Dosing & Uses
Dosage Forms & Strengths
tablet
- 5mg
capsule
- 5mg
tablet disintegrating
- 1.25mg
Parkinson Disease
Conventional
- 5 mg PO at breakfast & 5 mg at lunch (10 mg/day)
- After 2-3 days of selegeline therapy, can begin to taper levadopa dose by 10-30% as tolerated; continue to taper based upon patient response
- Not to exceed 10 mg/day
Orally-disintegrating (with levodopa/carbidopa)
- Initial 1.25 mg PO qDay, may increase after 6 weeks if inadequate response, no more than 2.5 mg/day
- Do not swallow
- Take in the morning before breakfast and without liquid; patient should avoid ingesting food or liquids for 5 minutes before and after taking medication
Renal Impairment
-
Tablets/capsules
- Use caution; dosage adjustment not provided in manufacturer’s labeling; not studied
-
Disintegrating tablets
- Mild to moderate impairment (CrCl 30-89 mL/min): Dose adjustment not necessary; maintenance dose determined by individual response
- Severe impairment (CrCl<30 ml/min): Not recommended
- End-stage renal disease: Not recommended
Hepatic Impairment
-
Tablets/capsules
- Use caution; dosage adjustment not provided in manufacturer’s labeling; not studied
-
Disintegrating tablets
- Mild to moderate hepatic disease (Child-Pugh class A and B): Daily dose should be reduced (from 2.5 to 1.25 mg daily), depending on clinical response and tolerability
- Severe hepatic impairment (Child-Pugh class C): Not recommended
Safety and efficacy not established
Parkinson Disease
Conventional
- 5 mg PO at breakfast & 5 mg at lunch (10 mg/day)
- <5 mg/day when combined with levodopa
- After 2-3 days of selegeline therapy, can begin to taper levadopa dose by 10-30% as tolerated; continue to taper based upon patient response
- Not to exceed 10 mg/day
Orally-disintegrating (with levodopa/carbidopa)
- Initial 1.25 mg PO qDay, may increase after 6 weeks if inadequate response, no more than 2.5 mg/day
- Do not take food or liquid for 5 minutes after dose
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (63)
- amitriptyline
selegiline and amitriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- amoxapine
selegiline and amoxapine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- amphetamine
selegiline and amphetamine both increase serotonin levels. Contraindicated. Amphetamines should not be administered during or within 14 days following the use of most MAOIs or drugs with MAO-inhibiting activity
selegiline increases effects of amphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs. - apraclonidine
selegiline, apraclonidine. Mechanism: unknown. Contraindicated. Risk of selegiline-induced hypertension may be increased. Coadministration is contraindicated. Do not coadminister within 14 days of each other.
- atomoxetine
selegiline increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.
- brimonidine
selegiline, brimonidine. Mechanism: unknown. Contraindicated. Coadministration is contraindicated.
- bupropion
selegiline and bupropion both increase dopaminergic effects. Contraindicated. Bupropion inhibits reuptake of dopamine and norepinephrine (NE), and MAOIs decrease metabolism of dopamine and NE; coadministration increases risk for hypertensive reactions; allow at least 14 days between discontinuation of MAOI and initiating bupropion
- carbamazepine
carbamazepine increases toxicity of selegiline by unknown mechanism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- citalopram
selegiline and citalopram both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of MAOI therapy and the start of citalopram therapy, and at least 2 weeks between discontinuation of citalopram therapy and commencement of MAOI therapy.
- clomipramine
selegiline and clomipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- cyproheptadine
selegiline, cyproheptadine. Other (see comment). Contraindicated. Comment: MAO inhibitors may prolong and intensify the anticholinergic effects of antihistamines. Cyproheptadine may diminish the serotonergic effect of MAO inhibitors.
- desipramine
selegiline and desipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- desvenlafaxine
selegiline and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drug
- deutetrabenazine
selegiline, deutetrabenazine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Deutetrabenazine should not be used in combination with an MAOI, or within 14 days of discontinuing therapy with an MAOI.
- dexmethylphenidate
selegiline increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Dexmethylphenidate use is contraindicated during treatment with MAOIs and also within a minimum of 14 days following discontinuation of treatment with an MAOI.
- dextroamphetamine
selegiline and dextroamphetamine both increase serotonin levels. Contraindicated. Amphetamines should not be administered during or within 14 days following the use of most MAOIs or drugs with MAO-inhibiting activity
selegiline increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs. - dextromethorphan
selegiline and dextromethorphan both increase serotonin levels. Contraindicated.
