Classes
DEA Class; Rx
Common Brand Names; Eldepryl, Zelapar, Emsam
- Antiparkinson Agents, MAO Type B Inhibitors
Description
Selective type-B monoamine oxidase inhibitor (MAOI) available orally and as a transdermal patch
Oral formulations used as an adjunct treatment in Parkinson’s disease; transdermal patch approved for major depressive disorder in adults
Tyramine reactions, such as hypertensive crisis, are unlikely but possible at therapeutic dosing; follow tyramine restrictions as recommended
Close monitoring is required in pediatrics and young adults receiving antidepressant therapy due to an increased risk of suicidality during the initial stages of treatment; transdermal selegiline is contraindicated in children less than 12 years due to an increased risk of hypertensive crisis
Indications
Indicated for the treatment of Parkinson’s disease or parkinsonism in combination with levodopa or levodopa/carbidopa.
Contraindications
Hypersensitivity
Concomitant use of opioids (eg, meperidine and derivatives, methadone, or tramadol) and other MAO inhibitors, including selective MAO-B inhibitors or other drugs in the MAO class, including linezolid, an oxazolidinone antibacterial
Within 14 days of taking opioids, another MAO inhibitor, or other drugs in the MAO class
Concomitant use of St. John’s wort or cyclobenzaprine (a tricyclic muscle relaxant).
Concomitant use of dextromethorphan
Adverse Effects
- Dyskinesia
- Nausea (20%)
- Abdominal pain
- Dry mouth
- Arrhythmias
- Confusion
- EPS
- Generalized pain
- Hallucinations
- Headache
- HTN
- Insomnia
- Mood changes
- Orthostatic hypotension
- Syncope
- Urinary retention
- Vomiting
- Suicidal thoughts and behaviors
- Serotonin syndrome
- Blood pressure elevation
- Activation of mania/hypomania
- External heat
Warnings
Prescriptions should be written for the smallest quantity consistent with good patient care
May potentiate dopaminergic side effects of levodopa and cause dyskinesia or exacerbate preexisting dyskinesia, which may, in turn, require a reduction of levodopa dose
In patients with bipolar disorder, treating a depressive episode may precipitate a mixed/manic episode; prior to initiating treatment, screen patients for any personal or family history of bipolar disorder, mania, or hypomania
Risk of melanoma development increased in Parkinson disease patients; monitor patients closely
Drug contains phenylalanine, a component of aspartame; each 1.25 mg tablet contains 1.25 mg phenylalanine; patients taking the 2.5 mg dose will receive 2.5 mg phenylalanine; before prescribing drug to a patient with PKU, consider combined daily amount of phenylalanine from all sources, including therapy
Concomitant use of dextromethorphan, may result in episodes of psychosis or bizarre behavior
Orthostatic hypotension may occur; incidence of orthostatic hypotension reported to be higher in geriatric patients ≥65 years
Pregnancy and Lactation
The available data on use in pregnant women are not sufficient to inform a drug-associated risk of adverse pregnancy-related outcomes; When treating a pregnant woman, the physician should carefully consider both the potential risks of taking an MAOI, particularly the risk of hypertensive crisis during pregnancy, along with the established benefits of treating depression with an antidepressant
There is no information regarding presence in human milk, or effects on milk production or breastfed infant
Maximum Dosage
10 mg/day PO (oral tablets or capsules); 2.5 mg/day PO (orally-disintegrating tablet); Emsam 12 mg/24 hour transdermally.
10 mg/day PO (oral tablets or capsules); 2.5 mg/day PO (orally-disintegrating tablet); Emsam 12 mg/24 hour transdermally.
Safety and efficacy have not been established.
12 years: Safety and efficacy have not been established.
Less than 12 years: Transdermal patch is contraindicated.
Not indicated.
How supplied
Selegiline hydrochloride
tablet
5mg
capsule
5mg
tablet disintegrating
1.25mg
transdermal patch
- 6mg/24hr
- 9mg/24hr
- 12mg/24hr