Psychopharmacology (1992) 106: S 32-S 34
Psychopharmacology © Springer-Verlag 1992
Mini-Paper Tyramine content of preserved and fermented foods or condiments of Far Eastern cuisine M. Da Prada and G. Ziircher Pharmaceutical Research Department (PRPN), F. Hoffmann-La Roche Ltd, CH~002 Basel, Switzerland
Abstract. The tyramine content of foodstuffs typical of the Far East was analysed: the items included fermented food and condiments as well as seven menus from different Far Eastern restaurants. The results o f the present analysis extend to Far Eastern foods our previous conclusion that no severe dietary restrictions are needed in patients treated with moclobemide, a novel R I M A antidepressant. Key words: Far Eastern foods - Tyramine in food Dietary restrictions - Hypertensive crises Cheese effect - Moclobemide
The initial enthusiasm for iproniazid and related irreversible monoamine oxidase (MAO) inhibitor antidepressants declined rapidly, as a consequense of some major toxic events, e.g. hepatic necrosis (Popper 1959). In addition, irreversible MAO inhibitors fell into disrepute largely because of uncritical reports on their dangerous potentiation of the effects of indirectly acting amines (e.g. tyramine contained in foods or beverages), leading rarely to fatal hypertensive crises (Blackwell et al. 1967). Moclobemide, the prototype of a new generation of non-hydrazine, reversible inhibitors of MAO type A (RIMA), is an M A O - A antidepressant that is free of hepatotoxicity (Schl/ippi 1985) and does not require serious dietary restrictions (Da Prada et al. 1988). Extensive preclinical (Da Prada et al. 1989) and clinical investigations (Bieck and Antonin 1988; Korn et al. 1988) have shown that moclobemide produces a much weaker potentiation of the tyramine pressor effect than do the classical irreversible MAO inhibitors. The available clinical results clearly indicate that even after repeated therapeutic doses of moclobemide (e.g. 450 mg daily for 14 days), as much as 100-150 mg tyramine in food is needed to produce a systolic blood pressure rise of 30 m m H g (Bieck and Antonin 1988). Offprint requests to: M. Da Prada
Thus, the risk of triggering a sudden hypertensive crisis seems to increase with the ingestion of fermented foods and/or beverages with a high tyramine content. Detailed, extensive, and up-to-date information on the amount of tyramine contained in European foodstuffs, condiments, beverages, etc. has been published recently (Da Prada et al. 1988). To assess whether Far Eastern foodstuffs, beverages, and condiments have a tyramine content similar to that of European foods, additional studies were performed. Here, we report these analyses of typical Far Eastern foods purchased from specialised food stores, as well as menus served in both large and small-sized restaurants in Zurich.
Materials and methods The content of free (unconjugated) tyramine was measured by a specific and highly sensitive, high-performance liquid chromatography (HPLC) method with fluorometric detection (Da Prada et al. 1988). The analyses were carried out within a few weeks of receipt of the samples. To avoid fermentative processes, all specimens were stored at - 10° C until analysis.
Results Nearly all the items of common Far Eastern foods and beverages examined in the present study contained tyramine (Tables 1 and 2). As expected, relatively high tyramine levels were found in fermented specimens, e.g. soya beans, soya bean paste, or soya bean condiments, as well as in Korean beer. The total tyramine contents of seven menus served in Far Eastern restaurants in Zurich were relatively low, ranging from 1.6 to 20.9 mg tyramine (Table 2).
Discussion In accordance with a recent study carried out with a new analytical method (Sung et al. 1986), our results show
$33 Table 1, Tyramine content of Far Eastern foods, beverages and condiments Food/beverage
Tyramine (mg/kg or mg/1)
32.4 48.0
Seasonings for sauces and cooking
Soya beans, fermented, Singapore Soya sauce, Taiwan Soya sauce, Swiss, Dr. Dunners
713 (50 g)* 878 (10 ml)* 293 (10 ml)* 0.10 0.29
Dried duck, China
Duck dried, breast Duck dried, shank Duck dried, rib
35.3 19.9 2.3 30.6
Sausages Soya bean drinks
, Soya bean drink, Singapore Soya bean drink, Swiss Soya bean drink, dehydrated, China, P.R.