- doxepin
selegiline and doxepin both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- doxepin cream
selegiline increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. Avoid combination within 14 days of MAOI use.
- duloxetine
selegiline and duloxetine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.
- ephedrine
selegiline increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- escitalopram
selegiline and escitalopram both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.
- fentanyl
selegiline increases toxicity of fentanyl by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics. .
- fentanyl intranasal
selegiline increases toxicity of fentanyl intranasal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics. .
- fentanyl transdermal
selegiline increases toxicity of fentanyl transdermal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics. .
- fentanyl transmucosal
selegiline increases toxicity of fentanyl transmucosal by Other (see comment). Contraindicated. Comment: Avoid fentanyl in patients who require concomitant administration MAOIs, or within 14 days of stopping an MAOI. Severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics. .
- fluoxetine
selegiline and fluoxetine both increase serotonin levels. Contraindicated. At least 5 weeks should elapse between discontinuation of fluoxetine and initiation of selegiline.
- fluvoxamine
fluvoxamine will increase the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Contraindicated.
- gepirone
selegiline and gepirone both increase serotonin levels. Contraindicated. Gepirone is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), including linezolid or IV methylene blue or in patients who have taken MAOIs within the preceding 14 days. Allow at least 14 days after stopping gepirone before starting an MAOI.
- imipramine
selegiline and imipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- isocarboxazid
selegiline and isocarboxazid both increase serotonin levels. Contraindicated.
- levodopa
selegiline, levodopa. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Concomitant therapy with selegiline and carbidopa-levodopa may be associated with severe orthostatic hypotension not attributable to carbidopa-levodopa alone.
- levomilnacipran
selegiline and levomilnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use
- lisdexamfetamine
selegiline increases effects of lisdexamfetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs.
selegiline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Contraindicated. Do not use amphetamines during and within 14 days of discontinuation of monoamine oxidase inhibitors. . - meperidine
selegiline and meperidine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.
- methadone
selegiline increases toxicity of methadone by unknown mechanism. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.
- methamphetamine
selegiline increases effects of methamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Coadministration is contraindicated during or within 14 days following the administration of MAOIs.
- methylphenidate
selegiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.
- methylphenidate transdermal
methylphenidate transdermal and selegiline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.
- mirtazapine
selegiline and mirtazapine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of mirtazapine.
- nortriptyline
selegiline and nortriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- ozanimod
selegiline and ozanimod both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of ozanimod with MAO-B inhibitors may decrease exposure of the active metabolites of ozanimod, which may inhibit MAO. The potential for a clinical interaction with MAO inhibitors has not been studied; however, the increased risk of nonselective MAO inhibition may lead to a hypertensive crisis. Allow at least 14 days to elapse between discontinuing ozanimod and initiating with MAO inhibitors.
- paroxetine
selegiline and paroxetine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.
- phenelzine
selegiline and phenelzine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of another MAOI.
- phenylephrine PO
selegiline increases effects of phenylephrine PO by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- procarbazine
selegiline and procarbazine both increase serotonin levels. Contraindicated. At least 2 weeks should elapse between discontinuation of one MAOI and initiation of therapy with the other.
- protriptyline
selegiline and protriptyline both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- pseudoephedrine
selegiline increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- rasagiline
rasagiline and selegiline both increase serotonin levels. Contraindicated. Increased risk of hypertensive crisis. At least 14 days should elapse between discontinuation of rasagiline and initiation of another MAOI or discontinuation of another MAOI and initiation of rasagiline.
- safinamide
selegiline, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration increases risk of nonselective MAO inhibition, that may lead to hypertensive crisis. At least 14 days should elapse between discontinuating safinamide and initiating MAOIs.
- serdexmethylphenidate/dexmethylphenidate
selegiline increases effects of serdexmethylphenidate/dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Dexmethylphenidate use is contraindicated during treatment with MAOIs and also within a minimum of 14 days following discontinuation of treatment with an MAOI.
- sertraline
selegiline and sertraline both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.
- solriamfetol
selegiline will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.
- St John's Wort
selegiline and St John's Wort both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of St. John's Wort.
- tapentadol
selegiline increases toxicity of tapentadol by unknown mechanism. Contraindicated. At least 14 days should elapse between the discontinuation of a MAO-inhibiting drug and the initiation of tapentadol.
