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 |
Ontology: Selegiline (C0036579)
Definition (MSH) | A selective, irreversible inhibitor of Type B monoamine oxidase. It is used in newly diagnosed patients with Parkinson's disease. It may slow progression of the clinical disease and delay the requirement for levodopa therapy. It also may be given with levodopa upon onset of disability. (From AMA Drug Evaluations Annual, 1994, p385) The compound without isomeric designation is Deprenyl. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D012642 |
SnomedCT | 108466000, 372497003 |
LNC | LP18099-9, MTHU003384 |
English | L-Deprenyl, Selegiline, Selegyline, Benzeneethanamine, N,alpha-dimethyl-N-2-propynyl-, (R)-, selegiline (medication), (-)-Deprenil, (-)-Phenylisopropylmethylpropynylamine, SELEGILINE, Selegiline [Chemical/Ingredient], l-deprenyl, Selegiline, (R)-Isomer, (-)-Selegiline, l-Deprenyl, selegiline, Selegiline (product), Selegiline (substance) |
Swedish | Selegilin |
Czech | selegilin |
Finnish | Selegiliini |
Russian | SELEGILIN, DEPRENIL, DEPRENALIN, ДЕПРЕНАЛИН, ДЕПРЕНИЛ, СЕЛЕГИЛИН |
Japanese | デプレナリン, 塩酸セレギリン, デプレニール, デプレニル, L-塩酸デプレニル, セレギリン, エフピー, セレギリン塩酸塩, L-デプレニル塩酸塩 |
Croatian | SELEGILIN |
Polish | Selegilina, Deprenyl |
Spanish | selegilina (producto), selegilina (sustancia), selegilina, Selegilina |
French | Sélégiline |
German | Selegilin |
Italian | Selegilina |
Portuguese | Selegilina |