Selegiline

Selegiline is a medication approved for the treatment of major depressive disorder and Parkinson’s disease. It’s important to follow all precautions from your doctor or healthcare provider when taking this medication, as it can come with risks and side effects.

Selegiline brand names

Selegiline is available in several brand names, which can vary based on the specific usage of the drug. These include ^{[1] [2]}:

• Eldepryl®
• Zelapar®
• Emsam®

What is selegiline prescribed for?

Selegiline is primarily used to treat Parkinson’s disease and major depressive disorder. In the treatment of Parkinson’s disease, selegiline is used in combination with other medications, primarily levodopa. Selegiline is unlikely to benefit patients with Parkinson’s disease when taken without levodopa ^[3].

How does selegiline work?

Selegiline belongs to a class of drugs called monoamine oxidase inhibitors (MAOIs). Medications in this class work by preventing the breakdown of certain neurotransmitters in the brain, so that larger quantities of these neurotransmitters are available in the nervous system ^[3].  

When used in the treatment of Parkinson’s disease, selegiline exerts its effects by preventing the breakdown of dopamine in the nervous system. When treating major depressive disorder, selegiline works by stopping the breakdown of not only dopamine, but also serotonin and norepinephrine ^[3].

How is selegiline usually taken?

Selegiline is taken in different ways, depending on the reason a person is taking the medication. To treat Parkinson’s disease, selegiline is taken as either a capsule or a tablet that dissolves in the mouth. The oral selegiline capsule is taken twice daily, with one capsule at both breakfast and lunch. The disintegrating tablet is taken once a day in the morning before a person has eaten breakfast ^[1].

On the other hand, when selegiline is used for the treatment of major depressive disorder, it comes as a transdermal patch that is applied once daily to the skin. The patch remains in place for 24 hours, and a new patch is applied the next day. The patch should be applied at around the same time each day ^[2].

The most typical dose of tablet or capsule selegiline is 5 mg, taken twice daily. The oral disintegrating form of the medication is available in 1.25 mg tablets. When used as a transdermal patch, selegiline is available in 5 mg, 9 mg, and 12 mg patches. Patients typically begin at a  daily dose of 6 mg, and doses can be increased by 3 mg every 24 hours if needed ^[3].

How long does selegiline stay in your system?

A drug’s half-life indicates how long the medication stays in the system. The average half-life of selegiline is 2 hours, meaning that half of the initial dose of the drug is eliminated from the system within this time. However, once a person is taking the medication regularly and reaches a steady state, the half-life increases to 10 hours ^[3].

When you’ve been taking selegiline for an extended period, it can take several weeks for all of the medication to clear from your system ^{[1] [2]}.

Selegiline side effects

As with any medication, selegiline can come with side effects, so it’s important to monitor yourself and keep in close contact with your doctor when taking it. Many adverse effects are mild and will go away with time.

If your doctor has prescribed selegiline, it is because they believe that the benefits will outweigh the risks. If side effects are severe or do not improve, talk with your doctor.

Side effects of selegiline can vary, based on whether a person is using the capsule form or the transdermal patch form.

Side effects of selegiline capsules

The following side effects of oral selegiline capsules are considered mild and typically improve with time ^[1]:

• Loss of balance or lightheadedness
• Fainting
• Dry mouth
• Nausea and vomiting
• Stomach pain
• Difficulty swallowing
• Heartburn
• Gastrointestinal problems like heartburn and diarrhea
• Constipation
• Problems sleeping
• Strange dreams
• Sleepiness
• Depression
• Leg and back pain
• Muscle weakness
• Development of purpleblotches on the skin
• Rash
• Irritation and sores in the mouth, if taking the disintegrating version of selegiline

The following side effects of selegiline are rare but serious ^[1]:

• Intense headache
• Chest pain
• Racing or irregular heart rate
• Sweating
• Intense nausea and vomiting
• Confusion
• Stiff or sore neck
• Uncontrollable shaking of the body
• Unusual, uncontrollable body movements
• Hallucinations
• Breathing problems

Contact your doctor immediately or seek medical attention if you experience severe side effects.

Side effects of selegiline patches

Mild side effects associated with selegiline patches, which vary from those of the capsule form of the medication, include ^[2]:

• Redness in the area where the patch is applied
• Diarrhea
• Heartburn
• Dryness in the mouth
• Weight loss
• Rashes

The more serious side effects of the selegiline patch, which require immediate contact with your doctor, include ^[2]:

• Severe headache
• Fast or slow heart rate
• Chest pain
• Stiff or sore neck
• Nausea and vomiting
• Confusion
• Sweating
• Enlarged pupils
• Sensitivity to light

Selegiline precautions

When taking selegiline, there are certain precautions you must keep in mind. There are also some people who should not take this medication, because of health conditions or other risk factors.

