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MAOI FAQ - DIETARY & DRUG INTERACTIONS / RESTRICTIONS


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#1 Hippie3

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Posted 02 December 2007 - 12:08 PM

c & p from Mycotopia Web Archive: Ayahuasca-Ideas and tips

Interactions Between MAOIs, SSRIs, and Recreational Drugs
by Erowid


1. Avoid mixing MAOIs and SSRIs.

This can lead to serotonin syndrome and can be dangerous.

2. Do not mix MAOIs with Stimulants (including MDMA).

This can lead to hypertensive crisis and can be deadly.

3. SSRIs in Combination with MDMA

Generally reduces the effects of the MDMA significantly.

4. SSRIs in Combination with Psychedelics

Generally reduce the effects of the psychedelic a bit.

5. MAOIs in Combination with Psychedelics

Generally increase the effects of the psychedelic significantly. Be extremely careful.

SSRIs
Strong SSRIs are significantly more common than MAOIs. Many commonly prescribed pharmaceutical anti-depressants are SSRIs, including Prozac (Fluoxetine), Paxil (Paroxetine), Zoloft (Sertraline), Celexa (Citalopram), and Desyrel (Trazodone).

MAOIs
Strong MAOIs are less common, but include prescription anti-depressants like phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), l-deprenyl (Eldepryl), moclobemide (Aurorex or Manerix), furazolidone, and pargyline. Ayahuasca also contains MAOIs, generally in the form of Banisteriopsis caapi or Syrian rue (harmine and harmaline).

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Foods to Avoid with MAOIs
From: [email protected]<script data-cfhash='f9e31' type="text/javascript">/* */</script> (Stephen R. Saklad)
Subject: Re: MAO-I's dietary restrictions
Date: Mon, 28 Nov 1994 23:05:01 -0600

© 1974-1994 Micromedex Inc. - All rights reserved - Vol. 82 Exp. 12/94



Tyramine is an amino acid which is found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. Monoamine oxidase is found in the gastrointestinal tract and inactivates tyramine; when drugs prevent the catabolism of exogenous tyramine, this amino acid is absorbed and displaces norepinephrine from sympathetic nerve ending and epinephrine from the adrenal glands. If a sufficient amount of pressor amines are released, a patient may experience a severe occipital or temporal headache, diaphoresis, mydriasis, nuchal rigidity, palpitations, and the elevation of both diastolic and systolic blood pressure may ensue (Anon, 1989; Da Prada et al, 1988; Brown & Bryant, 1988).

On rare occasions, cardiac arrhythmias, cardiac failure, and intracerebral hemorrhage have developed in patients receiving MAOI therapy that did not observe dietary restrictions (Brown & Bryant, 1988). Therefore, dietary restrictions are required for patients receiving MAOIs. Extensive dietary restrictions previously published were collected over a decade ago and due to changes in food processing and more reliable analytical methods, new recommendations have been published (Anon, 1989; McCabe, 1986).

The tyramine content of foods varies greatly due to the differences in processing, fermentation, ripening, degradation, or incidental contamination. Many foods contain small amounts of tyramine and the formation of large quantities of tyramine have been reported if products were aged, fermented, or left to spoil. Because the sequela from tyramine and MAOIs is dose-related, reactions can be minimized without total abstinence from tyramine-containing foods.Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction. Foods that normally contain low amounts of tyramine may become a risk if unusually large quantities are consumed or if spoilage has occurred (McCabe, 1986).
Three lists were compiled (foods to avoid, foods that may used in small quantities, and foods with insufficient evidence to restrict) to minimized the strict dietary restrictions that were previously used and improve compliance and safety of MAOI therapy. The foods to avoid list consists of foods with sufficient tyramine (in small or usual serving sizes) that would create a dangerous elevation in blood pressure and therefore should be avoided (McCabe, 1986)

FOODS TO AVOID

# Alcoholic beverages Avoid Chianti wine and vermouth.
# Consumption of red, white, and port wine in quantities less than 120 mL present little risk (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).
# Beer and ale should also be avoided (McCabe, 1986), however other investigators feel major domestic (US) brands of beer is safe in small quantities (½ cup or less than 120 mL) (Anon, 1989; Da Prada, 1988), but imported beer should not be consumed unless a specific brand is known to be safe.
# Whiskey and liqueurs such as Drambuie and Chartreuse have caused reactions.
# Nonalcoholic beverages (alcohol-free beer and wines) may contain tyramine and should be avoided (Anon, 1989; Stockley, 1993).