n.d. n.d. 0.23 n.d. 0.09 0.01 0.66 939 (20 g)*
Soya bean soups
Soya bean Soya bean Soya bean Soya bean
fermented, Miso Soup, Japan paste, fermented, Korea soup, prepared, Korea soup, concentrate, Japan
Tyramine (mg/portion)
Beef (dry roasted) Bean curd with pork Bean curd with vegetables Sea cucumbers Fried rice White rice Noodles fried
75 75 75 75 150 150 200
0.099 0.091 0.36 0.34 0.12 0.017 0.58 1.61 mg
Menu 2: Indian~Indonesian mid-size restaurant
Indonesian salad Spring roll Malaysian curry Dry curry (Indian) Beans with coconut sauce Rice, Indian Beer Campari Minerale nature
100 50 75 75 75 200 350 20 250
Total
0.031 0.008 2.88 0.95 0.035 0.086 0.36 0.003 n.d. 4.35 nag
Menu 3: Small Chinese restaurant
Soya bean curd (Tofu)
Tofu, Japan Tofu, dehydrated mix, Japan Tofu, baked, Japan Tofu, fried, Hong Kong Soya bean, condiment, Formosa
Portion (g or ml)
Total
Dried soya bean products
Bean flour, to thicken sauces, etc., Thailand Dried bean curd, China, P.R.
Identity
Menu 1 : Large Chinese restaurant
Preserved foods
Vegetarian curd, cooked, Taiwan Vegetarian curd, cooked, Taiwan
Table 2. Tyramine contained in foods and beverages consumed in Zurich restaurants
1.82 206 (50 g)* 0.22 2.22
* Amount of food consumed in a normal serving; n.d.: under detection limit that soya bean items contain a m o u n t s o f tyramine which could be a m a t t e r for c o n c e r n only in t h e r a p y with irreversible M A O inhibitors o f the old generation (Blackwell et al. 1967). H o w e v e r , based on the tyramine content (Table 1), these fermented items can safely be c o n s u m e d in a n o r m a l serving by patients treated with the new R I M A antidepressant, moclobemide. Similarly, the total tyramine c o n t e n t o f different meals (1.6-20.9 m g tyramine per meal) offered in seven typical F a r Eastern restaurants in Zurich (Table 2) indicates that these meals can be c o n s u m e d safely by patients receiving m o c l o b e m i d e therapy. Unexpectedly, the total a m o u n t o f tyramine in the F a r Eastern menus was even lower than that o f typical E u r o p e a n servings. Several clinical studies have indicated that patients treated with the R I M A antidepressant m o c l o b e m i d e m a y ingest up to 100-150 m g tyramine w i t h o u t c o n c e r n a b o u t d a n g e r o u s hypertensive responses (Bieck and A n t o n i n 1988; K o r n et al. 1988).
Duck roasted Soya bean salad Noodles fried Squid in soya bean sauce Fruit canned from Far East Tea Minerale nature Total
75 100 200 75 0.075 100 350
0.57 0.012 2.12 2.36 n.d. n.d. n.d. 5.06 mg
50 150 50 150 100 50 20 75 355 330
0.179 0.248 0.357 0.432 6.31 0.54 2.03 1.69 0.348 0.347
Menu 4: Very small Thai restaurant
Papaya salad Fried rice/beef Grilled squid Fried noodles Chicken/coconut sauce Fried chicken/ginger Thai sausages (grilled) Chicken/bamboo curry Beer-Thai Singha Beer-Heineken Total
12.48 mg
Menu 5: Large Korean restaurant
Soup (bean curd base) Glass noodles with mushrooms Fried fish Fried seaweed Vegetables zucchini/soya beans Hot vegetable pickles radish preserved Rice plain white Sweet sour beef Korean beer Total
100 100 50 10 50 30
0.439 3.36 0.013 0.005 0.005 0.942
200 100 350
0.030 2.18 13.97 20.94 mg
(Continued on page 34)
$34 Table 2. Continued Identity
Portion (g or ml)
Tyramine (mg/portion)
150 150 100 100 50 200
0.371 0.968 0.521 0.480 0.069 n.d.
the meal so t h a t d i e t a r y t y r a m i n e is a b s o r b e d a n d d e a m i nated by gastrointestinal MAO before enzyme inhibition a t t a i n s its m a x i m u m . T h e p r e s e n t results s t r e n g t h e n the n o t i o n t h a t severe d i e t a r y restrictions are n o t necessary during antidepressant therapy with moclobemide.
Menu 6: Small Chinese restaurant
Soup-chicken Fried rice with shrimps/chicken Sweet sour shrimps Bean sprouts Spring roll Tea Total
Total
References
2.41 mg
Menu 7." Small Chinese restaurant (airport)
Dim Sum Wanton soup Fried fish Chicken fried Scallops Sea food in basket Plain rice Tea
Acknowledgement. The authors thank Dr. V. Chan-Palay (Zurich) for invaluable and competent help in the selection of typical Far Eastern foodstuffs and menus.
