Talk:List of foods containing tyramine

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[edit] Amounts?

Anyone going to fill in these boxes? If not, we should take them off and just make it a list until someone finds the data... --Anaraug 10:04, 3 May 2006 (UTC)

I absolutely agree. This list is dangerously wrong. And I'm not sure it is right to even have one.

First off, the problem with MAOIs is rarely a food interaction. The number of recorded instances in decades is such that we can consider them to have an *excellent* track record, safetywise. And they lack the long-term effects on neuronal density, clotting, bone density, etc. seen elsewhere.

Such food interactions are simply treated. I have myself used 50mg QID (ergo 200mg/day, the maximum dosage) of tranylcypromine for an extended period of time, both as monotherapy, and in polytherapy.

Because of some freak circumstances, that were not food-related, I experienced three hypertensive crises in the span of two weeks. Nifedipine capsules resolved the issue every time; it's no big deal for the doctor to prescribe a minimum-size box of these, and using them isn't rocket science.

I've researched this topic extensively.

This one-sided focus on dietary restrictions has a triply negative effect:

  • Low complience due to overly restrictive diets with little understanding of the chances taken.
  • Doctor avoidance due to perceived danger in excess of actual danger.
  • Distracts from the real problems of drug-drug interactions, both pharmacodynamic and pharmacokinetic.

To illustrate the point about inadequate warnings, a single tablespoon of Marmite delivers 500mg of tyramine, which will raise the diastolic blood pressure of a non-medicated person by 30mmHg on average. The amount of tyramine required to achieve this effect in a patient treated with tranylcypromine is on the order of 5-15mg on average.

To illustrate the point about excessive warnings:

  • This page prohibits several foods/drinks that are perfectly safe, such as bottled beers and processed cheeses. The tyramine content of regular beer is negligible; however, improper hygiene and maintenance of the equipment may cause tap beer to gain a significant content.
  • Bananas, whether fresh, ripe or even spoiled do not contain relevant levels of tyramine. The peels do, however, regardless of the condition of the banana. The pulp contains some L-5-HTP, however.
  • Chocolate does not contain tyramine. It contains phenylethylamine and theobromine. The latter in generally insignificant quantities. The former in quantities that dictate caution to prevent the potential for psychosis. Essentially, regular servings are quite okay. A chocolate tasting party in Switzerland may not be okay.

As you can see, hard-and-fast rules end up generalized to the point that "the safest thing for you is to go back to depression; then, you'll kill yourself, rather than risk being killed by the food".

Note also that the tyramine sensitivity depends a lot on the MAO-inhibitor in use; tranylcypromine is generally the one with highest risk of a hypertensive crises. Realize that there is also on the order of a 10:1 difference in sensitivity between the most sensitive and least sensitive patients.

Such lists as these don't get across the point that it's okay for you to have a bit of aged cheese, but eating a single tablespoon of marmite has a mortality rate of 60% with intensive care.

I've ranted too much already. Maybe one of these days I'll register and start cleaning up these articles for real, but wikipedia is not a place to put much information, nor is neuropharmacology a field given to an alignment of consensus and truth. Verifiability, as practiced on wikipedia, is a dangerous policy to pursue in relation to drugs. -- 212.169.96.218 01:25, 7 August 2006 (UTC)

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