- tetrabenazine
tetrabenazine, selegiline. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode; separate by 14 days. Mechanism: MAOI causes accumulation of norepinephrine in neuron and tetrabenazine stimulates norepinephrine release.
- tramadol
selegiline and tramadol both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.
- tranylcypromine
selegiline and tranylcypromine both increase serotonin levels. Contraindicated.
- trimipramine
selegiline and trimipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- venlafaxine
selegiline and venlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.
- vilazodone
selegiline, vilazodone. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration with MAO inhibitors are contraindicated. Do not prescribe vilazodone within 14 days of discontinuing or starting an MAO inhibitor.
- viloxazine
viloxazine and selegiline both increase serotonin levels. Contraindicated. Viloxazine is contraindicated with monoamine oxidase inhibitors (MAOIs), or within 14 days following discontinuing an MAOI owing to increased risk of hypertensive crisis.
- vortioxetine
selegiline increases toxicity of vortioxetine by serotonin levels. Contraindicated.
Serious - Use Alternative (44)
- benzhydrocodone/acetaminophen
selegiline increases toxicity of benzhydrocodone/acetaminophen by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.
- buprenorphine
selegiline increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Buprenorphine transdermal is not recommended for in patients who have received MAOI within 14 days, because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.
- buprenorphine buccal
selegiline increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Buprenorphine transdermal is not recommended for in patients who have received MAOI within 14 days, because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.
- buspirone
selegiline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug. Concurrent use is not recommended. Risk of acute hypertensive episodes.
- desflurane
selegiline increases levels of desflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.
- difenoxin hcl
selegiline increases toxicity of difenoxin hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- diphenoxylate hcl
selegiline increases toxicity of diphenoxylate hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- dolasetron
dolasetron, selegiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- fedratinib
selegiline will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.
- fexinidazole
fexinidazole will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. Coadministration may decrease plasma concentrations of CYP2B6 substrates owing to fexinidazole inducing CYP2B6.
- fluvoxamine
fluvoxamine and selegiline both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of either drug and initiation of the other one
- granisetron
granisetron, selegiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- hydrocodone
selegiline increases toxicity of hydrocodone by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.
- hydromorphone
selegiline increases toxicity of hydromorphone by unknown mechanism. Avoid or Use Alternate Drug. At least 14 days should elapse between the discontinuation of a MAO-inhibiting drug and the initiation of hydromorphone.
- iobenguane I 131
selegiline will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- ketamine
selegiline increases levels of ketamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.
- levodopa inhaled
levodopa inhaled increases effects of selegiline by dopaminergic effects. Avoid or Use Alternate Drug. Levodopa may enhance risk for acute hypertensive episode if coadministered with nonselective MAOIs. High dose PO selegiline (>10 mg/day tab/cap or >2.5 mg/day ODT) or transdermal selegiline exhibits nonselective MAOI activity.
- linezolid
selegiline and linezolid both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
- lonafarnib
selegiline will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.
- lorcaserin
selegiline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- maprotiline
selegiline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.
- metformin
selegiline will increase the level or effect of metformin by unspecified interaction mechanism. Avoid or Use Alternate Drug.
- methylene blue
selegiline and methylene blue both increase serotonin levels. Avoid or Use Alternate Drug. Both methylene blue and selegiline may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- metoclopramide intranasal
selegiline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
metoclopramide intranasal increases toxicity of selegiline by Other (see comment). Avoid or Use Alternate Drug. Comment: Metoclopramide may enhance the hypertensive effect of monoamine oxidase inhibitors. - midodrine
selegiline increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Midodrine should not be given concurrently with monoamine oxidase inhibitors (MAOIs). Risk of acute hypertensive episode.
- milnacipran
selegiline and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.
- nefazodone
selegiline and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.
- netupitant/palonosetron
netupitant/palonosetron, selegiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- olopatadine intranasal
selegiline and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
ondansetron, selegiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- opium tincture
selegiline increases toxicity of opium tincture by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- palonosetron
palonosetron, selegiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- phendimetrazine
selegiline increases effects of phendimetrazine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Phendimetrazine should not be administered during or within 14 days following the use of most MAOIs or drugs with MAO-inhibiting activity. Risk of acute hypertensive episode. .
- phentermine
selegiline increases effects of phentermine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Phentermine should not be administered during or within 14 days following the use of most MAOIs or drugs with MAO-inhibiting activity. Risk of acute hypertensive episode. .
