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Dr. Bob is Robert Hsiung, MD,
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Posted by brooke484 on June 7, 2007, at 14:16:15
In reply to I have my first Nardil pill on the palm of my hand, posted by girlnterrupted78 on June 7, 2007, at 1:05:19
Spinach is not listed at all in the booklet. Either are nuts. This was printed in 2006, so maybe this is the updated version.
brooke
Posted by gardenergirl on June 7, 2007, at 14:49:58
In reply to spinach, posted by brooke484 on June 7, 2007, at 14:16:15
Brooke, that booklet sounds great! A lot of what girlinterrupted was asking about sounded like pre-1996 restrictions, i.e. before that large study actually measuring tyramine amounts.
If gi's still reading, I'd recommend getting a BP monitor. I use that whenever I try an "iffy" food for the first time--one of those "use with caution" or other types I've not had yet. I take a small amount, and then measure my BP immediately, and 10-15 minutes later. If no change, I proceed cautiously.
I've never heard of spinach being a problem, especially fresh spinach. I think it's not hard to tell what an overripe avocado is like. It's much much softer and perhaps even starting to smell a bit. I've not had any trouble with nuts, though I don't eat filberts, which I think was one listed specifically? I just don't like them.
About tofu, from what I understand, it's the marinated type that is a no-no. Fresh tofu, prepared as you like though without any other no-no's is fine. I would think soy-based "dairy" products are also fine as long as they are fresh. If there's some kind of soy protein paste type thing that's not quickly perishable, that might be iffy. Sorry, I don't know enough about vegetarian and vegan foods.
Re: autolyzed yeast extract...I think I've posted about this before, so you might look in the archives. Lots of great MAOI diet info there...but I avoided it altogether at first. But since it's everywhere in commercially processed foods, that got old really quick. I learned it was something used to bind flavoring in foods. Reading the ingredients on packages showed that it's often one of the smallest quantity ingredients. For me, the lower it is in the ingredient list, the safer I feel eating the product. In something like Marmite or Vegemite, the amount would be quite high, so those are no-no's. Which is just fine for me. :)
gg
Posted by girlnterrupted78 on June 7, 2007, at 15:48:05
In reply to Re: I have my first Nardil pill on the palm of my hand, posted by brooke484 on June 7, 2007, at 10:29:22
Thanks for the info, Brooke.
Just curious about where you got your booklet?
There's a list of MAOI restricted foods right here at the Dr-bob website. That's where I read that spinach should be used cautiously and all about the other foods I can eat. Could you take a look at it and tell me if it's obsolete?
http://www.dr-bob.org/tips/maoi.html
Could you please tell me where I can get one of those booklets? It would be very useful.
Sorry to ask for so many things, but if you get a chance, would you check this foods for me in your booklet:
Peanut butter
Soy yogurt
I go to a whole-foods store that carries TONS of bars and organic foods and protein shakes, etc. So I definitely need to have not just a list of foods, but a list of INGREDIENTS to check in the nutritional info of everything I want to buy something.Thanks for your help again.
Also, when exactly do you need to run to the emergency room? IF you feel a headache, do you run right away?
I ate 2 soy yogurts today... should I take my first Nardil?
Posted by girlnterrupted78 on June 7, 2007, at 16:09:51
In reply to Re: I have my first Nardil pill on the palm of my hand, posted by brooke484 on June 7, 2007, at 10:29:22
I just read in the "precautions" sheet that was given to me by CVS when I bought my first dose of Nardil.
The precautions say: Avoid strenuous exercise while taking this medication.
I go to the gym 4-5 times a week and I do lots of strenuous cardio and some weightlifting.
I asked my doctor before he even gave me my prescription, whether I could exercise as much as I wanted to. He said yes. But now this information sheet contradicts what he said.
Who should I listen to? Exercise is one of the healthiest things to do, it helps your brain, your body, your heart, and your mood. Its a commitment I made to myself. So I don't know if I could stop it. I also need to keep my weight on check.
Please somebody tell me whether they exercise while on Nardil and how much.
Thanks in advance.