# Banana peels A single case report implicates a banana as the causative agent, which involved the consumption of whole stewed green banana, including the peel. Ripe banana pulp contains 7 µg/gram of tyramine compared to a peel which contains 65 µg/gram and 700 µg of tyramine and dopamine, respectively (McCabe, 1986).

# Bean curd Fermented bean curd, fermented soya bean, soya bean pastes contain a significant amount of tyramine (Anon, 1989).

# Broad (fava) bean pods These beans contain dopa, not tyramine, which is metabolized to dopamine and may cause a pressor reaction and therefore should not be eaten particularly if overripe (McCabe, 1986; Anon, 1989; Brown & Bryant, 1988).

# Cheese Tyramine content cannot be predicted based on appearance, flavor, or variety and therefore should be avoided.
# Cream cheese and cottage cheese have no detectable level of tyramine (McCabe, 1986; Anon, 1989, Brown & Bryant, 1988).

# Fish Fresh fish (Anon, 1989; McCabe, 1986) and vacuum-packed pickled fish or caviar contain only small amounts of tyramine and are safe if consumed promptly or refrigerated for short periods; longer storage may be dangerous (Anon, 1989).
# Smoked, fermented, pickled (Herring) and otherwise aged fish, meat, or any spoiled food may contain high levels of tyramine and should be avoided (Anon, 1989; Brown & Bryant, 1988).

# Ginseng Some preparations have resulted in a headache, tremulousness, and manic-like symptoms (Anon, 1989).

# Protein extracts Three brands of meat extract contained 95, 206, and 304 µg/gram of tyramine and therefore meat extracts should be avoided (McCabe, 1986).
# Avoid liquid and powdered protein dietary supplements (Anon, 1989).

# Meat nonfresh or liver
# no detectable levels identified in fresh chicken livers
# high tyramine content found in spoiled or unfresh livers (McCabe, 1986).
# Fresh meat is safe, caution suggested in restaurants (Anon, 1989; Da Prada et al, 1988).
# Sausage, bologna, pepperoni and salami contain large amounts of tyramine (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).
# No detectable tyramine levels were identified in country cured ham (McCabe, 1986).

# Sauerkraut Tyramine content has varied from 20 to 95 µg/gram and should be avoided (McCabe, 1986).

# Shrimp paste Contain a large amount of tyramine (Anon, 1989).

# Soups Should be avoided as protein extracts may be present; miso soup is prepared from fermented bean curd and contain tyramine in large amounts and should not be consumed (Anon, 1989).

# Yeast Brewer's or extracts - yeast extracts (Marmite) which are spread on bread or mixed with water,
# Brewer's yeast, or Yeast vitamin supplements should not be consumed.
# Yeast used in baking is safe (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).

The foods to use with caution list categorizes foods that have been reported to cause a hypertensive crisis if foods were consumed in large quantities, stored for prolong periods, or if contamination occurred. Small servings (½ cup, or less than 120 mL) of the following foods are not expected to pose a risk for patients on MAOI therapy (McCabe, 1986).
FOODS TO USE WITH CAUTION
(½ cup or less than 120 mL)

Alcoholic beverages - see under foods to avoid.

Avocados - contain tyramine, particularly overripe (Anon, 1989) but may be used in small amounts if not overripened (McCabe, 1986).

Caffeine - contains a weak pressor agent, large amounts may cause a reaction (Anon, 1989).

Chocolate - is safe to ingest for most patients, unless consumed in large amounts (Anon, 1989; McCabe, 1986).

Dairy products - Cream, sour cream, cottage cheese, cream cheese, yogurt, or milk should pose little risk unless prolonged storage or lack of sanitation standards exists (Anon, 1989; McCabe, 1986). Products should not be used if close to the expiration date (McCabe, 1986).

Nuts - large quantities of peanuts were implicated in a hypertensive reaction and headache. Coconuts and brazil nuts have also been implicated, however no analysis of the tyramine content was performed (McCabe, 1986).

Raspberries - contain tyramine and small amounts are expected to be safe (McCabe, 1986).

Soy sauce - has been reported to contain large amounts of tyramine and reactions have been reported with teriyaki (Anon, 1989), however analysis of soy sauce reveals a tyramine level of 1.76 µg/mL and fermented meat may have contributed to the previously reported reactions (McCabe, 1986).

Spinach, New Zealand prickly or hot weather - large amounts have resulted in a reaction (Anon, 1989; McCabe, 1986).