- propofol
selegiline increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.
- sevoflurane
selegiline increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.
- sufentanil SL
selegiline increases toxicity of sufentanil SL by serotonin levels. Avoid or Use Alternate Drug. MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Opioids are not recommended for patients taking MAOIs or within 14 days of stopping MAOIs. If urgent opioid treatment needed, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.
- tedizolid
tedizolid, selegiline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Interaction with MAOIs were not studied in clinical trials; drugs within the same class(eg linezolid) are contraindicated with MAOIs.
- trazodone
selegiline and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
selegiline and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
- valbenazine
selegiline, valbenazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of valbenazine with MAOIs may increase monoamine neurotransmitter concentration in synapses, potentially increasing risk of serotonin syndrome or attenuating valbenazine effect.
- vilanterol/fluticasone furoate inhaled
selegiline and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
- yohimbine
selegiline increases effects of yohimbine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode. It is recommended to avoid yohimbine during MAOI therapy and for 2 weeks after the discontinuation of a MAOI.
- zuranolone
selegiline, zuranolone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of zuranolone with other CNS depressants may increase impairment of psychomotor performance or CNS depressant effects. If unavoidable, consider dose reduction.
Monitor Closely (112)
- 5-HTP
selegiline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
- alfentanil
selegiline increases toxicity of alfentanil by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- almotriptan
almotriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- aripiprazole
selegiline, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- armodafinil
selegiline increases effects of armodafinil by pharmacodynamic synergism. Use Caution/Monitor. Use caution when administering MAOIs and armodafinil.
- asenapine
selegiline, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- atogepant
selegiline will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- avapritinib
selegiline will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- axitinib
selegiline increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- belladonna and opium
selegiline increases toxicity of belladonna and opium by unknown mechanism. Use Caution/Monitor. Risk of hypotension, hyperpyrexia, somnolence, or death.
- benazepril
selegiline, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.
- bretylium
selegiline increases effects of bretylium by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. Bretylium produces release of catecholamines from nerve endings. This increased catecholamine release is potentiated by MAOIs.
- buprenorphine subdermal implant
selegiline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
selegiline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Concomitant use could result in life-threatening serotonin syndrome or opioid toxicity (eg, respiratory depression, coma). Buprenorphine long-acting injection is not recommended for patients taking MAOIs or within 14 days of stopping such treatment.
- butorphanol
selegiline increases toxicity of butorphanol by unknown mechanism. Use Caution/Monitor. Concomitant use of butorphanol with other CNS depressants can potentiate the effects of butorphanol on respiratory depression, CNS depression and sedation.hyperpyrexia, somnolence, or death.
- caffeine
selegiline increases effects of caffeine by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Risk of acute hypertensive episode.
- cannabidiol
cannabidiol, selegiline. affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP2B6 induction and inhibition with the coadministration of CYP2B6 substrates and cannabidiol, consider reducing dosage adjustment of CYP2B6 substrates as clinically appropriate.
- captopril
selegiline, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.
- carbamazepine
carbamazepine will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- cariprazine
selegiline, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- cenobamate
cenobamate will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.
- chlorpropamide
selegiline increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- clozapine
selegiline, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- cocaine topical
selegiline and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
- codeine
selegiline increases toxicity of codeine by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- cyclobenzaprine
selegiline and cyclobenzaprine both increase serotonin levels. Modify Therapy/Monitor Closely.
- daridorexant
selegiline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- dichlorphenamide
dichlorphenamide and selegiline both decrease serum potassium. Use Caution/Monitor.
- diethylpropion
selegiline increases effects of diethylpropion by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.
- difelikefalin
difelikefalin and selegiline both increase sedation. Use Caution/Monitor.
- dihydroergotamine
selegiline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine intranasal
selegiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- eletriptan
eletriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- epinephrine
selegiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.
- ergotamine
selegiline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- ethinylestradiol
ethinylestradiol increases levels of selegiline by Other (see comment). Use Caution/Monitor. Comment: Oral contraceptives inhibit the N demethylatin of selegiline.
- finerenone
selegiline will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
- flibanserin
selegiline will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
- fluphenazine
selegiline, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- frovatriptan
frovatriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- gepirone
gepirone and selegiline both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.
