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Azilect and Tyramine and Other Foods to Avoid

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Guest

Dear Kathrynne,

 

The literature says to avoid wine, cheese, and chocolate and also lists many foods that contain tyramine. Is this true for MAO B? I can't imagine doing this diet. Quality of Life seems like it would be harder on this med. It's hard enough juggling Sinemet and protein. Thanks for your thoughts.

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Dear Friend,

Which literature are you looking at? That can make a big difference. In earlier days the guidelines were much more restrictive; thankfully, these have eased considerably. If you do not have a copy of Teva’s booklet “Meal Ideas and Menus: Avoiding High-tyramine Foods Made Easy,” ask your neurologist to obtain one for you. Only foods very high in tyramine are a concern.

 

Furthermore, it’s likely that not everyone using MAOIs is susceptible to tyramine. Here is a study that, while small, is very promising for those using 1 mg rasagiline daily. It’s good to be prudent, especially if you have problems with hypertension; however, I would certainly discuss this with your neurologist

 

-----------------

 

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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Guest

Thank you for your reply. The "avoid cheese, chocolate, and wine" was on a yellow warning label from the pharmacist. The teva official website brochure says to avoid aged meats, cheeses, most soybean products including soy sauce and tofu, beer and red wines. I then looked up low-tyramine diet and it says to limit tomatoes to 1/2 cup per day. Tomatoes have tyramine? I love spaghetti sauce! I am prone to hypertension. I used to take hyzaar, then a diuretic, and then nothing because my blood pressure got too low. I've started taking Effexor and less Sinemet [took Tasmar, and now Azilect instead] and my blood pressure seems to be rising again. I'm anxious that I might have a hypertensive crisis if I'm not careful. Thank you for your thoughts.

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Dear Friend,

As you are prone to hypertension, you may be among those who are susceptible to the combination of MAOIs and tyramine, and I would discuss this with your neurologist. However, I would still ask him/her for a copy of the booklet I mentioned. It gives the approximate amounts of tyramine (when known) in common foods and also the amounts likely to lead to hypertensive crisis. Tomatoes should be fine, also Romano cheese and a glass of red wine. Oh -- and chocolate can be eaten without restriction!

 

Let me know how you are doing.

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