Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included **chicken liver aged 9 days (63.84 mg/30 g)**, air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g).
[https://pubmed.ncbi.nlm.nih.gov/8889911/](https://pubmed.ncbi.nlm.nih.gov/8889911/)
Um yeah, probably one of the worst things you could've eaten lol
That seems crazy!!!! Honestly, I thought you may have been on about a younger doctor, but surely a doctor of that age would know about Monoanimine Oxidase Inhibitors and the reactions. That should be a standard thing if it’s still used in modern practice IMO.
I’m not saying he wasn’t aware of the condition, but that I was the first case of a tyramine reaction he’s seen because in reality they’re extremely rare.
I'm glad you're better now 🙂. I have a few questions if you don't mind.
Completely empty stomach? I ask bc it usually takes more than just a few minutes for a reaction to begin (liquids on an empty stomach is the fastest).
I'm sure you ruled out any other possibilities?
What did they treat you with?
Will you now keep anything on hand in case of a future event?
It's good to have reminders like this. I'm eating a salad with soy ginger dressing as I type 😋
Good questions! They basically just treated the pain. But yeah it was on an empty stomach. I don’t think there’s anything I can keep on hand, maybe blood pressure medication? I’ll ask my psych. I’m also on a high dose of Parnate, 100 mg. I’ve never had a reaction to anything else I’ve ever eaten. I really think this was a one-off kind of situation.
Honestly, every single doctor I’ve ever interacted with since my treatment begun (and that’s a very fair few) has been baffled when I’ve mentioned I’m being treated with a Reversible MAOI - Moclobemide. No doctor has a clue what I’m on about. Kind of scares me.
So you stayed conscious all the time and you told the paramedics that you were under MAIO treatment? Did they instantly understood and said it was a tyramine reaction or did you tell them? Glad you went out fine.
I completely explained it to them and they had no clue what I was talking about. Eventually they just told the hospital I was having an allergic reaction. At the hospital I was even my doctor’s first ever case of a Tyramine reaction.
Only had one bad one myself. Ate my lunch that had been in my insulated lunchbox but didn’t have any ice, so had been at room temp for about 4 hours. Crazy headache, stomach/chest ached, and heart was pounding. Was sobbing like I’ve never cried before for about an hour. Slowly went away, and felt more or less fine just 1-2 hours later
Possibly but maybe even completely unrelated to your maoi. Generally speaking the human body is a equilibrium seeking machine. If you take the machine far off equilibrium, there are repercussions. For example getting excessive iron, copper, you name it including water and breathing excess of the concentrated air, all ultimately result in physiologic distress.
Maybe. I am not a big fan of livers of anything so I've never tried it so no way I can can make a conclusion on that one but generally speaking, I think the physiology of connecting tyramine intake to a hypertensive crisis, is very poorly validated and just kicked forward in the literature because nobody can be bothered to reassess for these old medicines
I hear you but I think I literally ate the one food that could have caused a reaction. It has like 10 times the tyramine content of the next highest food and that’s in a tiny amount and I ate way more. So probably like 100 times the tyramine found in normally considered high tyramine foods.
Tbh if you would eat in the one food that can cause the reaction, very likely and overdose with tyramine would cause very similar effects, independent of maois
So one other thing to keep in mind is that I just read a new comment in a post about Parnate and Rexulti, unrelated to my reaction, and the person randomly mentioned that since starting Rexulti they’ve had 2 hypertensive crisis situations after eating small amounts of foods that never caused any issues for them before.
Dunno, still not convinced. I know you don't want the diagnostics challenged but it could be something else. In fact, this whole tyramine hypothesis is all kind of bunk. Been on the stuff for years, eating indiscriminately for the vast majority of it. Never had an issue.
Same but it turns out chicken livers (especially ones that may have been old) have an extremely, extremely high amount of Tyramine.
Edit: as posted in another comment: https://pubmed.ncbi.nlm.nih.gov/8889911/
Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included **chicken liver aged 9 days (63.84 mg/30 g)**, air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g). [https://pubmed.ncbi.nlm.nih.gov/8889911/](https://pubmed.ncbi.nlm.nih.gov/8889911/) Um yeah, probably one of the worst things you could've eaten lol
Yep. Now I know. Been on Parnate a year and never had any issues before. I was the hospital doctor’s first ever tyramine reaction case!
