NAPLEX Question of the Week: Parkinson's Disease

Parkinson's Disease is a progressive disease with significant morbidity and mortality. Today's question focuses on potential drug-food interactions with pharmacotherapy.

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GS is a 59 year-old female who recently was diagnosed with Parkinson’s disease. After consultation with her neurologist she agrees to begin treatment with oral selegiline in order to preserve carbidopa/levodopa therapy for a later time in her disease. After 3 months she has been titrated to 5mg twice daily. The patient inquires regarding any potential dietary restrictions with this agent long term. Which of the following foods/drinks would not be recommended with selegiline therapy at the current dosage? Select all that apply.

A. Aged cheeses

B. Hard salami

C. Green peas

D. Pickled herring

E. White breads

Answer with rationale:

The correct answers are A, B, and D. Selegiline is a MAO-B inhibitor. Tyramine containing foods are to be avoided with higher doses of selegiline during therapy and for at least 2 weeks after stopping selegiline therapy as concomittant usage of these foods/drinks could result in a hypertensive crisis due to sympathomimetic overload. Specifically for the Emsam patch which can also be used for major depressive disorder, dietary restrictions are only recommended for the 9mg and 12mg/24h doses but not the 6mg/24h dosage.

MAO-inhibitors are also associated with further drug interactions. Those will be the subject of next week's question!

Dr. B

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.