SelegilineSelegiline Hydrochloride

About Selegiline

Selegiline is an irreversible inhibitor of monoamine oxidase type B; by slowing the breakdown of dopamine it is thought to leave more dopamine available in the brain, though exactly how it helps is not established. Capsules, tablets and Zelapar are labeled as an add-on for Parkinson’s disease in people taking carbidopa and levodopa whose response has worn down; controlled studies have not shown it helps without levodopa. The capsule or tablet dose is 5 mg at breakfast and 5 mg at lunch, with no added benefit from more, and after two or three days the prescriber may lower the levodopa dose. Zelapar starts at 1.25 mg once a day for at least six weeks and may go to 2.5 mg. Emsam is labeled for major depressive disorder in adults: 6 mg per 24 hours to start, raised in 3 mg steps no sooner than every two weeks to at most 12 mg, and 6 mg for people 65 and older.

Selegiline’s selectivity for MAO-B is not absolute and fades as the dose rises, so the labels warn against exceeding 10 mg a day (2.5 mg for Zelapar); even at labeled doses, rare blood pressure spikes after tyramine-rich foods have been reported. Meperidine is contraindicated with every form, and Zelapar also lists tramadol, methadone, other MAO inhibitors including linezolid, dextromethorphan, St. John’s wort and cyclobenzaprine. Antidepressants risk serotonin syndrome, so at least 14 days pass after stopping selegiline before a tricyclic or SSRI is started, and at least five weeks after stopping fluoxetine before selegiline is started. With levodopa it can add dizziness on standing, involuntary movements, hallucinations, sudden sleepiness and compulsive urges; nausea, hallucinations and confusion were the most frequent reasons for stopping in trials.

Emsam’s boxed warning says antidepressants raised the risk of suicidal thoughts and behavior in children and young adults, so anyone starting it is watched for worsening mood; it is contraindicated under age 12 because of the risk of a hypertensive crisis, and not recommended from 12 to 17. It must not be combined with SSRIs, SNRIs, clomipramine, imipramine, meperidine, tramadol, methadone, pentazocine, dextromethorphan or carbamazepine, nor used with a pheochromocytoma. At 6 mg per 24 hours no diet change is needed; at 9 or 12 mg, tyramine-rich foods are avoided from the first day until two weeks after going back to 6 mg or stopping. Zelapar contains phenylalanine, which matters in phenylketonuria.

Taking Selegiline

How to take it

Capsules or tablets: 5 mg with breakfast and 5 mg with lunch. Zelapar: once a day before breakfast, placed on the tongue to dissolve, with no food or drink for five minutes before and after. Emsam: one patch every 24 hours on dry, intact skin of the upper torso, upper thigh or outer upper arm, a new site each day; do not cut it, wash your hands afterward, and keep heating pads, electric blankets, saunas, hot tubs and long direct sunlight away from it.

If you miss a dose

Capsules, tablets or Zelapar: take a missed dose when you remember unless the next is nearly due, then skip it; do not double up. If a patch falls off, put a new one on a different site and keep to your usual schedule.

Storage

At room temperature, tightly closed, away from heat and moisture, out of reach of children. Keep Zelapar tablets in the blister pack until use and throw away any left three months after the pouch is opened. Keep Emsam patches in their sealed pouches until use, and fold a used patch in half, sticky sides together, before throwing it away where children and pets cannot reach it.

Interactions to know about

Meperidine, tramadol, methadone, the cough suppressant dextromethorphan, St. John’s wort and other MAO inhibitors are dangerous with selegiline, and antidepressants risk serotonin syndrome. Carbamazepine is contraindicated with Emsam. Tell every prescriber and pharmacist that you take it.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Selegiline differs from pharmacy to pharmacy

For Parkinson’s disease, generic capsules and tablets are the only option besides Zelapar, so quotes for them depend mostly on the pharmacy’s fee and markup, and on whether it keeps them in stock or orders them in. Zelapar and Emsam have no generic, so each is priced as a brand. The three products differ in dose and use, so a prescription for one cannot be filled with another.

Ways to pay less for Selegiline without insurance

• For Parkinson’s disease, ask for generic capsules or tablets and compare more than one pharmacy.
• Ask for a ninety-day supply once the dose is settled.
• If Zelapar is prescribed, ask the prescriber whether generic capsules or tablets would suit you.
• For Emsam, ask the maker whether a savings or patient assistance program applies to someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Selegiline

1. 1.Which cough, cold or pain medicines must I avoid with it?
2. 2.Do I need to avoid tyramine-rich foods at my dose?
3. 3.How long must I wait after stopping it before starting an antidepressant?
4. 4.Is it safe with my other Parkinson’s medicines?

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