Selegiline 5mg

Selegiline, Eldepryl/Emsam/Zelapar (US)
Description: Anti-Parkinson Agent, MAO Type B Inhibitor; Antidepressant, Monoamine Oxidase Inhibitor

“ALERT: US Boxed Warning

Suicidal thoughts and behaviors (transdermal patch):
Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors.

Selegiline transdermal patch is contraindicated in patients less than 12 years of age because of an increased risk of hypertensive crisis.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Selegiline, Eldepryl/Emsam/Zelapar is a potent, irreversible inhibitor of monoamine oxidase (MAO) with a greater affinity for type B receptors in the central nervous system, which plays a major role in the catabolism of dopamine and other neurotransmitters. At lower doses, selegiline can serve as a selective inhibitor of MAO-B, but as selegiline concentrations increase, MAO-B selectivity is lost. Inhibition of dopamine depletion in the striatal region of the brain reduces the symptomatic motor deficits of Parkinson’s disease. Effects may also be mediated through its metabolites, including amphetamine and methamphetamine, which interfere with neuronal uptake and enhance release of several neurotransmitters.  When administered transdermally, selegiline achieves higher blood levels with significantly lower exposure for all metabolites when compared with oral dosing.

Parkinson disease; Major depressive disorder

Before starting Selegiline, Eldepryl/Emsam/Zelapar make sure your physician is aware of any allergies or medications you currently take, if you have hepatic impairment, renal impairment, bipolar disorder, a psychotic disorder, pheochromocytoma, severe dementia, an active peptic ulcer, an extrapyramidal disorder, are pregnant, or breastfeeding. Selegiline, Eldepryl/Emsam/Zelapar use has been associated with rare but serious adverse events such as suicidal ideation, blood pressure effects, CNS depression, dyskinesia, impulse control disorders, melanoma, psychosis, and serotonin syndrome.

Depression: Transdermal: 6-12 mg/24 hours once daily

Parkinson disease: Capsule, tablet: 5 mg twice daily with breakfast and lunch with concomitant carbidopa/levodopa therapy; Orally disintegrating tablet: Initial: 1.25-2.5 mg once daily with concomitant carbidopa/levodopa therapy

How to Take: Remove orally disintegrating tablet from pouch immediately before administering. Administer in morning before breakfast; do not swallow; place on top of tongue and allow to dissolve. Avoid food or liquid 5 minutes before and after administration.  Apply transdermal patch to clean, dry, intact skin to the upper torso (below the neck and above the waist), upper thigh, or outer surface of the upper arm.  Apply at the same time each day and rotate application sites. Wash hands with soap and water after handling.  Discard any used or unused patches by folding adhesive ends together and discard properly in trash.

You Need to Avoid:  Significant drug interactions exist, requiring dose/frequency adjustment or avoidance so avoid starting any new medications without consulting prescriber.  Alcohol may increase toxic effects of MAO inhibitor and should be avoided.  Concurrent ingestion of foods rich in tyramine, dopamine, tyrosine, phenylalanine, tryptophan, or caffeine may cause sudden and severe high blood pressure (hypertensive crisis or serotonin syndrome).
Management: Avoid foods containing high amounts (>150 mg) of tyramine (aged or matured cheese, air-dried or cured meats including sausages and salamis; fava or broad bean pods, tap/draft beers, Marmite concentrate, sauerkraut, soy sauce, and other soybean condiments). Food’s freshness is also an important concern; improperly stored or spoiled food can create an environment in which tyramine concentrations may increase. Avoid these foods during and for 2 weeks after discontinuation of medication. Abrupt discontinuation or interruption of antiparkinsonian/antidepressant therapy has been associated with a discontinuation/withdrawal syndrome.

Headache, dizziness, insomnia, nausea, application site reaction, hypotension, pain, confusion, hallucination, weight loss, diarrhea, xerostomia, abdominal pain, dyskinesia, rhinitis

Note this is not a complete list of side effects, only the most common

1. What do I do if side effects are intolerable?
   If side effects are causing a lot of distress speak to your physician as soon as possible to discuss options.
2. What is Neuroleptic Malignant Syndrome?
   NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly.  Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status.  As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures.  Seek medical attention immediately if this reaction is suspected.
3. What is serotonin syndrome?
   Serotonin syndrome is a rare, but potentially life-threatening condition of serotonin toxicity from too much of it in your system generally from the use of certain medications and supplements.  Usually, multiple agents are at play or very high doses are involved.  The signs and symptoms include agitation, hallucinations, delirium, coma, tachycardia (rapid heart rate), diaphoresis (excessive sweating), tremor, muscle rigidity, nausea, vomiting, diarrhea, and/or seizures.  If serotonin syndrome is suspected, discontinue any serotonergic medications, and seek immediate medical attention.