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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Meri-Tuuli on April 30, 2006, at 3:40:55
So I had my first pdoc appointment on the NHS and I survived. In fact, it was altogether a postive experience, something I wasn't expecting!
Anyway I sort of had my eye on moclobemide, and the pdoc asked if there was anything of thinking of trying and er I said moc. He said, "very good choice" and sort of looked impressed. So now I have a box of moc.
So bearing in mind that I have a phobia about poisening myself and I'm quite scared to take any meds anyway...
What exactly is a *large* amount of tyramine containing food?
I asked the pdoc and he was sort of like don't eat a whole jar of marmite. But......
I can quite happily eat 150g of chorizo sausage slices in a day, or say 150g of cheddar. Or say 300g of raspberries. Would this be a large amount???
Any insight? The insert doesn't say anything other than "avoid eating large amounts of tyramine containing foods" which isn't much help!
Thanks!
Posted by capricorn on April 30, 2006, at 7:03:29
In reply to Large amount of tyramine containing foods?? HELP!, posted by Meri-Tuuli on April 30, 2006, at 3:40:55
> So I had my first pdoc appointment on the NHS and I survived. In fact, it was altogether a postive experience, something I wasn't expecting!
>
> Anyway I sort of had my eye on moclobemide, and the pdoc asked if there was anything of thinking of trying and er I said moc. He said, "very good choice" and sort of looked impressed. So now I have a box of moc.
>
> So bearing in mind that I have a phobia about poisening myself and I'm quite scared to take any meds anyway...
>
> What exactly is a *large* amount of tyramine containing food?
>
> I asked the pdoc and he was sort of like don't eat a whole jar of marmite. But......
>
> I can quite happily eat 150g of chorizo sausage slices in a day, or say 150g of cheddar. Or say 300g of raspberries. Would this be a large amount???
>
> Any insight? The insert doesn't say anything other than "avoid eating large amounts of tyramine containing foods" which isn't much help!
>
> Thanks!
http://www.dr-bob.org/tips/maoi.html should help you.
Posted by gardenergirl on April 30, 2006, at 13:19:54
In reply to Large amount of tyramine containing foods?? HELP!, posted by Meri-Tuuli on April 30, 2006, at 3:40:55
For things like aged cheese, including cheddar, even a tiny amount could very well be too much. I avoid aged cheeses altogether. I don't know about chorizo, but if it's not an aged sausage like salami or other hard sausages, it might be okay. Still, if you're going to try something that does contain a measurable amount of tyramine (and again, I don't know about the sausage), you definitely want to start small. I had a reaction from eating about a cup of stuffing at Thanksgiving that had giblet broth in it. I doubt that this portion had a great deal of broth, but turkey livers/giblets apparently are bad news.
And raspberries...I've not had any reaction. I'm not aware of them containing tyramine. But again, start small and see how you feel. If you have a BP cuff that's even better. The first time I tried red wine, I took my BP before, immediately after a sip or two, and again about a half hour later.
Being careful is good. A moderate amount of anxiety about this is probably good, too, as there are dangers. But if anxiety gets to the point where you feel paralyzed about trying the med or have too much worry about eating the wrong thing, then an MAOI might not be the right choice.
Good luck with it. And ask questions. Check the archives. There are tons of food-related questions and answers there. Better to be safe and ask than to have a reaction.
gg
Posted by Phillipa on April 30, 2006, at 13:43:37
In reply to Re: Large amount of tyramine containing foods?? HELP!, posted by gardenergirl on April 30, 2006, at 13:19:54
gg you amaze me you weren't afraid at all? Feeling better today I hope. Love Phillipa
Posted by Meri¬Tuuli on April 30, 2006, at 13:50:24
In reply to Re: Large amount of tyramine containing foods?? HELP!, posted by gardenergirl on April 30, 2006, at 13:19:54
Hello guys, thanks for your posts.
Sorry for the misunderstanding, but I'm going to take moclobemide which doesn't get the hypertensive reaction thing apparently.
But it says on the insert to avoid *large* amounts of tyramine containing foods, and I was wondering how much exactly, large is. My pdoc tried to say that a pot of marmite would be a large amount (and you obviously wouldn't eat this much) but I'm just being extra careful to be honest. I mean, cheese is something I can eat alot of!!
If anyone had any ideas/experiences etc that would be great.
My dose is 75mg twice a day, which is a pretty low dose anyway but er, anyway.
---------------
This is from wiki:Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA, a type of monoamine oxidase inhibitor (MAOI)) and acts on epinephrine (adrenaline), norepinephrine (noradrenaline), serotonin, and dopamine. Unlike standard MAOIs, possible side effects do not include cardiovascular complications (hypertension) with encephalopathy, liver toxicity or hyperthermia.
No special diet is necessary, in contrast to irreversible MAOIs. Nevertheless, the patient should avoid excessive consumption of foods containing tyramine (e.g. cheddar cheese, fava beans, chianti wine) in order to avoid a rise in blood pressure.
Posted by capricorn on April 30, 2006, at 14:26:55
In reply to Moclobemide.......help!, posted by Meri¬Tuuli on April 30, 2006, at 13:50:24
1: Acta Psychiatr Scand Suppl. 1990;360:78-80. Related Articles, Links
Interaction between orally administered tyramine and moclobemide.
Zimmer R, Puech AJ, Philipp F, Korn A.
Pharma Clinical Research, F. Hoffmann-La Roche, Basle, Switzerland.
