Selegiline and the CHEESE REACTION

[bassofspades]

I've been taking Selegiline for the past two months and have had halfway decent results with it. Not great but slight improvement all around. I am taking 5mg two times per day. In recent weeks Ive been getting bad headaches, whereas I never got them in the past. After some careful figuring, I figured out that the headaches are caused by a rise in blood pressure due to the drug inhibiting the breakdown of a monoamine called Tyramine. When Tyramine is not removed from someones body, it increases the neurotransmitter Norepinephrine which results in elevated blood pressure. Just sharing this because a hypertensive crisis could be fatal or, worse, cause a debilitating stroke!

Foods high in Tyramine will cause this reaction. I noticed it immediately after eating a turkey sandwich with one slice of Swiss cheese on it. Aged cheese is high in Tyramine. Some other foods to avoid are sauerkraut, salami, soy products, beer, anything smoked or aged, and any fruit, vegetable or meat that is not very fresh. ripening and spoilage increase Tyramine and cooking does not reduce it..

I stopped taking Selegilne a few days ago, but since it has built up in my system, my bp today was still 160. Im going to stop it for 2 weeks, let it settle, and then probably start up again at half the dose. Waiting for my neurologist to call me back to discuss this.

[laglag]

It is Tyramine. I've attached a link that talks a little bit about it. It's also in Red wine.

healthline.com/health/tyram...

[laglag]

Here is something else I found....

Researchers have found that people who have sluggish MAO activity or are taking monoamine oxidase inhibitors (the base of some antidepressants) may not be able to inactivate the influx of tyramine, which could cause the red wine headache. ... They're not only found in wine, but also in cheese, nuts, chocolate and tea.

[AmyLindy in reply to laglag]

Most food contraindications should be listed on the Rx fact sheet; curious, does yours list these and it was a mere oversight? Mine does, from each of the 3 different pharmacies I’ve used in the past -for Selegiline (with which I’ve had good success-> and Wish for you, too)!

[laglag in reply to AmyLindy]

Yes, they are listed on my fact sheet.

Thank you!

[bassofspades in reply to AmyLindy]

I saw them listed but i didn't think 1 slice would hurt. Apparently it would!!

[faridaro in reply to bassofspades]

Luncheon meats are high in tyramine. So the problem actually could be turkey or may be combination of turkey and cheese that overwhelmed your tyramine breaking capacity.

[bassofspades in reply to faridaro]

I read the opposite, that lunch meat is ok except for salami

[faridaro in reply to bassofspades]

It seems that there is variety of lists with tyramine high foods to avoid. Some say that lunch/deli meats are ok and some don't - see links:

verywellmind.com/foods-to-a...

and fdnow.org/wp-content/upload...

It may depend on how fresh or how cured (nitrated or not) those meats are which may differ from case to case. I am sure that salami or any dry aged sausages are the worst offenders, but would be cautious with other processed meats as well.

[laglag in reply to faridaro]

That's it, like everyone keeps reminding each other, everyone is different. I eat sausage, nuts & chocolate quite a bit & they don't bother me, but red wine will give me a slight headache.

[LAJ12345 in reply to laglag]

Also blackcurrant juice has MAOI activity

barkers.co.nz/shop/fruit-sy...

[Despe]

My husband is on 1/2 mg of Azilect. The only contra-indication listed on the RX fact sheet reads "Avoid aged cheese." On the other hand, I do cook fava beans and have a glass of red wine occasionally. Doctor gave us no specific instructions. Best if we call him!

Thanks Bass for bringing it to our attention!

PS. My husband's BP is around 105 to 120, tonight it was 98 over 62.

[amykp]

I'm just curious--why are you on Selegiline and not Azilect? Azilect is a more specifically targeted MAO B inhibitor. You can be much less careful. My doctor was emphatic that with Azilect I would not need to avoid anything, including aged cheese, and I don't. And I am a fermented food lover! :o)

[bassofspades in reply to amykp]

I think because it is cheaper, not 100 % sure. Any mao b inhibitor should be selective unless the dose is too high, from what I read. So my neurological nurse practitioner got her assistant to call me back and she advised me to cut the second dose of the day in half. If that doesn't work I'll look into axilect. I love a hunk of swiss cheee!! And i could sure use a glass of wine.

[ruff1 in reply to bassofspades]

My husband was on Azilect but was weaned off it and us now on Safinamide a selective MAOB , and there is no issue with foods 😀

[amykp]

Found this: forum.parkinson.org/topic/1...

and this: forum.parkinson.org/topic/2...

But then I found a bunch of stuff that still said avoid tyramine, imho because drug companies all have to cover their butts. And I agree all MAO B inhibitors should be OK but I think azilect is just a bit more specific than selegiline perhaps?

But holy heck yes it is pricey. When we are in the deductible insurance phase we get it from canada.

Here's hoping you can have your wine and cheese!

[Foodteacher in reply to amykp]

How do you get it from Canada? What is the process? It is a pricey drug. We are paying 145$ for 1 month but the cash price is 600$ !

[amykp in reply to Foodteacher]

Oh, crazy expensive, but with insurance I think we only pay $25 a month--totally affordable. We have blue cross.

