Posted by SLS on June 9, 2000, at 9:52:38
In reply to Re: MAOI Reaction Symptoms, posted by Jennifer on June 9, 2000, at 3:03:18
WHEN SYMPTOMS OF A TYRAMINE REACTION APPEAR, ACT IMMEDIATELY.
Hi Jennifer.
I thought it would be a good idea to post my experiences with MAO inhibitors and the tyramine reaction, also known affectionately as the "cheese-reaction".I have been taking MAO-inhibitors (MAOIs) on-and-off since 1982. I agree with some people that many of the special MAO diets are more restrictive than is necessary. I have never felt that my quality of life had been significantly impacted by adhering to such a diet. I deem it a worthwhile trade for the improvement in the quality of life offered by these drugs. Unfortunately, it seems the "relaxation" in the NUMBER of foods restricted in the diet is being confused with a relaxation in the importance of adhering to it. There has been no relaxation in the recognition of the SEVERITY of the consequences of eating a restricted food.
By the way, the reason I have been taking MAOIs off-and-on is because they have not worked. If they had worked, I would never have discontinued them.
> Your blood pressure rises over several HOURS. You don't need to worry if you have a headache all of the sudden while you're out to dinner that it may be a reaction.
This is 180 degrees opposite to my experience.
While I was taking 60mg of Parnate, I accidently ate one and a half (1 1/2) slices of pepperoni on a pizza. Once I recognized my mistake, I immediately employed the use of profanity. It was ineffective. Within TEN MINUTES, I experienced a painful pounding headache located at the base of my skull. It got worse when I sat down, so I remained standing until it dissipated. I think it took about between 45-60 minutes to disappear. I was at work and gambled that it wouldn't end up being fatal. I was lucky.
Let me just emphasize that the total amount of pepperoni I ingested was 1 1/2 slices that were about one inch in diameter and a few millimeters thick.
The tyramine-induced hypertensitive crisis ("cheese reaction") is a medical emergency for which a treatment decision must be made immediately upon the onset of headache or other symptoms. As you have mentioned, Procardia (nifedipine), a calcium-channel blocker, can be used. However, it is critical that it get into the blood stream as soon as possible. For this reason, it is a good idea to take it via absorption under the tongue (sublingual) or through the cheeks (buccal). I think there may be a sublingual preparation of Procardia, but I'm not sure. The gelatin capsule can be bitten through to release its liquid contents into the mouth. Then it can be spread with the tongue around the inner surface of the cheeks or under the tongue. I guess all of the liquid can be swallowed, but I don't know how effective this would be. I can't comment on the advisability of this method of treating the tyramine reaction, as some doctors insist that one call an ambulance or get to an emergency room as soon as possible.
The most effective treatment for a MAOI-related hypertensive crisis is to have an injection of a drug called Regitine (phentolamine). This is a potent antihypertensive that continues to be used in hospital emergency rooms and in certain surgical situations.
It would seem to be common sense to intervene as soon as possible once the tyramine-reaction is recognized by using an antidote like Procardia, but I don't know if having Procardia in the system would create a situation where Regitine could not be used. An oral preparation of phentolamine called Vasomax is available. Perhaps this would make an ideal substitute for Procardia for one to carry with them in case of an emergency.
* Does anyone know anything about using Vasomax for treating a MAOI tyramine reaction?
WHEN SYMPTOMS OF A TYRAMINE REACTION APPEAR, ACT IMMEDIATELY.
-----------------------------------------------------------
1. Monoamine Oxidase Inhibitors - MAO inhibitors - MAOIs:Parnate (tranylcypromine
Nardil (phenelzine)
Marplan (isocarboxezid)
Eldepryl (selegiline, deprenyl)
Manerix, Aurorix (moclobemide)
Eutonyl (pargyline)* regardless of selectivity or reversibility, all of these drugs have been associated with hypertensive crisis.
2. Symptoms of tyramine reaction:- high blood pressure
- occipital headache which may radiate frontally
- palpitations
- neck stiffness or soreness
- nausea or vomiting
- sweating (sometimes with fever or cold, clammy skin)
- dilated pupils
- photophobia-sensitivity to light
- tachycardia or bradycardia (fast or slow heart-beat)
- constricting chest pain
- intracranial bleeding-stroke (sometimes fatal)
3. MAOI Diet:http://www.dr-bob.org/tips/maoi.html
- Scott
poster:SLS
thread:35949
URL: http://www.dr-bob.org/babble/20000603/msgs/36698.html