II. Precautions
- See MAO Inhibitors
- MAO Inhibitors are not first-line agents for Mood Disorders or Parkinsonism
- Follow low tyramine diet and avoid Sympathomimetics, Serotonergic Medications
- Transdermal patch at 6 mg/day or less is lower risk, and does not require dietary changes
III. Indications
- Refractory Major Depression
-
Parkinsonism
- May be used as monotherapy in early Parkinsonism to delay Levodopa start (not FDA approved)
- Typically used as adjunctive therapy with Levodopa
- May slow Parkinsonism progression when used in combination with Levodopa
- Reduces "off" time
IV. Mechanism
- See MAO Inhibitor
- Selegiline is a MAO Inhibitor which irreversibly and selectively blocks MAO-B (CNS, Liver, Platelets)
- Inhibits intracerebral Dopamine metabolism
V. Dosing: Major Depression
- Transdermal Patch
- Start 6 mg patch/24 hour and replace each day
- May adjust dose at 2 or more week intervals, increasing in 3 mg dose adjustments
- Maximum 12 mg/day
- However, no evidence for benefit above 6 mg dose (which is also lower risk for adverse effects)
VI. Dosing: Parkinsonism
- Selegiline HCL (Eldepryl)
- Start 5 mg orally at breakfast and lunch (noon)
- Maximum: 10 mg/day
- Zelapar ODT
- Start: 1.25 mg SL every morning (taken before breakfast without liquid)
- After 6 weeks may increase to maximum of 2.5 mg every morning
VII. Adverse Effects
- See MAO Inhibitor
- Risk of Compulsive Gambling, hypersexuality and other addictions
VIII. Drug Interactions
- See MAO Inhibitors
- Risk of life threatening interactions (Hypertensive Crisis, Serotonin Syndrome)
-
Tyramine Containing Food
- Significant tyramine restriction is not typically needed at typical doses of Type B MAO Inhibitors
- Avoid foods with high tyramine concentrations
IX. Resources
- Selegiline Oral Tablet (DailyMed)
- Selegiline Patch (Dailymed)
X. References
- (2023) Med Lett Drugs Ther 62(1592): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| selegiline (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SELEGILINE HCL 5 MG CAPSULE | Generic | $0.93 each |
| SELEGILINE HCL 5 MG TABLET | Generic | $0.87 each |
| emsam (on 5/17/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| EMSAM 6 MG/24 HOURS PATCH | $64.95 each | |