NAPLEX Question of the Week: Parkinson's Disease

Drug-food interactions are the topic of this important disease state question of the week.
NAPLEX Question of the Week: Parkinson's Disease

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BJ is a 59 year-old female who recently was diagnosed with Parkinson’s disease. After being seen by 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 4 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 could potentially interact with selegiline therapy at the current dosage? Select all that apply.

A. Gorgonzola cheese

B. Hard salami

C. Green peas

D. Pickled herring

E. Brewer's yeast

Answer with rationale:

The correct answers are A, B, D and E. Selegiline is a MAO-B inhibitor. Tyramine containing foods could interact with higher doses of selegiline during therapy and should ideally be avoided for at least 2 weeks after stopping selegiline therapy. Concomitant usage of these foods could result in a hypertensive crisis due to sympathomimetic overload. Aged cheeses (such as gorgonzola), cured meats (i.e. salami), pickled foods (such as herring), and brewer's yeast all could potentially cause this interaction. 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.

A great list of foods/drinks that potentially cause this interaction can be found here at the Mayo Clinic website:

Congratulations to all students who are finishing rotations and will be graduating soon. Your hard work is about to pay off. 

Dr. B

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