More than 200 foods contain tyramine in small quantities and have been implicated in reactions with MAOI therapy, however the majority of the previous reactions were due to the consumption of spoiled food. Evidence does not support the restriction of the following foods listed if the food is fresh (McCabe, 1986).
FOODS WITH INSUFFICIENT EVIDENCE FOR RESTRICTION (McCabe, 1986)

* anchovies
* beetroot
* chips with vinegar
* Coca Cola
* cockles
* coffee
* corn, sweet
* cottage cheese
* cream cheese
* cucumbers
* egg, boiled
* figs, canned
* fish, canned
* junket
* mushrooms
* pineapple, fresh
* raisins
* salad dressings
* snails
* tomato juice
* wild game
* worcestershire sauce
* yeast-leavened bread

Any protein food, improperly stored or handled, can form pressor amines through protein breakdown. Chicken and beef liver, liver pate, and game generally contain high amine levels due to frequent mishandling. Game is often allowed to partially decompose as part of its preparation. Ayd (1986) reported that the freshness of the food is a key issue with MAOIs and that as long as foods are purchased from reputable shops and stored properly, the danger of a hypertensive crisis is minimal. Some foods should be avoided, the most dangerous being aged cheeses and yeast products used as food supplements (Gilman et al, 1985).

With appropriate dietary restrictions, the incidence of hypertensive crises has decreased to approximately 4% (Zisook, 1985). Treatment of a hypertensive reactions includes the=7F administration of phentolamine (Anon, 1989) 2.5 to 5 milligrams intravenously (slow) titrated against blood pressure (Zisook,=7F 1985; Lippman & Nash, 1990). One report has suggested that the use of sublingual nifedipine 10 milligrams was effective in treating 2 hypertensive reactions following the ingestion of a tyramine-containing food in a patient receiving MAOI therapy (Clary & Schweizerr, 1987). Chlorpromazine also has alpha-blocking properties and has been recommended as an agent for discretionary use (patient-initiated treatment) in the setting of dietary indiscretion (Lippman & Nash, 1990).
CONCLUSION:
Dietary restrictions are required for individuals receiving monoamine oxidase inhibitor therapy to prevent a hypertensive crisis and other side effects. The foods listed in the dietary restrictions have been categorized into those foods that must be avoided, foods that may be ingested in small quantities, and those foods that were previous implicated in reactions but upon analyses of fresh samples only a small tyramine content was identified and should be safe to consume if freshness is considered.
REFERENCES:

1. Anon: Foods interacting with MAOI inhibitors. Med Lett Drug Ther 1989; 31:11-12.
2. Ayd FJ: Diet and monoamine oxidase inhibitors (MAOIs): an update. Int Drug Ther Newslett 1986; 21:19-20.
3. Brown CS & Bryant SG: Monoamine oxidase inhibitors: safety and efficacy issues. Drug Intell Clin Pharm 1988; 22:232-235.
4. Clary C & Schweizer E: Treatment of MAOI hypertensive crisis with sublingual nifedipine. J Clin Psychiatry 1987; 48:249-250.
5. Da Prada M, Zurcher G, Wuthrich I et al: On tyramine, food, beverages and the reversible MAO inhibitor moclobemide. J Neural Transm 1988; 26(Suppl):31-56.
6. Gilman AG, Goodman LS & Rall TW et al (Ed): Goodman and Gilman's The Pharmacological Basis of Therapeutics, 7th ed., Macmillan Publishing, New York, NY, 1985.
7. Lippman SB & Nash K: Monoamine oxidase inhibitor update. Potential adverse food and drug interactions. Drug Safety 1990; 5:195-204.
8. McCabe BJ: Dietary tyramine and other pressor amines in MAOI regimens: a review. J Am Diet Assoc 1986; 86:1059-1064.
9. Stockley I: Alcohol-free beer not safe for MAOI patients. Pharm J 1993; 250:174.
10. Zisook S: A clinical overview of monoamine oxidase inhibitors. Psychosomatics 1985; 26:240-251.