100 150 75 100 75 75 100 200
0.302 0.153 0.484 0.754 0.017 0.010 0.013 1.73 mg
Conclusion P a t i e n t s t r e a t e d with m o c l o b e m i d e can safely c o n s u m e both Western and Far Eastern foods or menus, including f e r m e n t e d b e a n curd, f e r m e n t e d s o y a b e a n o r paste, a n d s o y a sauces o r c o n d i m e n t s . T h e clearly d e m o n s t r a t e d , negligible liability o f m o c l o b e m i d e to p o t e n t i a t e t y r a m i n e is f u r t h e r r e d u c e d b y t a k i n g the d r u g at the e n d o f
Bieck PR, Antonin KH (1988) Tyramine potentiation during treatment with MAO inhibitors: brofaromine and moclobemide vs irreversible inhibitors. J Neural Transm [suppl] 28:21-31 Blackwell B, Marley E, Price J, Tylor D (1967) Hypertensive interactions between monoamine oxidase inhibitors and foodstuffs. Br J Psychiatry 113 : 349-365 Da Prada M, Zfircher G, Wiithrich I, Haefely WE (1988) On tyramine, food, beverages, and the reversible MAO inhibitor moclobemide. J Neural Transm [suppl] 26:31 36 Da Prada M, Kettler R, Keller HH, Burkard WP, Haefely WE (1989) Preclinical profile of the novel reversible MAO-A inhibitors moclobemide and brofaromine, in comparison with irreversible MAO inhibitors. J Neural Transm [suppl] 28:5-20 Korn A, Da Prada M, Raffesberg W, Allen S, Gasic S (1988) Tyramine pressor effect in man: studies with moclobemide, a novel, reversible monoamine oxidase inhibitor. J Neural Transm [suppl] 26:57-71 Popper H (1959) Hepatic injury in patients who have received iproniazid. Ann NY Acad Sci 80:928-938 Schl/ippi B (1985) The lack of hepatotoxicity in the rat with the new and reversible MAO-A inhibitor moclobemide in contrast to iproniazid. Arzneimittelforschung 35:800-803 Sung SK, Lee CM, Young JD, Chen CN (1986) High levels of tyramine in some Chinese foodstuffs. Hum Psychopharmacol 1 : 103-107
Psychopharmacology © Springer-Verlag 1992
Mini-Paper Tyramine content of preserved and fermented foods or condiments of Far Eastern cuisine M. Da Prada and G. Ziircher Pharmaceutical Research Department (PRPN), F. Hoffmann-La Roche Ltd, CH~002 Basel, Switzerland
Abstract. The tyramine content of foodstuffs typical of the Far East was analysed: the items included fermented food and condiments as well as seven menus from different Far Eastern restaurants. The results o f the present analysis extend to Far Eastern foods our previous conclusion that no severe dietary restrictions are needed in patients treated with moclobemide, a novel R I M A antidepressant. Key words: Far Eastern foods - Tyramine in food Dietary restrictions - Hypertensive crises Cheese effect - Moclobemide
The initial enthusiasm for iproniazid and related irreversible monoamine oxidase (MAO) inhibitor antidepressants declined rapidly, as a consequense of some major toxic events, e.g. hepatic necrosis (Popper 1959). In addition, irreversible MAO inhibitors fell into disrepute largely because of uncritical reports on their dangerous potentiation of the effects of indirectly acting amines (e.g. tyramine contained in foods or beverages), leading rarely to fatal hypertensive crises (Blackwell et al. 1967). Moclobemide, the prototype of a new generation of non-hydrazine, reversible inhibitors of MAO type A (RIMA), is an M A O - A antidepressant that is free of hepatotoxicity (Schl/ippi 1985) and does not require serious dietary restrictions (Da Prada et al. 1988). Extensive preclinical (Da Prada et al. 1989) and clinical investigations (Bieck and Antonin 1988; Korn et al. 1988) have shown that moclobemide produces a much weaker potentiation of the tyramine pressor effect than do the classical irreversible MAO inhibitors. The available clinical results clearly indicate that even after repeated therapeutic doses of moclobemide (e.g. 450 mg daily for 14 days), as much as 100-150 mg tyramine in food is needed to produce a systolic blood pressure rise of 30 m m H g (Bieck and Antonin 1988). Offprint requests to: M. Da Prada
Thus, the risk of triggering a sudden hypertensive crisis seems to increase with the ingestion of fermented foods and/or beverages with a high tyramine content. Detailed, extensive, and up-to-date information on the amount of tyramine contained in European foodstuffs, condiments, beverages, etc. has been published recently (Da Prada et al. 1988). To assess whether Far Eastern foodstuffs, beverages, and condiments have a tyramine content similar to that of European foods, additional studies were performed. Here, we report these analyses of typical Far Eastern foods purchased from specialised food stores, as well as menus served in both large and small-sized restaurants in Zurich.