Canada ... there are a million sites. I use PlanetDrugsDirect.com, not that I'm saying it's the best, but they take credit cards and they definitely aren't a scam. You send your prescription by mail, email, or upload it, AFTER you order. It takes a while to get your drug though--this is not Amazon! :o)

You have your choice of real Azilect or generic made in India. I keep getting generic, and I'm just a little suspicious that it is inferior. The pills are smaller and a touch crumbly and...??? But a pharmacist friend said he knew the brand and they were actually OK.

[Foodteacher in reply to amykp]

Thank you very much. I will look into it. We are actually getting the generic azilect. Who knows where it is made! I have heard alot of generic meds are made in China! But who really knows. I will look into PlanetDrugs. I assume they dont take insurance? my hubs is on medicare and has part d drug plan. Thanks again!

[amykp in reply to Foodteacher]

Oh, goodness, HERE I get the generic too. Of course you're right that we don't know where it comes from either. It just seems more solid.

No, as far as I know Canadian pharmacies do not take insurance, though I've heard rumors they might start. So for now it might only be worthwhile during your deductible...does medicare HAVE a deductible?

[Foodteacher in reply to amykp]

Some Medicare prescription plans have a deductible, my husbands doesn’t. But Medicare has a cut off point of $3,700 ( I think) and then u go in the “donut hole”. It is very complex. But say you pay $50 for the prescription and the insurance company pays the rest, say $400, then that goes towards your total and puts u closer to the dreaded donut hole!

[amykp in reply to Foodteacher]

Yeah, OK, I hear all kinds of stuff about that donut hole. Frustrating.

[Foodteacher in reply to amykp]

Yes, it is frustrating!I talk to my pharmacist and she said that many of the drugs are made in countries like turkey, China, and India. If I wanted to know where her medication came from I would probably have to call that company. I checked out the website you told me about in Canada and I was surprised how much cheaper are many of the drugs are.

[chco]

whats is the cheese recaction?after I take selegine I feel like I am in a fog have to take 1/2 a klopin then by lunch next seleg normal to next morning?no beer at all but really constaped b/p is norm,only had p,d 4 a year or so held off on med til 2 monts ago just learing about off periods,

[amykp in reply to chco]

MAO inhibitors (like Selegiline and Azilect) work to keep dopamine from being broken down. They do this by blocking a dopamine-breaking-down enzyme called MonAmine Oxidase. (Hence M-A-O!) That's why they help folks with PD--the dopamine gets to float around longer and has more chance to work.

The problem with them is that the same enzyme also happens to break down tyramine--a product of diet. If you can't break tyramine down it will build up. It's a case where a little is no problem (our bodies even make some naturally!) but a lot causes stuff like high blood pressure.

So, tyramine is found especially in stuff that is fermented, like aged cheese, sauerkraut, beer on tap...everything good!

[chco in reply to amykp]

thxs for your info, this is my fourth day with out drinking my coors lite and I feel better cause I was drinking 3 0r 4 cans and the selegine dont help so I have to give a chance I ck my b/p every day and its good and eat 3 good meals 8 h0urs sleep no problem got dx 1/19 held off on meds cause I hate taking any at all I cycle 1 hr a day along with yard work and house work. I still ride my Harley when I feel 100%just learning about off time but so far just slow small motor skills I feel lucky that this hit me at 63 it seem like somebody always got it worse off so just fight and live the best you can it takes work how you doing?do you drink at all?what stage r u in.

[amykp in reply to chco]

I am very lucky--I've had PD for >4 yrs but my symptoms have remained very mild...unnoticeable...and one-sided. I only take Azilect, nothing else. I hate pills also. But I do take a few supplements.

The one thing I do is eat a crazy diet--keto, no carbs, no sugar. (Which, BTW, includes lots of fermented foods that I love.) I believe it's kept me from progressing. But of course, I can't prove it!

I certainly do agree with the living the best you can!

[chco in reply to amykp]

nice to hear your doing so well stay postive witch sounds like you do! you did not say if you drink? my son told me maybe 1 coors lite and thats it on ahot day mite no hurt on a week end bbq I stick with fish n chiken lots of vegs fruit grape nut n blue berrys you r what u eat lort 25 lbs since jan/went from size 40 to 36 p/d has help me in a lot of ways in life take the good with bad,live with a pit bll that was in the camp fire he was in a shelter 4 a year! he wont leave my side or couch haha keep it up amypy.

[amykp in reply to chco]

Eh...not really. Don't like it much! But I think 1 a day is fine.

Love pittys, love dogs, lost our old mixed up mutt a few years ago :o( Haven't got another. Hubby travels too much for work now and I go along.

[bassofspades in reply to chco]

Vodka gin rum and bourbon are all low or no tyramine. Open bar!!

[chco in reply to bassofspades]

10/4

[amykp in reply to chco]

But...

Selegiline, and especially Azilect, are TARGETED MAO inhibitors.

To simplify: that means they don't block the tyramine-breaking part of the enzyme as much, so your no-cheese diet does not have to be as strict. Some doctors (mine!) say with Azilect you don't have to watch your diet at all.

[bassofspades in reply to amykp]

Which is why I believe that my dose is too high. If the dose is too high it becomes non selective.

[Foodteacher in reply to amykp]

our dr just told us that Azilect is a MAO-B inhibitor so eat what you want. It works differently. I think we will be careful but not completely exclude foods.

[amykp]

Yeah, and I think selegiline is already less selective than azilect.