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Clayton B Sullivan

Azilect and Parkinson's Diet

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I am so confused, I have read and searched information about taking Azilect and the special diets that you have to be on. Then I call and speak to a person at the Parkinson's Foundation and I was told that because Azilect is a MAOB that I can eat most anything and not worry about all the cautions that I have read on the web about FOODS TO AVOID

Eating fresh, untreated food is a good way to avoid tyramine and a potential reaction with Azilect. Stay away from those with additives or processing ingredients. Tyramine levels are highest in aged, dried, smoked, fermented or spoiled products. These include aged cheeses (for example: blue, cheddar, Swiss and Stilton); meats such as salami, mortadella, beef jerky; and smoked or pickled herring. Fruit is fine, unless extremely ripe or moldy. Most vegetables are acceptable, with the exception of sauerkraut and beans with broad pods, such as fava bean.


Do not eat fermented soy products such as miso, tempeh, tofu and soy sauce. The fermentation process produces high tyramine amounts. These products can commonly be found in soup bases, vegetarian dishes and condiments. Also avoid Brewer's yeast tablets and products like meat tenderizer that contain yeast because they also contain high levels of tyramine. Leavened yeast breads, except for sourdough types, have little tyramine and should cause no problem.


Please Help

my parkinson’s

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When Azilect was about to be released, the FDA insisted that it include the tyramine warning, even though rasagiline, like selegiline, is an MAO type B inhibitor. I anticipated that in time this fact would become clear and the warning would be withdrawn. That did indeed happen, and as feared, it has caused enormous confusion.


But the good news is that the FDA has withdrawn the warning regarding tyramine in foods for those taking up to 1 mg of Azilect daily. Unless you are taking one of the other drugs listed below, you should not need to be concerned about tyramine-containing foods. See:


FDA Cuts Food and Drug Restrictions for Parkinson's Medication

By Cole Petrochko, Staff Writer, MedPage Today

Published: December 15, 2009

Click here to rate this report


WASHINGTON -- The FDA reduced food and medication restrictions in prescribing information for the Parkinson's drug rasagiline (Azilect).


The revision allows patients to use the drug while taking various medications, including over-the-counter cough and cold remedies, and eliminates a dietary restriction on levels of tyramine, an amino acid found in air-dried meats, aged cheeses, and many soy products.


The change was based on a double-blind, placebo-controlled, randomized, dose-ranging clinical study demonstrating the drug's selective monoamine oxidase-B (MAO- B) inhibition. The study used phenelzine, a nonselective MAO inhibitor, as a control.


Nonselective MAO-B inhibitors can cause hypersensitivity to tyramine and result in a serious increase in blood pressure.


The study had 179 healthy patients of both sexes from 40 to 70 years old who received escalating doses of tyramine, from 25 to 800 mg, under fasting conditions. Participants' tyramine sensitivity factors were then calculated based on blood pressure increase over baseline before the introduction of tyramine.


The mean value for tyramine sensitivity in patients taking rasagiline 1 mg once daily was 2.03, versus 17.3 for those in the phenelzine group and 1.5 in the placebo group.


However, there was a 25% increase in tyramine sensitivity for every 1 mg increase in rasagiline dose.


Rasagiline is indicated as an initial treatment for the signs and symptoms of Parkinson's disease and as part of a combination therapy with levodopa in the disease's later stages.


Patients should not take the drug if they are taking meperidine, tramadol, methadone, propoxyphene, dextromethorphan, St. John's wort, mirtazapine, or cyclobenzaprine.


The drug may cause increased blood pressure if taken with other MAO inhibitors, amphetamines, cold remedies containing decongestant and weight-reducing drugs containing pseudoephedrine, phenylephrine, phenylpropanolamine, or ephedrine.


Adverse effects from the drug as a stand-alone therapy include headache, joint pain, and indigestion. When taken with levodopa, side effects include dyskinesias, accidental injury, nausea, weight loss, constipation, low blood pressure when standing, joint pain, vomiting, dry mouth, rash, and sleepiness.


Rasagiline is produced by Teva Pharmaceutical Industries in Israel.




I hope this is helpful; let me know if you have further concerns.

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