Posted by gardenergirl on June 7, 2007, at 16:32:31
In reply to Re: spinach, posted by gardenergirl on June 7, 2007, at 14:49:58
From: Clinical Psychopharmacology Seminar
Monoamine Oxidase Inhibitors: Adverse Effects
Original Author: Paul Perry, Ph.D, BCPP
Latest Revisers: Paul Perry, Ph.D, BCPP, Brian C. Lund, Pharm.D.
http://www.tu.edu/user_files/10/19.html
TABLE 4: TYRAMINE-CONTAINING FOODS PRECIPITATING HYPERTENSIVE CRISIS
TYRAMINE CONTENT
(mcg/g or ml) (mg/serving)
Cheeses
English Stilton 1157 17
blue 998 15
3-year old white 780 12
extra-old 608 9
old cheddar 498 8
Danish Blue 295-370 4.4-5.5
Mozzarella 158 2.4
Swiss Gruyere 125 1.9
Muenster, CAN. 102 1.5
Old Colored, CAN 77 1.2
Feta 76 1.1
Parmesan, grated 75 1.1
Gorgonzola Ital. 56 0.8
Parmesan, grated
(Kraft) 15 0.2
Cream chs. plain 9 0.1
Cheese Whiz 8 0.1
Brie w/o rind 15 0.2
Sour Cream 1.23 < 0.1
Processed chs slice nil nil
Cream Cheese nil nil
Ricotta nil nilTABLE 5: TYRAMINE-CONTAINING FOODS PRECIPITATING HYPERTENSIVE CRISIS
Tyramine content per serving (mg) serving size (g)
Fish
Pickled herring 2.45 30
Lup fish roe 0.13 30
Slice schmaltz
herring in oil 0.12 30
smoked fish nil nil
Meat
Chicken Liver, fresh 0.20 30
Chicken Liver (day 5) 63.84 30
Salami cacciatore
{inside) 4.58 30
Salami genoa inside 1.16 30
Bologna 0.11 30
Cacciatore sausage mild 4.50 30
Fruit
Raspberries, 4 days in
refrigerator, no mold 0.3 30
Raspberries, frozen 0.63 30
Banana Peel 52 1.4 mg/peel
Avocados, banana pulp,
raisins, figs nil nil
Yeast Extracts
Marmite concentrated
yeast extract 645 6.45/10 g
Brewer's yeast - 191 mcg/400 mg
Miscellaneous
Tofu 0.80 100
Sauerkraut 7.75 250
Soy sauce 14.12 15 mlTABLE 6: TYRAMINE CONTENT OF COMMON FOODS THAT CAN PRECIPITATE HYPERTENSIVE CRISIS WITH MAOIs DUE TO INGESTION OF 25 MG OF TYRAMINE
Food * Median Tyramine Content (mcg/gm or ml) *Amount required for a hypertensive crisis(gm or ml)
Cheddar cheese, old 1530 16 gm (0.5 oz)
Beer 2-11 2280-12480 ml(19-104)
Sherry Wine 3 6944 ml (245 oz)
Chianti Wine 25 904 ml (35 oz)TABLE 7: RELATIVE RESTRICTIONS OF FOODS AND BEVERAGES WITH MAOI USE (GARDNER ET AL 1996)
Restriction Foods
Absolute Aged cheeses, aged and cured meats, banana peel, broad bean pods, improperly stored or spoiled meats, poultry, and fish, Marmite, sauerkraut, soy sauce and other soybean condiments, tap beer
Moderate Red or white wine, bottled or canned beer (including nonalcoholic varieties)
Unnecessary Avocados, bananas, beef/chicken bouillon, chocolate, fresh and mild cheeses (e.g., ricotta, cottage, cream cheese, processed slices), fresh meat, poultry or fish, gravy (fresh), monosodium glutamate, peanuts, properly stored pickled or smoked fish (e.g. herring), raspberries, soy milk, yeast extracts (except Marmite)I use this reference and interpret the relative safety based on the authors' conclusions and the actual amount of tyramine measured. For example, I've had foods with Kraft grated parmesan cheese, because it does not seem to contain as much tyramine as a good block of aged parmesan. Still, I don't use that much of it, because the more I ingest, the more tyramine I ingest, which would increase the likelihood of a reaction.
