Posted by Jennifer on June 10, 2000, at 23:49:44
In reply to Re: MAOI Reaction Symptoms -SCOTT, posted by Tina1 on June 9, 2000, at 14:58:36
Just had time to read up on these posts. I agree with Scott about seeking emergency help ASAP with signs of a tyramine rxn. I had 3 reasons for pointing out that the tyramine rxn is often a delayed one. First, if you eat something with high tyramine content and begin to have symptoms 6-12 hours later...don't ignore them. Also, many people rush to the hospital or call their MD with the onset of any HA. Close monitoring of bp should reveal a slow increase. A diastolic bp over 120 &/or systolic of 220 is indicative of the beginning of a HTN crisis...seek medical help. This can be helpful to those that are close to medical care, and can wait to see if any rxn's occur. The third reason is that if you may have the onset of a severe headache, but no bp changes, the ER doc may conclude that you have a migraine. By noting the often delayed rxn to tyramines, you can be informed since many medical professional aren't.
The severe HA in the base of the skull is the classical onset of a rxn, however, if it does not proceed past that point, it only requires monitoring of bp (by a professional, unless you are skilled at this). If you have the increased BP, heart palpitations, chest pains, severe HA that starts at the base of the skull and moves up and over the top of your head, emergency care is essential.
MAOI rxn's can not only occur with food rxn's, but also with med rxn's and overdosage. The symptoms for all 3 are nearly identical.
The most common high tyramine foods are: aged cheese (check the label, many are not aged), aged or pickled meats (ie: salami), yeast extracts, beer (dark is worst, on tap is bad, glass bottles are best as tyramine is absorbed into the glass...domestic beers in glass are lowest - avoid imported beers), red wine is higher than white wine, avocado, sauerkraut.
Drugs can cause bad rxn's too: Meperidine (Demerol), Dextromethorphan (cough med), and epinephrine are 3 of the worst. Whenever in the hospital, I say I'm allergic to Demerol in addition to being on MAO. I also always check when the dentist is going to use novacaine...if it has black lettering it's without epinephrine, red lettering has epinephrine. I actually caught my dentist as the needle was approaching my mouth. This would cause an immediate rxn, and I doubt most dental offices are perfectly compliant with their CPR and emergency management skills.
Hope this made more sense. Jen> Quite a list of questions. Here goes:
> I was taking it for depression/anxiety
> I discontinued it because I felt that I was cured and i think I was a little cockey
> I titrated up to 450mg/day slowly and stayed there with no increases over the two year period
> I take clonazepam 1.5-2mg daily to control anxiety/panic attacks.
> Thanks for being interested, I love this place. You are a very knowledgable person and have found your posts insightful and informative. You're a great asset to this board.
> Love ya
> Tina
>
>
>
>
>
> > > Scott---I was on Manerix 7 years ago and stayed on it for 2.5 years. I never had one single problem and I didn't even know that I was supposed to change my diet. I eat cheese by the brick, pepperoni pizzas, processed lunchmeat etc. Is it possible that I'm just not sensitive to this syndrome? Oh, BTW, I'm taking Manerix again now. Been on it 3 days. Take care--Tina
> >
> >
> >
> > Hi Tina,
> >
> > I'm glad you posted a reply.
> >
> > I did not do a good job of describing Manerix. I should have stated that the risk of experiencing a hypertensive reaction to tyramine is reduced for Manerix (moclobemide). It is also reduced for Eldepryl (selegiline, deprenyl) when it is taken at dosages of 30mg or less. I tried to emphasize the fact that neither of these two drugs are free of the potential to cause it. The potential is not simply theoretical, it is documented. However, the incidence of this happening is infrequent. The term "wide safety margin" has been used.
> >
> > One of the putative advantages of using Manerix is that there is no need to adhere to a special diet. I really don't know on what side of the fence to stand on this issue. When I tried it a few years ago, I remained cautious about my choices of foods. I was not willing to tempt fate by eating a chunk of cheddar or blue cheese and washing it down with a bottle of chiante. I have seen recommendations that when Manerix is taken at dosages of 600mg and higher, the tyramine content of a meal should not exceed 50mg.
> >
> > I think the words you used were well chosen. You are not sensitive to this syndrome.
> >
> > Thanks for helping to create a more balanced view regarding Manerix and the low-tyramine diet. A good Canadian pharmacist would be able to offer some valuable input based upon his experience with it. Just in case, I'll offer the Good Lord a little prayer for you. *** Now you're immune. :-)
> >
> >
> > For what ailment are you taking Manerix?
> >
> > Why did you discontinue Manerix?
> >
> > What dosages do you use?
> >
> > Did you find that you needed raise the dosage a few times when you began taking it the last time?
> >
> > Are you taking any other drugs along with it?
> >
> > Thanks.
> >
> > GOOD LUCK!
> >
> >
> > - Scott
poster:Jennifer
thread:35949
URL: http://www.dr-bob.org/babble/20000610/msgs/36894.html