II. Precautions

  1. See MAO Inhibitors
  2. MAO Inhibitors are not first-line agents for Mood Disorders or Parkinsonism
  3. Follow low tyramine diet and avoid Sympathomimetics, Serotonergic Medications
    1. Transdermal patch at 6 mg/day or less is lower risk, and does not require dietary changes

III. Indications

  1. Refractory Major Depression
  2. Parkinsonism
    1. May be used as monotherapy in early Parkinsonism to delay Levodopa start (not FDA approved)
    2. Typically used as adjunctive therapy with Levodopa
      1. May slow Parkinsonism progression when used in combination with Levodopa
      2. Reduces "off" time

IV. Mechanism

  1. See MAO Inhibitor
  2. Selegiline is a MAO Inhibitor which irreversibly and selectively blocks MAO-B (CNS, Liver, Platelets)
    1. Inhibits intracerebral Dopamine metabolism

V. Dosing: Major Depression

  1. Transdermal Patch
    1. Start 6 mg patch/24 hour and replace each day
    2. May adjust dose at 2 or more week intervals, increasing in 3 mg dose adjustments
      1. Maximum 12 mg/day
      2. However, no evidence for benefit above 6 mg dose (which is also lower risk for adverse effects)

VI. Dosing: Parkinsonism

  1. Selegiline HCL (Eldepryl)
    1. Start 5 mg orally at breakfast and lunch (noon)
    2. Maximum: 10 mg/day
  2. Zelapar ODT
    1. Start: 1.25 mg SL every morning (taken before breakfast without liquid)
    2. After 6 weeks may increase to maximum of 2.5 mg every morning

VII. Adverse Effects

  1. See MAO Inhibitor
  2. Risk of Compulsive Gambling, hypersexuality and other addictions

VIII. Drug Interactions

  1. See MAO Inhibitors
  2. Risk of life threatening interactions (Hypertensive Crisis, Serotonin Syndrome)
  3. Tyramine Containing Food
    1. Significant tyramine restriction is not typically needed at typical doses of Type B MAO Inhibitors
    2. Avoid foods with high tyramine concentrations

X. References

  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

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