Following this diet requires some reasoning and judgment. I've found it impossible to eat in the real world and to have absolute yes or no's about my choices. But I can make a very good, educated and reasoned decision. And sometimes still, I get screwed. For example, I didn't know my aunt used the turkey giblets broth in the dressing, and I had a reaction to the dressing one Thanksgiving. I would not have guessed that any ingredient in dressing/stuffing would be on the restricted list, but I also didn't ask her. I never use the giblets, so I didn't think about it. I've found it's more difficult when eating out or eating food someone else has prepared, because you do have to ask about ingredients. Most people in restaurants and private homes have been quite cooperative, in my experience, though. They usually assume it's food allergies, and I don't give a lot of details about why, just what.
good luck
gg
Posted by gardenergirl on June 7, 2007, at 16:39:38
In reply to I also need to avoid strenuous exercise on Nardil?, posted by girlnterrupted78 on June 7, 2007, at 16:09:51
I can't find anything in the prescribing information from Pfizer about exercise precautions. http://www.pfizer.com/pfizer/download/uspi_nardil.pdf
gg
Posted by Quintal on June 7, 2007, at 18:50:29
In reply to I also need to avoid strenuous exercise on Nardil?, posted by girlnterrupted78 on June 7, 2007, at 16:09:51
This is probably a precaution in case you get low blood pressure and pass out during whatever vigorous activity you were doing. You'd probably limit your exercise naturally if you began to feel faint anyway so I wouldn't worry about it. Just listen to your body and if you feel fine there's no need to limit the exercise you take.
One Nardilian here actually eats small amounts of cheese to raise the low blood pressure he developed on Nardil, so it's possible small amounts of tyramine in avocados etc *could* be beneficial in this sense.
Q
Posted by brooke484 on June 7, 2007, at 20:03:58
In reply to Re: Where you got your teva booklet, Brooke? » brooke484, posted by girlnterrupted78 on June 7, 2007, at 15:48:05
I just sent you an email about the booklet.
I did not see any mention of peanut butter or soy yogurt. They list miso soup, fermented soy bean/bean curd, soy sauce and tofu as problems.
brooke
Posted by brooke484 on June 7, 2007, at 20:39:26
In reply to Re: spinach, posted by gardenergirl on June 7, 2007, at 14:49:58
It says, "large amounts have resulted in a reaction." I think you will be ok. You're not going to eat 3 lbs of the stuff.
Posted by Justherself54 on June 7, 2007, at 20:59:13
In reply to Re: spinach, posted by brooke484 on June 7, 2007, at 20:39:26
I'm one week taking Parantge..I didn't know about the spinach thing either..last nite I ate a romaine lettuce/spinach salad and didn't have any type of reaction..
Posted by girlnterrupted78 on June 7, 2007, at 23:32:56
In reply to I have my first Nardil pill on the palm of my hand, posted by girlnterrupted78 on June 7, 2007, at 1:05:19
Are fermented drinks out of the question? I drink something called SYNERGY, which is a handmade Chinese tea that is cultured (fermented) for 30 days. According to it, during this fermentation time, essential nutrients form, like Active Enzymes, Viable Probiotics, Amino Acids, antioxidants, and polyphenols.
Here's its website: http://www.gtskombucha.com/
I have no idea whether those aminoacids are related to dopamine, and I read somewhere that nothing with dopamine should be ingested while on Nardil. I drank one of those just 1 hour ago, and I plan to start Nardil tomorrow morning. Could I have a reaction from it? How many hours should I wait to avoid having a reaction if it happens to be a food to avoid?
I stopped buying anymore soy products (I bought some rice milk instead) and I will stop eating avocados for the time being.
There's another product that I like a lot and consume all the time, it's called Maggi Seasoning:
http://www.nestleusa.com/PubOurBrands/BrandDetails.aspx?lbid=85ADBBF7-66FE-4905-A752-50FAFE569748
I got scared off it because in the ingredients section, it says it's done with YEAST, and I read (here in the Dr-Bob's MAOI restriction list) that yeast is one of the foods to avoid.
There's a bunch of other ingredients in this seasoning sauce that I have NO CLUE whether they can be dangerous: wheat gluten, wheat bran, acetic acid, disodium inosinate, disodium guanylate, dextrose monohydrate, and YEAST.
If I had any of those foods tonight, how many hours should I wait to take my first Nardil pill tomorrow morning?
