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    Includes Expert Content
    Dr. G - Black Cohosh
    Anneinside posted:
    Dr. G, I am into menopause now and have hot flashes. My sister take black cohosh for them so I thought I'd try it. My concern is that I am on seligiline - Emsam - patches and I wonder if there could be an interaction with the MAOI. What do you think?
    ddnos responded:
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    bpcookie replied to ddnos's response:
    The world is round and the place which may seem like the end may also be only the beginning. ~Ivy Baker Priest
    Joseph F Goldberg, MD responded:
    Dear Anneinside,

    Sorry for not responding sooner. Somehow I got "locked out" of signing in to this website for the last few days! Magically, the system now seems to have let me back in.

    So, black cohost is a plant exract that is touted to have value for a range of maladies including menopause hot flashes. The scientific community is not so overwhelmed with the evidence to support such claims, but, yes, it is safe to combine with an MAO inhibitor such as Emsam.

    Incidentally, latest inside word on Emsam is that the higher doses (9-12 mg/day) my be more effective than lower doses. There are 2 kinds of monoamine oxidase, A and B, A being the one that's mainly associated with boosting serotonin and norepinephrine as well as dopamine. There is some impression that the higher Emsam doses may more effectively inhibit MAO-A (though the 9-12 mg doses require following a tyramine-free diet, while the 6 mg dose doesn't).

    - Dr. G.
    margaroo replied to Joseph F Goldberg, MD's response:

    I took Black Cohosh when I was having hot flashes, but my hot flashes were not very strong. The Black Cohosh worked well, though.
    Good luck,
    Of all the things I've lost, I miss my mind the most.
    Anneinside replied to Joseph F Goldberg, MD's response:
    Thanks so much for the information. I'll give it a try. I do take 12mg of Emsam and follow the diet. I've been on it since July and really miss soy sauce on my rice.
    Joseph F Goldberg, MD replied to Anneinside's response:
    Dear anneinside,

    2 tablespoons of soy sauce doesn't have much tyramine....more than that does, so you may have a little wiggle room. Also, while the tyramine risks are well-known with traditional MAOIs like Nardil and Parnate, there is frankly less established risk with Emsam and it is conceivable that the higher doses (9-12 mg/day) may not necessarily pose the same tyramine risks as Parnate and Nardil.

    Dr. G.
    Anneinside replied to Joseph F Goldberg, MD's response:
    Thank you so much! I have eaten small amounts of some "forbidden" foods (like small pieces pepperoni I missed when taking it off the pizza) without any problems. I'll try a little bit of soy sauce the next time I have rice.
    Joseph F Goldberg, MD replied to Anneinside's response:
    Dear Anneinside,

    Pepperoni, sausage or other preserved meats are only high in tyramine if they are aged. Packaged products at the grocer, or even fast-food chain pepperoni pizzas, have very little tyramine. It's the more expensive aged meat (and cheese) products from the fancy food stores that are tyramine-loaded. (Processed packaged cheeses like American cheese also have very little tyramne [or cheese!> -- they are mostly hydrogenated oil.)

    - Dr. G.

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