- glimepiride
selegiline increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- glipizide
selegiline increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- glyburide
selegiline increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- green tea
green tea, selegiline. Other (see comment). Use Caution/Monitor. Comment: Avoid combination or excessive consumption of green tea. Combination may increase risk of cardiac arrhythmias or severe hypertension can occur due to caffeine component of green tea.
- haloperidol
selegiline, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- iloperidone
selegiline, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- iloprost
iloprost, selegiline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. When administering iloprost IV, consider temporary discontinuation of concomitant vasodilators or other medications that reduce blood pressure to mitigate potential additive hypotensive effects. If hypotension persists despite discontinuing other antihypertensives and fluid resuscitation, consider iloprost dose reduction or discontinuation.
- insulin aspart
selegiline increases effects of insulin aspart by unknown mechanism. Use Caution/Monitor.
- insulin detemir
selegiline increases effects of insulin detemir by unknown mechanism. Use Caution/Monitor.
- insulin glargine
selegiline increases effects of insulin glargine by unknown mechanism. Use Caution/Monitor.
- insulin glulisine
selegiline increases effects of insulin glulisine by unknown mechanism. Use Caution/Monitor.
- insulin lispro
selegiline increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- insulin NPH
selegiline increases effects of insulin NPH by unknown mechanism. Use Caution/Monitor.
- insulin regular human
selegiline increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- ioflupane I 123
selegiline decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.
- isavuconazonium sulfate
selegiline will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoniazid
selegiline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.
- isoproterenol
selegiline increases effects of isoproterenol by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.
- ivacaftor
selegiline increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .
- L-tryptophan
selegiline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
- lasmiditan
selegiline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.
- lemborexant
lemborexant will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Monitor CYP2B6 substrate for adequate clinical response. Consider increasing the CYP2B6 substrate dose according to specific prescribing recommendations.
selegiline will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification. - levorphanol
selegiline increases toxicity of levorphanol by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- lithium
selegiline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
- lomitapide
selegiline increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.
- loxapine
selegiline, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- loxapine inhaled
selegiline, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lumacaftor/ivacaftor
lumacaftor/ivacaftor, selegiline. affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2B6 substrates. .
- lurasidone
lurasidone, selegiline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed. Risk of seizures may increase.
selegiline, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - maraviroc
maraviroc, selegiline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- mavacamten
selegiline will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- midazolam intranasal
selegiline will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
midazolam intranasal, selegiline. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect. - mifepristone
mifepristone will increase the level or effect of selegiline by Other (see comment). Use Caution/Monitor. Inhibits CYP2C8/2C9/2B6; use smallest recommended dose for substrates and monitor
- modafinil
selegiline increases effects of modafinil by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode. Use caution when administering MAOIs and modafinil.
- molindone
selegiline, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- morphine
selegiline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- naratriptan
naratriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- nevirapine
nevirapine will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- norepinephrine
selegiline increases effects of norepinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.
- olanzapine
selegiline, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- oliceridine
selegiline, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
- oxycodone
selegiline increases toxicity of oxycodone by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- oxymorphone
selegiline increases toxicity of oxymorphone by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- paliperidone
selegiline, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pentazocine
selegiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- perphenazine
selegiline, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- phenylephrine
selegiline increases effects of phenylephrine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.
- pimavanserin
selegiline, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pimozide
selegiline, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- quetiapine
selegiline, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- remifentanil
remifentanil increases toxicity of selegiline by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- rifampin
rifampin will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
- risperidone
selegiline, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- rizatriptan
rizatriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- SAMe
selegiline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely. Routine addition of SAM-e to other conventional antidepressant medications, especially MAOIs is not recommended.
- sparsentan
sparsentan will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. Sparsentan (a CYP2B6 inducer) decreases exposure of CYP2B6 substrates and reduces efficacy related to these substrates.
- stiripentol
stiripentol, selegiline. affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP2B6 inhibitor and inducer. Monitor CYP2B6 substrates coadministered with stiripentol for increased or decreased effects. CYP2B6 substrates may require dosage adjustment.
- sufentanil
selegiline increases toxicity of sufentanil by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- sumatriptan
sumatriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- sumatriptan intranasal
sumatriptan intranasal and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- tapentadol
selegiline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- tazemetostat
selegiline will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- teriflunomide
teriflunomide increases levels of selegiline by Other (see comment). Use Caution/Monitor. Comment: Teriflunomide inhibits CYP2C8; caution when coadministered with CYP2C8 substrates.