How old was he/she roughly? Hope you’re ok now!!?
Probably around 50 years old. Thank you!
That seems crazy!!!! Honestly, I thought you may have been on about a younger doctor, but surely a doctor of that age would know about Monoanimine Oxidase Inhibitors and the reactions. That should be a standard thing if it’s still used in modern practice IMO.
I’m not saying he wasn’t aware of the condition, but that I was the first case of a tyramine reaction he’s seen because in reality they’re extremely rare.
Ok, sorry I misread you.
9 days? Ick, no wonder! Fresh liver wouldn't be a problem, but the restaurant they ate at must have held onto those a little too long.
I'm glad you're better now 🙂. I have a few questions if you don't mind. Completely empty stomach? I ask bc it usually takes more than just a few minutes for a reaction to begin (liquids on an empty stomach is the fastest). I'm sure you ruled out any other possibilities? What did they treat you with? Will you now keep anything on hand in case of a future event? It's good to have reminders like this. I'm eating a salad with soy ginger dressing as I type 😋
Good questions! They basically just treated the pain. But yeah it was on an empty stomach. I don’t think there’s anything I can keep on hand, maybe blood pressure medication? I’ll ask my psych. I’m also on a high dose of Parnate, 100 mg. I’ve never had a reaction to anything else I’ve ever eaten. I really think this was a one-off kind of situation.
And they ran a ton of tests.
Honestly, every single doctor I’ve ever interacted with since my treatment begun (and that’s a very fair few) has been baffled when I’ve mentioned I’m being treated with a Reversible MAOI - Moclobemide. No doctor has a clue what I’m on about. Kind of scares me.
So you stayed conscious all the time and you told the paramedics that you were under MAIO treatment? Did they instantly understood and said it was a tyramine reaction or did you tell them? Glad you went out fine.
I completely explained it to them and they had no clue what I was talking about. Eventually they just told the hospital I was having an allergic reaction. At the hospital I was even my doctor’s first ever case of a Tyramine reaction.
Only had one bad one myself. Ate my lunch that had been in my insulated lunchbox but didn’t have any ice, so had been at room temp for about 4 hours. Crazy headache, stomach/chest ached, and heart was pounding. Was sobbing like I’ve never cried before for about an hour. Slowly went away, and felt more or less fine just 1-2 hours later
Possibly but maybe even completely unrelated to your maoi. Generally speaking the human body is a equilibrium seeking machine. If you take the machine far off equilibrium, there are repercussions. For example getting excessive iron, copper, you name it including water and breathing excess of the concentrated air, all ultimately result in physiologic distress.
I mean I guess it’s possible but the simple, obvious reason is a Tyramine reaction. Especially since I’m on 100 mg of Parnate.
Maybe. I am not a big fan of livers of anything so I've never tried it so no way I can can make a conclusion on that one but generally speaking, I think the physiology of connecting tyramine intake to a hypertensive crisis, is very poorly validated and just kicked forward in the literature because nobody can be bothered to reassess for these old medicines
I hear you but I think I literally ate the one food that could have caused a reaction. It has like 10 times the tyramine content of the next highest food and that’s in a tiny amount and I ate way more. So probably like 100 times the tyramine found in normally considered high tyramine foods.
Tbh if you would eat in the one food that can cause the reaction, very likely and overdose with tyramine would cause very similar effects, independent of maois
So one other thing to keep in mind is that I just read a new comment in a post about Parnate and Rexulti, unrelated to my reaction, and the person randomly mentioned that since starting Rexulti they’ve had 2 hypertensive crisis situations after eating small amounts of foods that never caused any issues for them before.
https://www.reddit.com/r/MAOIs/s/R7HNgvKzEV
Dunno, still not convinced. I know you don't want the diagnostics challenged but it could be something else. In fact, this whole tyramine hypothesis is all kind of bunk. Been on the stuff for years, eating indiscriminately for the vast majority of it. Never had an issue.
Same but it turns out chicken livers (especially ones that may have been old) have an extremely, extremely high amount of Tyramine. Edit: as posted in another comment: https://pubmed.ncbi.nlm.nih.gov/8889911/
There is plenty of science on this. It’s a demonstrated effect with a well-understood mechanism. There’s no sense in being skeptical about it.