Thanx in advance for any advice or info
Posted by girlnterrupted78 on June 7, 2007, at 23:46:47
In reply to Re: spinach, posted by gardenergirl on June 7, 2007, at 14:49:58
Thanks a lot for your response, gardenergirl.
By the way, where can I get an BP monitor? Are they expensive? And how would I use it?
So has it worked for you? Could you give me an example of a time where it has stopped from your eating something because it has given you an indication of high blood pressure or something?
Thanks a lot. If there's any additional info you could add to this topic (the BP monitor) I'd really appreciate it because I honestly have no clue about it and I'm so nervous about this new drug that I just haven't dared take the first one!
Thanks again!
Posted by girlnterrupted78 on June 7, 2007, at 23:48:29
In reply to Re: Where you got your teva booklet, Brooke?, posted by brooke484 on June 7, 2007, at 20:03:58
I received your bable-mail, Brooke. Thank you so much, I really appreciate the info!
Posted by Honore on June 8, 2007, at 17:02:37
In reply to Re: spinach » gardenergirl, posted by girlnterrupted78 on June 7, 2007, at 23:46:47
Pharmacies (drug stores) have BP monitors. They cost about $30-60, depending (I think).
They're very easy to use; you just put on the cuff and they either pump up automatically, or you use a little hand pump that's quite simple. There's a digital readout that tells you how high the pressure is, at any point, and records the pressure you need.
They usually also tell you your pulse rate.
Honore
Posted by girlnterrupted78 on June 8, 2007, at 23:15:05
In reply to Re: spinach, posted by Honore on June 8, 2007, at 17:02:37
Thank you for the info.
I'm just not sure how to use it for the Nardil.
I mean, I eat something, and 5 minutes later I check my BP, and then either run to ER or not?
Sorry I know that sounds dumb but I simply have NO CLUE as to how would anyone use those things for an MAOI.
It doesn't seem like something you use for prevention, but once the damage's been done. It won't tell you whether the food is dangerous, it will tell you ONCE the food has been dangerous and at that point is already time to run.
Posted by Jedi on June 9, 2007, at 2:56:45
In reply to Re: spinach » Honore, posted by girlnterrupted78 on June 8, 2007, at 23:15:05
Hi,
Use your BP monitor frequently to get used to it and obtain a baseline of where your BP usually tests. Mine can easily vary by 10 or 20 points within 15 minutes.If you are eating a food that could be a marginal problem, eat a very small amount, then test your BP. Then eat a little more and test again. Sounds tedious, but as I've mentioned in other posts, taking a MAOI requires the person to be somewhat organized and be able to raise their level of responsibility. What the doctor, pharmacist or book says may be wrong for you.
Of course, a splitting headache with a BP reading that is off the charts, should mean a quick trip to the ER. Don't expect them to know anything about this type of hypertensive crisis. It may be the first time they've ever seen it. Take the prescription bottle if possible so they can quickly look up the problem. If they try to make you wait, let them know that this type of tyramine hypertensive reaction can lead to stroke and even death(very,very rare).
Good luck,
JediPS Be very wary of any over the counter cold remedies. Most contain a combination of medications where at least one is contraindicated with a MAOI.
...
> I'm just not sure how to use it for the Nardil.
>
> I mean, I eat something, and 5 minutes later I check my BP, and then either run to ER or not?
>
> Sorry I know that sounds dumb but I simply have NO CLUE as to how would anyone use those things for an MAOI.
>
> It doesn't seem like something you use for prevention, but once the damage's been done. It won't tell you whether the food is dangerous, it will tell you ONCE the food has been dangerous and at that point is already time to run.
...
Posted by stargazer2 on June 9, 2007, at 8:10:17
In reply to BP monitor for prevention of hypertensive crisis, posted by Jedi on June 9, 2007, at 2:56:45
My pdoc has always given me a script for a small number of Nifedipine pills used in the event of a hypertensive crisis which you can verify with your BP monitor. A throbbing headache is usually an early sign of a escalating BP. If you suspect that you are having a BP crisis, you can bite on the pill which releases a liquid under your tongue (the fastest way to get the BP to come down)and then using your monitor you can follow the BP as it should decline. Obviously, if the BP stays high or your symptoms persist, a trip to the ER is warranted. You should taken your medication and tell them what your BP is and that you took Nifedipine at a certain time and give them any BP readings since you took the Nifedepine.