- thiothixene
selegiline, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- tinidazole
selegiline will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tolazamide
selegiline increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- tolbutamide
selegiline increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.
- trifluoperazine
selegiline, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- tyramine
selegiline increases effects of tyramine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode. Tyramine containing foods include cheese, red wine, caviar, herring, canned figs, fermented meats, fava beans, yeast extracts, miso, avocado.
- ziprasidone
selegiline, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- zolmitriptan
zolmitriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
Minor (2)
- ruxolitinib
selegiline will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib topical
selegiline will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
Adverse Effects
>10%
Dyskinesia
Nausea (20%)
1-10%
Abdominal pain
Dry mouth
Frequency Not Defined (selected)
Arrhythmias
Confusion
EPS
Generalized pain
Hallucinations
Headache
HTN
Insomnia
Mood changes
Orthostatic hypotension
Syncope
Urinary retention
Vomiting
Postmarketing Reports
Suicidal thoughts and behaviors
Serotonin syndrome
Blood pressure elevation
Activation of mania/hypomania
External heat
Warnings
Contraindications
Hypersensitivity
Concomitant use of opioids (eg, meperidine and derivatives, methadone, or tramadol) and other MAO inhibitors, including selective MAO-B inhibitors or other drugs in the MAO class, including linezolid, an oxazolidinone antibacterial
Within 14 days of taking opioids, another MAO inhibitor, or other drugs in the MAO class
Concomitant use of St. John’s wort or cyclobenzaprine (a tricyclic muscle relaxant).
Concomitant use of dextromethorphan
Cautions
Prescriptions should be written for the smallest quantity consistent with good patient care
May potentiate dopaminergic side effects of levodopa and cause dyskinesia or exacerbate preexisting dyskinesia, which may, in turn, require a reduction of levodopa dose
In patients with bipolar disorder, treating a depressive episode may precipitate a mixed/manic episode; prior to initiating treatment, screen patients for any personal or family history of bipolar disorder, mania, or hypomania
Risk of melanoma development increased in Parkinson disease patients; monitor patients closely
Drug contains phenylalanine, a component of aspartame; each 1.25 mg tablet contains 1.25 mg phenylalanine; patients taking the 2.5 mg dose will receive 2.5 mg phenylalanine; before prescribing drug to a patient with PKU, consider combined daily amount of phenylalanine from all sources, including therapy
Concomitant use of dextromethorphan, may result in episodes of psychosis or bizarre behavior
Orthostatic hypotension may occur; incidence of orthostatic hypotension reported to be higher in geriatric patients ≥65 years
Irritation of buccal mucosa may occur
- Patients may experience new or worsening mental status and behavioral changes, which may be severe, including psychotic-like behavior during treatment or after starting or increasing the dose
- A symptom complex resembling neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability), with no other obvious etiology, reported in association with rapid dose reduction, withdrawal of, or changes in antiparkinsonian therapy
Compulsive behaviors
- Patients can experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and the inability to control these urges while taking one or more of the medications, including selegiline, that increase central dopaminergic tone and that are generally used for the treatment of Parkinson’s disease
- In some cases, although not all, these urges have been reported to have stopped when dose was reduced or medication was discontinued; because patients may not recognize these behaviors as abnormal, it is important for prescribers to specifically ask patients or their caregivers about development of new or increased gambling urges, sexual urges, uncontrolled spending, binge eating, or other urges while being treated with the medication; physicians should consider dose reduction or stopping medication if patient develops such urges while receiving therapy
Hallucination/psychotic-like behavior
- This abnormal thinking and behavior can consist of one or more of a variety of manifestations including paranoid ideation, delusions, hallucinations, confusion, psychotic-like behavior, disorientation, aggressive behavior, agitation, and delirium
- Patients with a major psychotic disorder should ordinarily not be treated with selegiline because of risk of exacerbating psychosis; in addition, certain medications used to treat psychosis may exacerbate symptoms of Parkinson's disease and may decrease effectiveness of selegiline
Hypertension
- May cause exacerbation of hypertension and orthostatic hypotension; use with caution in patients at risk for this effect of those who do not tolerate transient hypotensive episode
- Hypertensive reactions associated with ingestion of tyramine-containing foods reported even in patients taking recommended daily dose of swallowed selegiline, a dose which is generally believed to be selective for MAOB; selectivity for MAO-B inhibition is gradually lost with increasing daily doses
- An increase in tyramine sensitivity for blood pressure responses appears to begin at dose of 5 mg daily; however, precise dose at which drug becomes a non-selective inhibitor of all MAO enzymes in individual patients is unknown
