, posted by SFY on July 25, 2006, at 14:42:00

> > Hello,
> > My dad was recently put on selegiline. They have told him what he cannot eat. But my mother and I are more interested in sample items he can eat.
> > IF u have any suggestions or resources I would love it if you would pass them on.
> >
> > Ms_Princess
>
> The list of things that CAN be eaten is a lot longer than the list of things that CAN'T be eaten while on a MAOI. It's difficult to know where to start. Your best bet is to come up with a list of foods that your dad would like and check then against the restricted list.
>
> What dosage of selegiline is your dad taking? At the typical dose (about 5 to 10 mg. per day) there are no dietary restrictions?
>
>

The problem is that alot of the foods that Dad eats are on the no no list....... I am looking for alternatives..... Is there a place I can use as a resource for a diet sample?

He is taking only 10mg per day, but one doctor says there are no restrictions another says that he must adhear to the restrictive diet.
I am most perplexed and just want to help him in any way I can.

 

Re: MAOI Diet

Posted by zadoch on September 13, 2008, at 23:32:09

In reply to Re: MAOI Diet, posted by Ms_Princess on July 26, 2006, at 19:34:15

There's a great article by David G. Folks about reevaluating dietary restrictions of an MAOI diet. You can find it through Google Scholar. However, your library or school would have to have access to the journal in which it is published. I do have a copy.

At any rate, I'm on 90 mg of Parnate, so I was very surprised at all the lower dosages.

 

Re: MAOI Diet zadoch

Posted by Nadezda on September 14, 2008, at 13:13:32

In reply to Re: MAOI Diet, posted by zadoch on September 13, 2008, at 23:32:09

And the gist of it is?

Nadezda

 

Re: MAOI Diet

Posted by zadoch on September 14, 2008, at 13:20:46

In reply to Re: MAOI Diet zadoch, posted by Nadezda on September 14, 2008, at 13:13:32

> And the gist of it is?
>
> Nadezda

You can eat a lot more than one thinks :-)

 

Re: MAOI Diet Addendum

Posted by palomina on September 21, 2013, at 0:06:54

In reply to MAOI Diet Addendum, posted by SalArmy4me on August 4, 2001, at 22:53:48

I have taken Parnate for about 20 years and my one terrible reaction (worst headache ever, went to ER, had to get antidote) was when I had some white wine...the wine was not at fault...but it was aged in oak barrels which, I was told, were the cause. I am new to this site, but wanted to communicate this. I do not know if authors took this into account. Many wines today are aged and stored only in stainless steel vats. I hope this will help.

 

Re: MAOI Diet Addendum palomina

Posted by SLS on September 21, 2013, at 0:12:05

In reply to Re: MAOI Diet Addendum, posted by palomina on September 21, 2013, at 0:06:54

> I have taken Parnate for about 20 years and my one terrible reaction (worst headache ever, went to ER, had to get antidote) was when I had some white wine...the wine was not at fault...but it was aged in oak barrels which, I was told, were the cause. I am new to this site, but wanted to communicate this. I do not know if authors took this into account. Many wines today are aged and stored only in stainless steel vats. I hope this will help.

Thanks for the info.

:-)


- Scott


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