Consider the following precautions ^[3]:

• Individuals with end-stagekidney disease should not take oral selegiline, as it will clear from the body more slowly in cases of severe kidney disease.
• Patients with mild to moderate liver impairment should take reduced doses of selegiline.The medication is not recommended for those with severe liver impairment.
• There is not enough research on the effects of selegiline during pregnancy to state that it is safe to use during this time. It should be used with caution by pregnant women.Tell your doctor if you’re pregnant or planning to become pregnant before taking selegiline.
• Selegiline can be toxic to babies when transferred via breast milk, so it is not recommended to take this medication while breastfeeding, and women should not breastfeed for one week after stopping the medication.
• Selegiline is not recommended for use in children. Children and young adults may also experience an increased risk of suicidal behavior when taking this medication, so it is not recommended for the treatment of depression in these populations.
• Older adults are at risk of adverse reactions to selegiline, including high blood pressure.  
• Talk with your doctor before stopping selegiline.Sudden discontinuation of treatment can lead to a worsening of symptoms.
• Selegiline should not be taken with foods that are high in tyramine, as it can lead to a hypertensive crisis. Foods to be avoided include:aged cheese, cured, smoked, or processed meat, pickled or fermented foods, soy and fava beans, dried or overripe fruits, soy sauce, and alcoholic beverages like homebrewed beer and red wine.

Selegiline interactions

Selegiline can lead to dangerous side effects when taken in combination with certain substances, so it’s important to tell your doctor about any and all medications and supplements you’re taking before the initiation of treatment. Substances that interact with selegiline can vary, depending upon whether you’re taking the oral or the transdermal version of the medication.

Oral selegiline interactions

While this list is not exhaustive, the following substances can cause dangerous interaction effects when taken with oral selegiline ^[1]:

• Robitussin cough medicine
• Meperidine
• Methadone
• Propoxyphene
• Tramadol
• Other medications containing selegiline (Eldepryl, Ensam, Selapar)
• Certain medications taken to treat cough or cold symptoms
• Antidepressant medications including amitriptyline and imipramine
• Carbamazepine
• Medications taken for weight loss
• Nafcillin
• Phenobarbital
• Phenytoin
• SSRI drugs taken for depression, such as citalopram, escitalopram, fluoxetine, paroxetine, and sertraline
• Rifampin

Transdermal selegiline interactions

While this list is not exhaustive, the following substances can cause dangerous interaction effects when taken with transdermal selegiline ^[2]:

• Amphetamine drugs including Adderall
• Benzphetamine
• Methamphetamine
• Antidepressants including amitriptyline and imipramine
• Bupropion
• Buspirone
• Carbamazepine
• Cyclobenzaprine
• Robitussin cough syrup
• Certain cough and cold medications
• Drugs taken for weight loss
• Meperidine
• Methadone
• Mirtazapine
• Other MAOI drugs including isocarboxazid and phenelzine
• Oral selegiline
• Oxcarbazepine
• Pentazocine
• Propoxyphene
• SSRI drugs used to treat depression, including citalopram, escitalopram, fluoxetine, paroxetine, and sertraline
• SNRI drugs used to treat depression, including duloxetine and venlafaxine
• John’s wort
• Tramadol
• Tyramine supplements

If you’re taking a medication that could interact with selegiline, your doctor may prescribe a lower dose of selegiline, carefully monitor you for drug interaction effects, or simply prescribe a different medication that is safer for you to take.

Selegiline storage

Your medication should be kept out of reach of children in its original, tightly closed container to prevent a child or someone else from mistakenly accessing the medication. The medication should be stored at room temperature, and not in excessively hot or moist environments, such as the bathroom. Selegiline patches should be kept in their protective pouches, and you should not open a patch until you’re ready to use it ^{[1] [2]}.

What to do if you overdose on selegiline

It is possible to overdose on selegiline. If someone you know has collapsed, has a seizure, is struggling to breathe, or cannot be awakened, contact 9-11 immediately ^[1].

Symptoms of overdose that suggest you may need medical care include ^[1]:

• Drowsiness
• Dizziness or faintness
• Irritability
• Hyperactivity or agitation
• Severe headache
• Hallucinations
• Tightness in the jaw
• Stiffness and arching in the back
• Coma
• Fast heart rate
• Chest pain
• Respiratory depression
• Sweating or fever
• Cold, clammy skin