- The safe use at doses above 2.5 mg daily without dietary tyramine restrictions has not been established
- Uncontrolled hypertension reported when taking recommended dose of swallowed selegiline and a sympathomimetic medication (ephedrine)
- After starting therapy, monitor patients for new onset hypertension or exacerbation of hypertension not adequately controlled
Serotonin syndrome
- Serotonin syndrome and hyperpyrexia reported with combined treatment of an antidepressant (eg, selective serotonin reuptake inhibitors-SSRIs, serotonin-norepinephrine reuptake inhibitors-SNRIs, tricyclic antidepressants, tetracyclic antidepressants, triazolopyridine antidepressants) and a non-selective MAOI (eg, phenelzine, tranylcypromine) or selective MAO-B inhibitors
- Avoid the combination with any antidepressant; at least 14 days should elapse between discontinuation of selegiline therapy and initiation of treatment with a SSRI, SNRI, tricyclic, tetracyclic, or triazolopyridine antidepressant; in patients taking antidepressants with a long half-life (eg, fluoxetine and its active metabolite), allow at least five weeks (perhaps longer, especially if fluoxetine has been prescribed chronically and/or at higher doses) to elapse between discontinuation of fluoxetine and initiation of selegiline
- Serotonin syndrome is a potentially serious condition, which can result in death; typical clinical signs and symptoms include behavioral and cognitive/mental status changes (eg, confusion, hypomania, hallucinations, agitation, delirium, headache, and coma), autonomic effects (eg, syncope, shivering, sweating, high fever/hyperthermia, hypertension, hypotension, tachycardia, nausea, diarrhea), and somatic effects (eg, muscular rigidity, myoclonus, muscle twitching, hyperreflexia manifested by clonus, and tremor)
- In the post-marketing period, fatal and non-fatal cases of serotonin syndrome reported in patients treated with antidepressants concomitantly with selegiline disintegrating tablets
Daily living and somnolence
- Patients with Parkinson’s disease treated with selegiline or other drugs increasing dopaminergic tone have reported falling asleep while engaged in activities of daily living, including operation of motor vehicles, which sometimes resulted in accidents; although many of these patients reported somnolence, some did not perceive warning signs, such as excessive drowsiness, and believed that they were alert immediately prior to the event; some of these events have been reported as late as one year after initiation of treatment
- It has been reported that falling asleep while engaged in activities of daily living always occurs in a setting of pre-existing somnolence, although patients may not give such a history; for this reason, prescribers should reassess patients for drowsiness or sleepiness especially since some of the events occur well after start of treatment
- Somnolence may occur in patients receiving selegiline; increased risk for somnolence in geriatric patients (≥65 years) vs. non-geriatric patients treated with selegiline
- Prescribers should also be aware that patients may not acknowledge drowsiness or sleepiness until directly questioned about drowsiness or sleepiness during specific activities
- Patients should be advised to exercise caution while driving, operating machines, or working at heights during treatment with selegiline; patients who have already experienced somnolence and/or an episode of sudden sleep onset should not participate in these activities during treatment with selegiline
- Before initiating treatment, advise patients about potential to develop drowsiness and specifically ask about factors that may increase this risk, such as concomitant sedating medications and presence of sleep disorders; if a patient develops daytime sleepiness or episodes of falling asleep during activities that require active participation (eg, conversations, eating, etc), therapy should ordinarily be discontinued
- If a decision is made to continue selegiline, patients should be advised not to drive and to avoid other potentially dangerous activities; there is insufficient information to establish whether dose reduction will eliminate episodes of falling asleep while engaged in activities of daily living
Pregnancy & Lactation
Pregnancy
The available data on use in pregnant women are not sufficient to inform a drug-associated risk of adverse pregnancy-related outcomes; When treating a pregnant woman, the physician should carefully consider both the potential risks of taking an MAOI, particularly the risk of hypertensive crisis during pregnancy, along with the established benefits of treating depression with an antidepressant
Animal data
- In animal studies, administration of drug during pregnancy was associated with developmental toxicity (decreased embryofetal and postnatal offspring growth and survival) at doses greater than those used clinically
Lactation
There is no information regarding presence in human milk, or effects on milk production or breastfed infant; selegiline and metabolites were detected in rat milk at levels higher than those in maternal plasma; because of potential for serious adverse reactions in breastfed infants from therapy, including potential for hypertensive crisis, advise a woman that breastfeeding is not recommended during treatment and for 7 days after final dose
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Selective MAO-B inhibitor; may increase dopaminergic activity by interfering with dopamine reuptake at the synapse.