AUTHOR INFORMATION:
Theodore G Tong, Pharm D/C Hansen
Assistant Clinical Professor of Pharmacy
University of California
San Franscisco, California 94143
10/79
Revised by DRUGDEX Editorial Staff
Denver, Colorado 80204, 09/82
Revised by DRUGDEX Editorial Staff, 09/83; 07/85; 07/86; 09/89; 04/93; 01/94

* Meats and Fish
o Liver of all kinds
o pate
o Pickled herring and other pickled fish
o Game (venison, etc.)
o Caviar
o Snails (escargot)
o Salted fish (lox)
o Pastrami
o Corned beef
o Sausages (salami, etc)
o Boveril

* Fruits and Vegetables
o Pods of broad beans
o English beans
o Chinese pea pods
o Miso and miso soup
o Fava beans
o Overripe fruit (especially bananas and Avocados)
o Raisins and other dried fruits
o Pickles of any type
o Sauerkraut
o Canned Figs

* Dairy Products
o All cheeses (Except for cream, cottage, farmer and ricotta)
o Frozen yogurt (Fresh yogurt is OK up to the expiration date on the container)
o Sour cream

* Beverages
o Red wine
o Beer and ale (including alcohol-free)
o Champagne
o Sherry
o Brandy
o Liqueurs and fruit brandies
o Cognac
o (Truly moderate amounts of white wine, gin or vodka are OK)
o Over four servings of caffeine-containing drinks such as coffee, cola drinks, etc.

* Miscellaneous
o Soy sauce
o Brewers yeast (Bread, cake, cookies etc. are OK as they do not contain brewers yeast)
o Marmite
o Licorice
o Over one ounce of chocolate


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Drugs to Avoid with MAOIs



It's not totally understood how various MAOIs interact with the body. Some are more likely to have negative interactions with foods and drugs than others. To be as safe as possible, avoid the following drugs while you are taking an MAOI antidepressant and for two weeks after stopping it.

* All SSRIs (prozac, zoloft, and several other anti-depressants)
SSRIs block the reuptake of serotonin in the brain. Because MAOIs inhibit the breakdown of serotonin, the combination of MAOIs and SSRIs can lead to dangerously high levels of serotonin in the brain (serotonin syndrome). Symptoms of serotonin syndrome include nausea, vomiting, blackouts, memory loss, increased blood pressure and increased heart rate.
* Demerol
* Cold preparations (tablets, capsules, or liquids such as Comtrex)
* Cough medications containing decongestants, Dextromethorphan (DXM)1, or Demerol
* Sinus medications
* Nose drops or nasal sprays
* Nasal decongestants
* Hay fever medications
* Diet pills
* Amphetamines --- speed
* MDMA --- Ecstasy
* MDE, MDA, and other "MD" compounds
* Cocaine --- crack


MAOIs can and will dramatically increase the effects of some of these drugs to the point of becoming dangerous. Other plants and chemicals are intentionally combined with some reversible MAOIs (plants such as Syrian Rue or Banisteriopsis Caapi, or their primary active chemicals the harmala alkaloids) to intentionally increase the effects of chemicals such as DMT (as is done in many forms of the ayahuasca brew) or sometimes phenethylamines such as Mescaline or 2-CB. All of these "potentiating" combinations can be dangerous if used improperly.


Edited by Sidestreet, 05 September 2016 - 07:33 AM.


#2 mrpanda

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Posted 02 December 2007 - 12:27 PM

Thank you muchly for bringing all that under one roof. :)

#3 LotRev

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Posted 02 December 2007 - 04:11 PM

Hey Hip-
I know you posted that from Erowid, but I had read on the Ayahuasca
dot come site that some of that information is outdated and incorrect...

The first line of the 1994 paper says "Tyramine is an amino acid..."
Tyramine is actually a monoamine (hence why you shouldn't have
much while on an MAO inhibitor)
Tyramine

That is a great archive link by the way!
This info is all coming together for me at just the right time...

#4 mycobri

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Posted 03 December 2007 - 11:55 AM

thanks for the nice organized info

looking forward to my first aya experience soon

#5 Phlux-

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Posted 04 December 2007 - 03:06 AM

mescaline is a hallucinogenic anphetamine right ?
is it safe to dose a maoi with it ?

#6 Hippie3

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Posted 04 December 2007 - 10:15 AM

not really,
mesc does increase heart-rate and blood pressure -
an maoi with mesc could lead to hypertensive crisis, stroke, heart attack
even death.

#7 aumbrellaforainydays

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Posted 04 December 2007 - 01:53 PM

just what i was looking for. my intent is to test the effects of some of the MAOI type foods in combination with typtamine containing species. what is the effect of consuming a diet of serotonin precursor foods on the experimenting of entheogenic substances? My hope is to cultivate, indoors or outdoors, in proximity to each other these foods and drugs.

From the list above; English beans, Chinese pea pods, Miso, soy beans, Fava beans, Avocado, pickled cucumbers and cabbage, plums, grapes, and figs.

growing with Ibogaine, HWBW, Ipomea sp, Yopo, Mucuna, cannabis, opium

also want to try LSD, psilocybin, and A. muscaria in combination with this diet.




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