This article describes a standardized oral tyramine pressor test designed to give information on safety aspects in the real everyday life situation where tyramine is ingested only with food. Results showed that significantly higher doses of tyramine were required to raise standing blood pressure by at least 30 mmHg (TYR 30) when it was taken with food than when subjects fasted. The same test was then conducted in 8 healthy volunteers during treatment with moclobemide 200 mg 3 times daily and tranylcypromine 10 mg 3 times daily. With moclobemide the mean TYR 30 dose was 306 mg, and the ratio of this to baseline was 5.0. With tranylcypromine, however, the mean TYR 30 dose was only 35 mg and the TSF ratio 38.2. The potentiation by tranylcypromine was thus 7.6 times greater than that of moclobemide. When tyramine was given in the food under treatment with MAO inhibitors, the TYR 30 doses were larger than those obtained under fasting conditions, but the TSF ratios were not altered. When the tyramine was given in a protein-rich or a lipid-rich meal, the previously established TYR 30 had significantly less effect on the blood pressure. The lowest TYR 30 dose during moclobemide treatment is at least 150 mg tyramine, an amount contained in about 300 g strong cheese or 100 g of yeast extract. These quantities are unlikely to be consumed in a normal meal. The corresponding TYR 30 dose for tranylcypromine, however, is only 20 mg tyramine, which can easily be contained in a fairly normal portion of strong cheese (40 g).(ABSTRACT TRUNCATED AT 250 WORDS)
Posted by Meri-Tuuli on April 30, 2006, at 15:02:20
In reply to Re: Moclobemide.......help!, posted by capricorn on April 30, 2006, at 14:26:55
Thanks Capricorn! (although I might need a translation)
So basically it is saying that erm,
1) Take moc AFTER a meal (I think I read this in an abstract somewhere else too)
2) Its fine to consume *normal* amounts of food, even tyramine containing ones. Just not alot of it ie 300g of strong cheese or 100g yeast extract. So basically 150mg of tyramine is needed to raise blood pressure by 30mmHg. Which is quite alot of cheese when I think about it. And not that much of an increase in blood pressure even if I were to consume 300g cheese.
Which I guess it says in the insert anyway.
ARGHHH I can't cope with all this!!!!!!
Well anyway I'm going to avoid all cheese altogether, um, yeast extract and er all the other maoi diet stuff. That way I can be sure that at least if I do eat some accidentally then it will be fine, because it will just be a normal amount, like abit of yeast extract in soup in a cafe, or something like that.
Oh man, this is crazy for someone who has a fear of poisening herself anyway.
Well regardless I have a blood pressure cuff and I took it 120/74 which is pretty normal.
And rest assured I'm only on 150mg/day for now anyway.
Well I'm going to start tomorrow regardless of my poisening phobias. I need to put that aside and think about it logically.
Thanks again!
Meri
> 1: Acta Psychiatr Scand Suppl. 1990;360:78-80. Related Articles, Links
>
> Interaction between orally administered tyramine and moclobemide.
>
> Zimmer R, Puech AJ, Philipp F, Korn A.
>
> Pharma Clinical Research, F. Hoffmann-La Roche, Basle, Switzerland.
>
> This article describes a standardized oral tyramine pressor test designed to give information on safety aspects in the real everyday life situation where tyramine is ingested only with food. Results showed that significantly higher doses of tyramine were required to raise standing blood pressure by at least 30 mmHg (TYR 30) when it was taken with food than when subjects fasted. The same test was then conducted in 8 healthy volunteers during treatment with moclobemide 200 mg 3 times daily and tranylcypromine 10 mg 3 times daily. With moclobemide the mean TYR 30 dose was 306 mg, and the ratio of this to baseline was 5.0. With tranylcypromine, however, the mean TYR 30 dose was only 35 mg and the TSF ratio 38.2. The potentiation by tranylcypromine was thus 7.6 times greater than that of moclobemide. When tyramine was given in the food under treatment with MAO inhibitors, the TYR 30 doses were larger than those obtained under fasting conditions, but the TSF ratios were not altered. When the tyramine was given in a protein-rich or a lipid-rich meal, the previously established TYR 30 had significantly less effect on the blood pressure. The lowest TYR 30 dose during moclobemide treatment is at least 150 mg tyramine, an amount contained in about 300 g strong cheese or 100 g of yeast extract. These quantities are unlikely to be consumed in a normal meal. The corresponding TYR 30 dose for tranylcypromine, however, is only 20 mg tyramine, which can easily be contained in a fairly normal portion of strong cheese (40 g).(ABSTRACT TRUNCATED AT 250 WORDS)
>
>
>
>
Posted by gardenergirl on April 30, 2006, at 16:28:35
In reply to Re: Moclobemide.......help!, posted by Meri-Tuuli on April 30, 2006, at 15:02:20
Good luck. I'm sure you'll do fine. :)
gg
Posted by gardenergirl on April 30, 2006, at 16:30:54
In reply to Re: Large amount of tyramine containing foods?? HELP! » gardenergirl, posted by Phillipa on April 30, 2006, at 13:43:37
> gg you amaze me you weren't afraid at all? Feeling better today I hope. Love Phillipa
Hi, I am feeling better now. Thanks for asking. I'm not sure what you're asking about as far as being afraid. If it's about trying red wine, then no, I was not afraid. Cautious, but not afraid. I'd read the studies that showed that there really was not likely to be enough tyramine in red wine to cause a reaction. A good Irish cheddar, though? Yeah, I'd be afraid, and so I still avoid that. :(
gg
This is the end of the thread.
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