Posted by King Vultan on September 9, 2004, at 9:02:27
In reply to Re: Seriously considering MAOI's....please read, posted by steve12 on September 8, 2004, at 20:15:38
> MAOI's get a bad rap in the US. They are great for anxiety and have few side effects (like sexual side effects), but have one big drawback: if you eat certain foods, you can have a hypertensive crisis (but you can have emergency meds to counteract it). The foods include red wine, cheese, and fish. Recent research suggests that the food restrictions need not be as severe as once thought. Unfortuantely, it is unlikely that a "safe" MAOI will be made due to the unique mechanism in which they act (for a good oveview, see Julian, A Primer of Psychoactive Drugs). The real problem with MAOI's is finding a doc to prescribe them as they have a notorious reputation for the reasons listed above and they are ***generic*** and the drug companies don't fly the doc's out to Palm Springs for "educational conferences" ;)
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Red wine is now thought to be okay with MAOIs, at least in moderation. The prohibition came about because of a very high level of tyramine (the problematic substance) found in a sample of Chianti wine in 1964. More recent studies have failed to reproduce these results; although, it is important to note that both wine and beer do contain some amount of tyramine. The modern recommendation is no more than 2 bottled beers or glasses of wine per day; however, tap beer is absolutely prohibited due to very high tyramine levels detected in more than one instance. There is also at least one case report of a Nardil patient suffering a hypertensive episode after drinking tap beer.Fresh fish is okay for MAOI users, and even though pickled herring is on many of the lists, two different studies from the 80's found very low levels of tyramine in pickled herring. Many cheeses are actually okay; the bad ones are the highly aged cheeses like cheddar and blue cheese. I take Parnate and personally avoid all cheeses except American, mozzarella, and parmesan, but there are other cheeses I could consume if I really wanted to. It is important for MAOI patients to avoid any food that is old or of questionable freshness--liver would be a good example. The reason it appears on some of the lists appears to be due to some case reports from the 60's involving MAOI patients suffering hypertensive crises from liver that had been improperly stored. It is also a good idea to avoid foods like yogurt that are close to the expiration date.
As for the generic issue, neither Nardil nor Parnate are actually generic, at least in the US, as the volume of their sales is so small that the generic companies don't appear to have much of a interest. Nardil comes from the Parke-Davis division of Pfizer, and Parnate is made by GlaxoSmithKlineBeecham. Hence, Glaxo is able to charge a pretty good buck for Parnate at over $100/month for 4 x 10 mg/day.
Todd
poster:King Vultan
thread:388325
URL: http://www.dr-bob.org/babble/20040909/msgs/388614.html