Trade Names:Emsam- Transdermal system 6 mg per 24 h (20 mg per 20 cm 2 )- Transdermal system 9 mg per 24 h (30 mg per 30 cm 2 )- Transdermal system 12 mg per 24 h (40 mg per 40 cm 2 )
Potentiation of monoamine neurotransmitter activity in the CNS resulting from inhibition of MAO activity is suspected.
Following dermal application, 25% to 30% of the selegiline content is delivered systemically over 24 h. The degree of absorption may be one-third higher than amounts of 6 to 12 mg per 24 h. Because extensive first-pass metabolism occurs with oral administration, substantially higher exposure to selegiline and lower exposure to metabolites occur with transdermal dosing.
Plasma protein binding is approximately 90%.
The major enzymes involved with selegiline metabolism appear to be CYP2B6, CYP2C9, and CYP3A4/5, with CYP2A6 having a minor role.
Urine and fecal elimination account for about 10% and 2%, respectively, of a dermal dose. At least 63% of the dose is not absorbed. The mean half-lives of selegiline and its 3 metabolites ranged from 18 to 25 h.
No adjustment of dermal dose is required with renal function impairment.Hepatic Function Impairment
No adjustment of dermal dose is required with moderate hepatic function impairment.Gender
No differences in pharmacokinetics have been observed based on gender.
Treatment of major depressive disorder (MDD).
Coadministration with analgesic agents (eg, methadone, propoxyphene, tramadol), bupropion, carbamazepine, cocaine or local anesthetics, cyclobenzaprine, dextromethorphan, dual serotonin and norepinephrine reuptake inhibitors (eg, duloxetine, venlafaxine), meperidine, mirtazapine, oral selegiline or other MAOIs (eg, phenelzine), oxcarbazepine, SSRIs (eg, fluoxetine, paroxetine, sertraline), St. John's wort, sympathomimetic amines (eg, amphetamine), tricyclic antidepressants (eg, amitriptyline), or vasoconstrictors (eg, pseudoephedrine); patients with pheochromocytoma; elective surgery requiring general anesthesia; tyramine-containing foods with higher doses of selegiline; hypersensitivity to any component of the product.
Transdermal Recommended starting and target dosage is 6 mg per 24 h. Based on clinical judgement, the dosage may be increased in increments of 3 mg per 24 h at intervals of no less than 2 wk (max, 12 mg per 24 h).
Store at 68° to 77°F. Do not store outside sealed pouch.
Coadministration with selegiline is contraindicated.Buspirone
Increased BP may occur.Drugs affecting monoamine activity (eg, amphetamines, meperidine, pentazocine, SSRIs, tricyclic antidepressants)
Severe, life-threatening toxicity, including serotonin syndrome (eg, rigidity, muscle twitching, mental status change, autonomic instability), may occur.General anesthetics
Patients should not undergo elective surgery requiring general anesthetics; discontinue selegiline transdermal at least 10 days prior to elective surgery.Oral contraceptives
Selegiline plasma levels may be elevated, increasing the pharmacologic and adverse reactions.Tyramine-containing foods, beverages, and nutritional supplements
Should be avoided.
None well documented.
Orthostatic hypotension (10%); low systolic BP (3%); hypertension (at least 1%).
Headache (18%); insomnia (12%); abnormal thinking, agitation, amnesia, paresthesia (at least 1%).
Rash (4%); acne, pruritus, sweating (at least 1%).
Pharyngitis (3%); taste perversion, tinnitus (at least 1%).
Diarrhea (9%); dry mouth (8%); dyspepsia (4%); anorexia, constipation, flatulence, gastroenteritis, vomiting (at least 1%).
Dysmenorrhea, metrorrhagia, urinary frequency, UTI (at least 1%); abnormal ejaculation (1%).
Ecchymosis (at least 1%).
Application-site reaction (24%).
Weight loss (5%); weight gain (2%); peripheral edema (at least 1%).
Myalgia, pathological fracture (at least 1%).
Sinusitis (3%); bronchitis, increased cough (at least 1%).
Chest pain, neck pain (at least 1%).
Compared with placebo, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for MOD and other psychiatric disorders. Appropriately monitor patients of all ages who are started on antidepressant therapy closely for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider.
Monitor and observe patients for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of therapy or at times of increasing or decreasing the dose.
Category C .
Safety and efficacy not established.
No overall differences in efficacy have been noted between elderly and younger patients.
Use with caution in patients with disorders or conditions that can produce altered metabolism or hemodynamic responses.
Patients taking selegiline 9 mg per 24 h or 12 mg per 24 h should avoid food and beverages rich in tyramine.
Ensure that patients do not undergo elective surgery requiring general anesthetics. Discontinue selegiline transdermal at least 10 days prior to elective surgery.
May be a risk in patients taking amine-containing medications or tyramine-containing foods if the dose of selegiline is exceeded or if plasma levels are elevated.
Postural hypotension, sometimes with orthostatic symptoms, can occur.
Activation may occur; use with caution in patients with history of mania.
Prior to initiating treatment, adequately screen patients with depressive symptoms to determine risk of bipolar disorder.
Agitation, coma, cool, clammy skin, death, diaphoresis, dizziness, drowsiness, faintness, hallucinations, hyperactivity, hyperpyrexia, hypertension, hypotension, irritability, opisthotonos, precordial pain, rapid and irregular pulse, respiratory depression and failure, seizures, severe headache, trismus, vascular collapse.
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