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Title: TRANSDERMAL SELEGILINE AND DIETARY TYRAMINE: IS THERE A CONCERN?

Author
item McCabe Sellers, Beverly
item GURLEY, BILL - UNIV ARKANSAS MEDICAL SCI

Submitted to: Journal Of The American Dietetic Association
Publication Type: Abstract Only
Publication Acceptance Date: 6/20/2003
Publication Date: 9/20/2003
Citation: McCabe, B.J., Gurley, B.J. 2003. Transdermal selegiline and dietary tyramine: Is there a concern [abstract]? Journal of the American Dietetic Association. 103(9):(Suppl 1)A25.

Interpretive Summary:

Technical Abstract: The interaction of dietary tyramine and monoamine oxidase inhibitor (MAOI) drugs has been a major barrier to the use of these effective antidepressants. The first clinical trial report of the efficacy and safety of transdermally delivered selegiline to outpatients with major depression was reported recently using a tyramine restricted diet. This method allows for the delivery of a lower dose than the oral form. Low dose selegiline has been used in Parkinson Disease with little or no adverse effects, but higher doses of this selective Type B MAOI produced a pressor response to as little as 10 mg of tyramine. Preliminary studies suggest that as much as 200 mg of dietary tyramine may be required to produce an effect with the transdermal form. The purpose of this study was to examine what foods would carry a likely risk of adverse reaction. A comprehensive literature review yielded analysis of 360 food samples in 17 food categories. Of these, only 40 samples contained sufficient tyramine in single or double servings to produce a pressor effect with most MAOIs. It would take five servings of seven foods to produce a pressor effect with the transdermal selegiline. Aged cheeses, fermented Asian products, and aged/decaying meat and vegetables in large servings would pose a danger. While a clinical trial without dietary tyramine restriction is needed to firmly establish safety, it is likely that only a very few foods would pose a significant risk if foods are bought fresh, cooked fresh, and eaten fresh. Counseling guidelines for food storage are suggested.