A prudent pdoc will prescibe Nifedepine or a similar medication to anyone taking a MAO as a first line defense with reducing the BP reaction associated with a food or medication reaction. My doctor is adamant about doing this and telling me exactly when and how to use it.I have only had to take Nifedepine once but it makes sense if you are having concerns about the dietary restrictions that you carry a pill with you until you have more confdence in whatyou are eating.
Stargazer
Posted by brooke484 on June 9, 2007, at 8:39:17
In reply to BP monitor for prevention of hypertensive crisis, posted by Jedi on June 9, 2007, at 2:56:45
It's ok to take regular Tylenol or Advil with nardil right?
brooke
Posted by Jedi on June 9, 2007, at 11:29:15
In reply to jedi, posted by brooke484 on June 9, 2007, at 8:39:17
Posted by Honore on June 9, 2007, at 13:02:31
In reply to Re: spinach » Honore, posted by girlnterrupted78 on June 8, 2007, at 23:15:05
Hi, girlinterrupted.
As I think stargazer was saying below-- you;ll know if there's a problem-- your BP will be much higher-- like 160/100, or perhaps higher-- and you'll feel it in your chest and general body-- that there's a heavy, very agitated physical feeling.
My BP is rather low (98/55 mostly) so my Pdoc said he would be concerned if it went over 150/100. It's mostly the first number you have to worry about. Depending on your BP, if it goes up to 160 or 170 or higher, it's time to think about the ER, especially if you have a bad headache and tightness at the back of your head and neck, or become extremely lightheaded and feel like you might pass out.
I had a minor case of serotonin syndrome once from taking cymbalta and trazadone (PS, it's not just MAOIs that can cause serotonin syndrome)-- and you really can tell when something's wrong. It's not like normal headache or lightheadedness from low BP-- it's a much more profound and persistent unpleasant and sick-feeling sensation. My case was not that severe and was time-limited-- but I knew FOR SURE that something was definitely wrong. It really wasn't the sort of thing you aren't that clear on, when it happens.
By the way, I do think the lists of potentially tyramine-high products are overstated. It's good to be vigilant at the beginning-- and check a lot of things. But you'll find that, unless you're unusually sensitive-- most of the prohibitons are things that happened once or twice-- and suddenly got onto a list. Most don't happen again. But they stay on the list.
Once you have a sense of what to avoid-- which things are fermented, which things like wine, certain cheeses, soy sauce, etc, you're just not going to try-- you'll have a regimen that you can rely on without thinking much about it.
The only time I even gave it any thought was when I was buying something new in a health food store-- or recently, when I was taking some homeopathic meds-- which did interact. But I felt the interactions long before they posed any problem.
At the beginning, I took my BP a lot-- after a while, I almost never took it. It's like anything-- you get desensitized-- and it becomes your ordinary, everyday, unconscious way of life.
Honore
Posted by Jedi on June 9, 2007, at 14:26:52
In reply to NIfedipine for BP crisis, posted by stargazer2 on June 9, 2007, at 8:10:17
Hi,
Many MDs will no longer write nifedipine scripts. The sublingual nifedipine can cause your BP to drop too far. The affect also lasts for four to six hours, so when the tyramine reaction is wearing off, your BP can drop to dangerously low levels. If you do take nifedipine, I would suggest starting at 5mg not 10mg. The one time I took the medication, 10mg put me in the hospital overnight on IV fluids. It caused my BP to drop but then it kept dropping long after the tyramine reaction had stopped. Extremely low BP can be fatal.
Be careful,
JediReference:
http://www.tu.edu/user_files/10/19.html
Monoamine Oxidase Inhibitors: Adverse Effects
Original Author: Paul Perry, Ph.D, BCPP
...
The antihypertensive effect lasts 4-6 hours. While the use of sublingual nifedipine in this setting has been reported to be reasonably safe, the general practice of sublingual nifedipine for hypertensive emergencies has been strongly challenged (Grossman et al 1996). The authors of this review/editorial site numerous reported cases of serious, even fatal complications of sublingual nifedipine use. Coupled with the lack of any clinical documentation attesting to a benefit, the authors argue that the use of sublingual nifedipine be abandoned. Therefore, when patients taking an MAOI experience a severe headache, especially when they've recently been non-compliant with their diet, they should report to the emergency room to receive appropriate hypertensive crisis management.
