Diet and procarbazine

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1- Avoid foods, which are matured or might be "going off"
Avoid tyramine-containing foods. Generally, the more "convenience" the food, the safer it is e.g. packet soups are generally safe. Although many foods have only small amounts of tyramine, it is possible to have local concentrations, which might give a reaction.


2- Tyramine-containing foods
The dietary information on the RPSGB/BMA card is brief and the following may be of use as general guidelines:

Dairy products:
Hard cheeses, soft cheeses and cheese spreads (e.g. pizzas, pies, etc) must also be avoided and are a known cause of inadvertent ingestion and heath. Cottage cheese and "Dairylea" cream cheese contain only minute amounts of tyramine and large quantities would be needed to produce a reaction.

Game, meat and fish:
Pickled or salted dried herrings and any hung or badly stored game, poultry or other meat, which might be "going off", must be avoided.

Avoid chicken liver pate, liver pate and any other liver, which is not fresh. Fresh chicken liver, fresh beef liver and fresh pate however, should be safe.

Fruit and vegetables:
Brad bean pods (but not the beans) and banana skins (occasionally cooked as part of whole unripe bananas in a stew) must be avoided. Avocado pears have been reported to produce a reaction and should be avoided if possible.

Yeast and meat extracts:
Oxo, Marmite, Bovril and other meat or yeast extracts must be avoided Gravy made with "Bisto" ‘(i.e. Original, Powder, Rich Gravy Granules, Onion Gravy Granules and Gravy Granules for Chicken) is safe (all contain less than 0.0022 mg/g tyramine and a full half pint of gravy would contain less than 0.05 mg tyramine). Gravy made from juices of the roast or fresh meat should also be safe. Bread is safe.

"Twiglets" are sprayed with 10% Marmite and contain about 10mg of tyramine per 50g bag. This could be sufficient to cause a reaction.

3 – Foods known to contain some tyramine where excessive consumption is not advisable, albeit unlikely
-Chocolate (one anecdotal report of headache)
-Soy sauce
-Cottage cheese
-Cream cheese
-Yoghurt (commercial)
-Fruit juices
- Dairylea cheese.

5 – Other foods with isolated reports:
Chicken nuggets (Am J Psych 1988, 145.651), Chypatty, Sea cale, protein dietary supplement (J Clin Psych 1987, 48, 499)

6 – Alcoholic drinks
Patient instructions usually state that all alcoholic and some non-alcoholic drinks must be avoided. There is some evidence that low or non-alcoholic beers contain significant amounts of tyramine (Lancet 1988. l 1167-8), shown by thee reactions to less than 2/3 pint of alcohol-free and "de-alcoholised" beer, 1992, 7, 59, mentioned in Pharm J 1993, 250, 174) The following may, however, be of use where a particular patient wishes to drink:

1. Avoid:    -Chianti
                   -Home made beers and wines
                   -Real ales
                   -Red wines*

2. True moderation (e.g.1 unit): -White wines
                                                     -Non-alcoholic beers and lagers

3. Safest:    -Gin. Vodka
                    -Other clear spirits

*Red wines contain phenolic flavanoids, which inhibit the enzymes, which metabolise catecholamines, including tyramine.

Over the counter medicines
Each patient should be warned about the possibility of interactions with over the counter medicines. The general advice for patients is-

Only buy medicines from a Pharmacy. Do not use supermarkets, drug stores, newsagents etc. For example, "Lemsip" contains phenylpropanolamine and is widely available. Do not take medicines given to you by friends or relatives. Do not take medicines taken before the MAOI was prescribed until advice has been sought.

Take special care over any medicines for coughs, colds, flu, hay fever, asthma and catarrh.



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