Materials and methods The content of free (unconjugated) tyramine was measured by a specific and highly sensitive, high-performance liquid chromatography (HPLC) method with fluorometric detection (Da Prada et al. 1988). The analyses were carried out within a few weeks of receipt of the samples. To avoid fermentative processes, all specimens were stored at - 10° C until analysis.
Results Nearly all the items of common Far Eastern foods and beverages examined in the present study contained tyramine (Tables 1 and 2). As expected, relatively high tyramine levels were found in fermented specimens, e.g. soya beans, soya bean paste, or soya bean condiments, as well as in Korean beer. The total tyramine contents of seven menus served in Far Eastern restaurants in Zurich were relatively low, ranging from 1.6 to 20.9 mg tyramine (Table 2).
Discussion In accordance with a recent study carried out with a new analytical method (Sung et al. 1986), our results show
$33 Table 1, Tyramine content of Far Eastern foods, beverages and condiments Food/beverage
Tyramine (mg/kg or mg/1)
32.4 48.0
Seasonings for sauces and cooking
Soya beans, fermented, Singapore Soya sauce, Taiwan Soya sauce, Swiss, Dr. Dunners
713 (50 g)* 878 (10 ml)* 293 (10 ml)* 0.10 0.29
Dried duck, China
Duck dried, breast Duck dried, shank Duck dried, rib
35.3 19.9 2.3 30.6
Sausages Soya bean drinks
, Soya bean drink, Singapore Soya bean drink, Swiss Soya bean drink, dehydrated, China, P.R.
n.d. n.d. 0.23 n.d. 0.09 0.01 0.66 939 (20 g)*
Soya bean soups
Soya bean Soya bean Soya bean Soya bean
fermented, Miso Soup, Japan paste, fermented, Korea soup, prepared, Korea soup, concentrate, Japan
Tyramine (mg/portion)
Beef (dry roasted) Bean curd with pork Bean curd with vegetables Sea cucumbers Fried rice White rice Noodles fried
75 75 75 75 150 150 200
0.099 0.091 0.36 0.34 0.12 0.017 0.58 1.61 mg
Menu 2: Indian~Indonesian mid-size restaurant
Indonesian salad Spring roll Malaysian curry Dry curry (Indian) Beans with coconut sauce Rice, Indian Beer Campari Minerale nature
100 50 75 75 75 200 350 20 250
Total
0.031 0.008 2.88 0.95 0.035 0.086 0.36 0.003 n.d. 4.35 nag
Menu 3: Small Chinese restaurant
Soya bean curd (Tofu)
Tofu, Japan Tofu, dehydrated mix, Japan Tofu, baked, Japan Tofu, fried, Hong Kong Soya bean, condiment, Formosa
Portion (g or ml)
Total
Dried soya bean products
Bean flour, to thicken sauces, etc., Thailand Dried bean curd, China, P.R.
Identity
Menu 1 : Large Chinese restaurant
Preserved foods
Vegetarian curd, cooked, Taiwan Vegetarian curd, cooked, Taiwan
Table 2. Tyramine contained in foods and beverages consumed in Zurich restaurants
1.82 206 (50 g)* 0.22 2.22
* Amount of food consumed in a normal serving; n.d.: under detection limit that soya bean items contain a m o u n t s o f tyramine which could be a m a t t e r for c o n c e r n only in t h e r a p y with irreversible M A O inhibitors o f the old generation (Blackwell et al. 1967). H o w e v e r , based on the tyramine content (Table 1), these fermented items can safely be c o n s u m e d in a n o r m a l serving by patients treated with the new R I M A antidepressant, moclobemide. Similarly, the total tyramine c o n t e n t o f different meals (1.6-20.9 m g tyramine per meal) offered in seven typical F a r Eastern restaurants in Zurich (Table 2) indicates that these meals can be c o n s u m e d safely by patients receiving m o c l o b e m i d e therapy. Unexpectedly, the total a m o u n t o f tyramine in the F a r Eastern menus was even lower than that o f typical E u r o p e a n servings. Several clinical studies have indicated that patients treated with the R I M A antidepressant m o c l o b e m i d e m a y ingest up to 100-150 m g tyramine w i t h o u t c o n c e r n a b o u t d a n g e r o u s hypertensive responses (Bieck and A n t o n i n 1988; K o r n et al. 1988).