...> My pdoc has always given me a script for a small number of Nifedipine pills used in the event of a hypertensive crisis which you can verify with your BP monitor. A throbbing headache is usually an early sign of a escalating BP. If you suspect that you are having a BP crisis, you can bite on the pill which releases a liquid under your tongue (the fastest way to get the BP to come down)and then using your monitor you can follow the BP as it should decline. Obviously, if the BP stays high or your symptoms persist, a trip to the ER is warranted. You should taken your medication and tell them what your BP is and that you took Nifedipine at a certain time and give them any BP readings since you took the Nifedepine.
>
>
> A prudent pdoc will prescibe Nifedepine or a similar medication to anyone taking a MAO as a first line defense with reducing the BP reaction associated with a food or medication reaction. My doctor is adamant about doing this and telling me exactly when and how to use it.
>
> I have only had to take Nifedepine once but it makes sense if you are having concerns about the dietary restrictions that you carry a pill with you until you have more confdence in whatyou are eating.
>
> Stargazer
Posted by girlnterrupted78 on June 9, 2007, at 22:00:58
In reply to Tylenol or Advil are OK (nm) » brooke484, posted by Jedi on June 9, 2007, at 11:29:15
My doctor told me to get off my Tylenol PM before starting Nardil. So he was wrong?
Posted by Quintal on June 9, 2007, at 22:37:51
In reply to Re: Tylenol or Advil are OK -- Are you sure? » Jedi, posted by girlnterrupted78 on June 9, 2007, at 22:00:58
Tylenol PM contains a sedating antihistamine called diphenhydramine in addition to acetaminophen, and can interact negatively with MAOIs. That's probably why he wanted you off it before starting Nardil. Plain ibuprofen, acetaminophen/paracetamol and aspirin are safe. Be careful of buying OTC products this because many of them contain additives like this that can be harmful. Decongestants are the most dangerous. Some people here have actually taken diphenhydramine with Nardil to treat insomnia and have been fine - it's not absolutely contraindicated, but Nardil can amplify the effects and side effects so you need to use it with caution.
Q
Posted by stargazer2 on June 11, 2007, at 11:47:24
In reply to Re: Nifedipine for BP crisis, posted by Jedi on June 9, 2007, at 14:26:52
That's very interesting since my pdoc prescribes Nifedipine as a precautionary measure for a hypertensive crisis and may not know about the study. I will print that out and give it to him. Does your pdoc precribe anything for a hypertensive crisis other than advising to go to the ER? I would prefer to have something to take to avoid the ER scene altogether, although if necessary I know I would have to go, but together with a vasodilator agent and my trusty BP cuff I would feel safer avoiding the ER, where you can really get messed up like my father being given Haldol while on Sinemet precipitating Neuroleptic Malignant Syndrone, and the ER staff being clueless about this reaction until I pointed it out. Unbelievable, that was at the holier than thou, best (not) in the nation for psychiatric illnesses, Yale New Haven Hospital. I was ready to sue them too although my father was so sick then it wouldn't have mattered and since I noticed the reaction and pointed it out to the medical staff, serious repercussions were avoided.
Haldol can never be given to someone for agitiation that has Parkinson's disease, and Haldol is given to just about everyone in the ER with agitiation. So I am extremely skeptical of ER situations and with a MAO the risk of receiving another medication that can react with it is very high. Most doctors know nothing about MAO interactions so the risk of a reaction is very high, hence my fear of ER's.
stargazer
Posted by girlnterrupted78 on June 11, 2007, at 12:03:14
In reply to Re: Nifedipine/ BP crisis/Jedi/ I'll inform my doc, posted by stargazer2 on June 11, 2007, at 11:47:24
Hey Stargazer,
You seem to be very well informed about the reactions with MAOI (Even more so than the ER themselves) would you mind just letting me know where you got educated on this? Are you a physician or have some kind of background on this? I am on my 4th day of Nardil, so I know I might be risking my life, but if the people at the best ER in the country are idiots, what can I expect from other ERs? Could you please tell us how you got to be more knowledgeable than the ER at Yale Med Hospital?
Thanks a lot
GI
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