If you use Azilect, a drug approved in 1996 by the U.S. Food and Drug Administration to treat Parkinson’s disease, you face the potential for fatal side effects related to eating some common foods. Azilect manages Parkinson's symptoms, such as tremors and muscle weakness. However, it also affects the way that the body handles tyramine, a natural component of various foods. Knowing how Azilect works and which food types contain tyramine can help you avoid a dangerous reaction.
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Azilect works by keeping up the level of dopamine, a chemical produced naturally in the brain. High dopamine levels in the brain prevent Parkinson's symptoms. Dopamine levels are lowered by the action of an enzyme called monoamine oxidase (MAO). An enzyme is a protein produced in the body that breaks down substances into smaller units. Azilect blocks, or inhibits, the MAO enzyme from breaking down dopamine in the brain. However, if you eat foods containing tyramine, the tyramine also blocks MAO from breaking down (digesting) tyramine.
Tyramine regulates blood pressure. Because Azilect prevents digestion of tyramine, if you take the medication and eat tyramine-rich foods, your body will have high tyramine levels. This can cause your blood pressure to rise sharply and result in a dangerous medical condition.
Risks and Symptoms
If blood pressure becomes very high due to tyramine levels, you may experience a hypertensive crisis. At this point, the systolic (top number) blood pressure reads about 180 mm of mercury (Hg) or higher and the diastolic (bottom number) at least 120 mm Hg. The following symptoms may be present: headache, nausea, vomiting, sweating, anxiety, shortness of breath, fast heartbeat. Seek immediate medical attention if you experience any of these while taking Azilect.
Foods to Avoid
Eating fresh, untreated food is a good way to avoid tyramine and a potential reaction with Azilect. Stay away from those with additives or processing ingredients. Tyramine levels are highest in aged, dried, smoked, fermented or spoiled products. These include aged cheeses (for example: blue, cheddar, Swiss and Stilton); meats such as salami, mortadella, beef jerky; and smoked or pickled herring. Fruit is fine, unless extremely ripe or moldy. Most vegetables are acceptable, with the exception of sauerkraut and beans with broad pods, such as fava bean.
Do not eat fermented soy products such as miso, tempeh, tofu and soy sauce. The fermentation process produces high tyramine amounts. These products can commonly be found in soup bases, vegetarian dishes and condiments. Also avoid Brewer's yeast tablets and products like meat tenderizer that contain yeast because they also contain high levels of tyramine. Leavened yeast breads, except for sourdough types, have little tyramine and should cause no problem.
Because Azilect as an MAO inhibitor has the potential for interacting with a broad range of foods, condiments and food additives (in addition to those listed in Foods to Avoid), speak with your doctor about the possibility of using another type of drug. If you switch to another medication, make sure to avoid tyramine in your diet for at least two weeks after discontinuing Azilect.