Duck roasted Soya bean salad Noodles fried Squid in soya bean sauce Fruit canned from Far East Tea Minerale nature Total
75 100 200 75 0.075 100 350
0.57 0.012 2.12 2.36 n.d. n.d. n.d. 5.06 mg
50 150 50 150 100 50 20 75 355 330
0.179 0.248 0.357 0.432 6.31 0.54 2.03 1.69 0.348 0.347
Menu 4: Very small Thai restaurant
Papaya salad Fried rice/beef Grilled squid Fried noodles Chicken/coconut sauce Fried chicken/ginger Thai sausages (grilled) Chicken/bamboo curry Beer-Thai Singha Beer-Heineken Total
12.48 mg
Menu 5: Large Korean restaurant
Soup (bean curd base) Glass noodles with mushrooms Fried fish Fried seaweed Vegetables zucchini/soya beans Hot vegetable pickles radish preserved Rice plain white Sweet sour beef Korean beer Total
100 100 50 10 50 30
0.439 3.36 0.013 0.005 0.005 0.942
200 100 350
0.030 2.18 13.97 20.94 mg
(Continued on page 34)
$34 Table 2. Continued Identity
Portion (g or ml)
Tyramine (mg/portion)
150 150 100 100 50 200
0.371 0.968 0.521 0.480 0.069 n.d.
the meal so t h a t d i e t a r y t y r a m i n e is a b s o r b e d a n d d e a m i nated by gastrointestinal MAO before enzyme inhibition a t t a i n s its m a x i m u m . T h e p r e s e n t results s t r e n g t h e n the n o t i o n t h a t severe d i e t a r y restrictions are n o t necessary during antidepressant therapy with moclobemide.
Menu 6: Small Chinese restaurant
Soup-chicken Fried rice with shrimps/chicken Sweet sour shrimps Bean sprouts Spring roll Tea Total
Total
References
2.41 mg
Menu 7." Small Chinese restaurant (airport)
Dim Sum Wanton soup Fried fish Chicken fried Scallops Sea food in basket Plain rice Tea
Acknowledgement. The authors thank Dr. V. Chan-Palay (Zurich) for invaluable and competent help in the selection of typical Far Eastern foodstuffs and menus.
100 150 75 100 75 75 100 200
0.302 0.153 0.484 0.754 0.017 0.010 0.013 1.73 mg
Conclusion P a t i e n t s t r e a t e d with m o c l o b e m i d e can safely c o n s u m e both Western and Far Eastern foods or menus, including f e r m e n t e d b e a n curd, f e r m e n t e d s o y a b e a n o r paste, a n d s o y a sauces o r c o n d i m e n t s . T h e clearly d e m o n s t r a t e d , negligible liability o f m o c l o b e m i d e to p o t e n t i a t e t y r a m i n e is f u r t h e r r e d u c e d b y t a k i n g the d r u g at the e n d o f
Bieck PR, Antonin KH (1988) Tyramine potentiation during treatment with MAO inhibitors: brofaromine and moclobemide vs irreversible inhibitors. J Neural Transm [suppl] 28:21-31 Blackwell B, Marley E, Price J, Tylor D (1967) Hypertensive interactions between monoamine oxidase inhibitors and foodstuffs. Br J Psychiatry 113 : 349-365 Da Prada M, Zfircher G, Wiithrich I, Haefely WE (1988) On tyramine, food, beverages, and the reversible MAO inhibitor moclobemide. J Neural Transm [suppl] 26:31 36 Da Prada M, Kettler R, Keller HH, Burkard WP, Haefely WE (1989) Preclinical profile of the novel reversible MAO-A inhibitors moclobemide and brofaromine, in comparison with irreversible MAO inhibitors. J Neural Transm [suppl] 28:5-20 Korn A, Da Prada M, Raffesberg W, Allen S, Gasic S (1988) Tyramine pressor effect in man: studies with moclobemide, a novel, reversible monoamine oxidase inhibitor. J Neural Transm [suppl] 26:57-71 Popper H (1959) Hepatic injury in patients who have received iproniazid. Ann NY Acad Sci 80:928-938 Schl/ippi B (1985) The lack of hepatotoxicity in the rat with the new and reversible MAO-A inhibitor moclobemide in contrast to iproniazid. Arzneimittelforschung 35:800-803 Sung SK, Lee CM, Young JD, Chen CN (1986) High levels of tyramine in some Chinese foodstuffs. Hum Psychopharmacol 1 : 103-107
