Posted by Crotale on August 8, 2008, at 6:22:55
In reply to Re: MAOI diet confusion » socialphobic, posted by Nadezda on August 6, 2008, at 19:37:03
Hi Nadezda. I agree with a lot of your advice (like listen to your pdoc rather than a pharmacist! I've occasionally known pharmacists who really know what they're talking about but in my experience they're rare). The one thing I disagree with is some of your recommendations re: specific foods.
> There aren't actually that many restrictions on Maois-- although lots of places will give you a list of everything that anyone had a reaction to. Most of the things on those lists are not important.
>
> The main things to look for is aged foods-- for example, soy sauce, aged cheese, red wines of certain kinds and food that has spoiled from being left out in the heat, especially foods mayonnaise based salads.I think most soy sauce, or at least, the typical bottled soy sauce that you get in your average grocery store, is fine in moderation.
Also, red wine is fine (although the party line is in general don't drink with antidepressants). Yes, that includes the infamous Chianti.
> The other category is certain medications like nasal sprays, decongestants, long-acting novocaine and some other anti-depressants (like most tricyclics), and some others.
Actually several of the tricyclics are okay. Desipramine, nortriptyline, amoxapine, and others that are fairly selective for NE reuptake (they do have some antagonist effects at various receptors - desipramine least so - but those aren't relevant to MAOI interactions) are fine. The ones you want to watch out for are amitriptyline, imipramine, doxepin, and others that also block serotonin retuptake.
Novocaine (with or without epinephrine) is fine. If you're worried, ask your dentist to monitor your blood pressure. In general, it's the indirect-acting sympathomimetic drugs, like pseudoephedrine and amphetamine, that you have to watch out for, not direct-acting ones like epinephrine. (although amphetamine can be used, and is, in low doses and with caution).
Also, not all nasal sprays are dangerous. It depends on the active ingredient, and also on whether it is absorbed into the bloodstream or whether it only acts locally.
> I never had a reaction that required me even to consider going to the hospital and I was on a very high dose. Once or twice I had mild serotonin reactions to normally safe ADs that my pdoc was trying out to help me sleep-- and that's only because I'm very sensitive to serotonin.
That's curious. Which ADs, and what sort of reactions did you have? I got full-blown serotonin syndrome on Cymbalta (no MAOI or anything).
I think that the supposed danger of MAOIs has been overstated a great deal. Especially since for a long time, TCAs (which are quite toxic, highly subject to pharmacokinetic interactions, and have such a low therapeutic index) were the only other ADs. Comparatively, MAOIs seem rather mild.
For a much more realistic guide to MAOI-food interactions, check out the Emsam package insert. I think it's pretty accurate, or at least, much closer than the monographs for Nardil, Parnate, etc. which say to avoid everything under the sun!
-Crotale
poster:Crotale
thread:844047
URL: http://www.dr-bob.org/babble/20080805/msgs/844910.html