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Avoiding High-tyramine foods

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I have just started taking selegeline my dr gave me your book. Can you tell me about the following foods rather I can have them or not.

Mozzarella cheese


peanut butter

ice tea

cola not diet I use to get my pills down with soda crackers a little 5 times a day

someone said no turkey is that true?

Home made pizza and home made bread. These I make myself so I would know what cheese is on it. Also I make my own sour dough bread

what about sweet pickles

I appreciate all the help. Also where can I find some more recipes

Have a Blessed Day


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Dear Joy,

If you have high blood pressure, then your neurologist could want you to restrict tyramine in your diet while using selegiline. Could you let me know whether that is the case?


It has been determined that no danger exists at the low doses of selegiline usually prescribed for PD, generally 10 mg per day. So, there is no tyramine restriction for those taking up to 10 mg per day of selegiline unless you have high blood pressure,


Please let me know what your doctor has determined, and we can proceed from there.

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Joy, you will be happy to know, I'm sure, that you do not need to avoid tyramine in foods. MAO Type B inhibitors, such as selegiline (Eldepryl) and rasagiline (Azilect) have not been found to cause hypertensive crisis, in the amounts used to treat PD (up to 10 mg per day). If an individual has high blood pressure, the physician may want to use extra caution; but as that is not the case for you, I would print out the following and give it to your doctor. It relates to rasagiline, but selegiline has long been considered safe as well.



FDA Cuts Food and Drug Restrictions for Parkinson's Medication

By Cole Petrochko, Staff Writer, MedPage Today

Published: December 15, 2009



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.





Tyramine challenge to Azilect


Safety and tolerability of tyramine challenge in levodopa-treated Parkinson's disease patients receiving rasagiline


JR Wilkinson, S Reichwein, MB Stern


P02.025; A58


High dietary tyramine is safe for PD patients on 1 mg daily rasagiline, according to this study.


Twenty patients were randomized to receive rasagiline at 1 mg or 2 mg daily, or placebo, for 10 weeks. Patients were free of uncontrolled hypertension, cardiovascular disease, and history of stroke. Mean duration of PD was approximately 5 years, ranging from 0 to 16 years. All patients were taking levodopa.


Patients received 5 tyramine challenges: 75 mg 7 days before commencing rasagiline; 25, 50, and then 75 mg on days 22-24 respectively; and then 75 mg again at the end of the study. Blood pressure monitoring was conducted during the challenges and at home over the course of the study. A significant response to tyramine was defined as systolic BP >180 mm, or a rise >30 mm; diastolic BP >105 mm or a rise >20 mm; or a heart rate >120 bpm or a rise >20 bpm.


No patient receiving 1 mg/day rasagiline experienced a significant response to any tyramine challenge. Two patients receiving 2 mg/day experienced significant responses, neither of whom displayed clinical manifestations:


Patient 1: 25 mg tyramine increased BP from 156/99 to approximately 185/100, which returned to normal without intervention after 15 minutes. In the same patient, 50 mg tyramine induced a larger response which returned to normal after 40 minutes. No further tyramine challenges were performed in this patient.


Patient 2: 75 mg tyramine on day 24 increased BP from 137/89 to 168/85, and on day 75 from 146/81 to 191/108, both times returning to normal without intervention.

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