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What is this medication?

Selegiline, Eldepryl/Emsam/Zelapar (US)
Anti-Parkinson Agent, MAO Type B InhibitorAntidepressant, Monoamine Oxidase Inhibitor

Selegiline is indicated for treatment of parkinson disease, and major depressive disorder.

“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.”

How does this medication work? 

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.

How should I take this medication?

 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

What should I watch for while using this medication? 

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.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible.  However, if it is almost time for your next dose, take only that scheduled dose.  Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times.  Store at room temperature, 59 to 86° F (15 to 30° C).  Protect from light.  Keep the container tightly closed.  Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

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