Pharmacokinetics
Peak plasma time: (conventional) 0.5-0.9 hr; (ODT) 15-40 min
Concentration: (conventional, 5 mg) 0.9-2.7 ng/mL; (ODT, 1.25 /2.5 mg) 3.34/4.47 ng/mL
Half-life elimination: 10 hr (PO); 18-25hr (TD)
Onset of action: Within 1 hr
Duration: 24-72hr (PO)
Bioavailability: 10%
Protein Bound: 90%
Vd: 300 L
Metabolism: cytochrome P-450 enzymes
Metabolites: L-amphetamine, L-desmethylselegiline, L-methamphetamine
Excretion: Urine
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Emsam transdermal - | 9 mg/24 hr transdermal system |  | |
| Emsam transdermal - | 6 mg/24 hr transdermal system |  | |
| Emsam transdermal - | 12 mg/24 hr transdermal system |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
selegiline transdermal
SELEGILINE - TRANSDERMAL
(seh-LEDGE-uh-leen)
COMMON BRAND NAME(S): Emsam
WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.This medication must not be used by children younger than 12 years due to an increased risk of serious side effects (such as extremely high blood pressure). Also, this medication is not recommended for use by children between 12 and 17 years old. Studies have not shown it to work in children in this age group.
USES: See also Warning section.This medication is used to treat depression. Selegiline belongs to a class of drugs known as monoamine oxidase inhibitors (MAO inhibitors). It works by helping to restore the balance of certain natural substances in the brain. This medication is a patch for use on the skin.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using selegiline and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Follow the package instructions for using this medication. Make sure you understand how to apply a new patch and dispose of the used product. Do not cut the patch into smaller sizes. Do not use the patch if it appears broken, cut or damaged. If you have any questions, consult your doctor or pharmacist.Before applying the patch, wash the area you will be using for the patch gently and thoroughly with soap and water. Rinse and dry with a clean dry towel. Do not apply the patch to hairy/oily/red/cut/irritated/broken or scarred/calloused skin. Remove the patch from the foil pouch and apply as directed by the manufacturer. Apply one patch to an area of clean dry skin on the upper body (torso), upper thigh, or on the outside of the upper arm where it will not be rubbed by tight clothing. Change the patch daily at about the same time each day. Apply the patch to a different area on your body each time to avoid irritation. If your patch falls off, apply a new patch to a new area and continue on your same schedule.Be sure to remove the old patch, fold it in half so it sticks to itself, and throw it away out of the reach of children and pets. Do not touch the sticky side with your fingers. Wash your hands with soap and water after handling the patch.To reduce your risk of side effects, your doctor may start you at a low dose and gradually increase your dose. Once your condition improves and you are better for a while, your doctor may work with you to reduce your regular dose. Follow your doctor's instructions carefully. Do not apply more patches or leave the patch on for longer than prescribed. Your condition will not improve any faster and your risk of side effects will increase.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day. It may take several weeks for the full benefits of this medication to be noticed. Do not stop using this medication without consulting your doctor.Inform your doctor if your condition lasts or gets worse.
SIDE EFFECTS: See also Warning section.Dizziness, drowsiness, redness/irritation at the application site, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, mental/mood changes (such as agitation, confusion), muscle stiffness/twitching, changes in sexual ability/interest, shaking (tremor), swollen ankles/legs, unusual weight gain/loss, eye pain/swelling/redness, vision changes (such as double/blurred vision), seizures.This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (See also Drug Interaction section.) Stop using selegiline and get medical help right away if any of these very serious side effects occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, sudden sensitivity to light (photophobia).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take. Get medical help right away if you develop some of the following symptoms: hallucinations, unusual restlessness, loss of coordination, fast heartbeat, severe dizziness, unexplained fever, severe nausea/vomiting/diarrhea, twitching muscle.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using selegiline, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (such as stroke), heart problems (such as heart failure, heart attack), personal or family history of high blood pressure, history of severe/frequent headaches, personal/family history of mental/mood disorders (such as bipolar disorder, depression, schizophrenia), liver problems, certain nervous system diseases (Parkinson's syndrome, seizures), overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Avoid exposing your skin to direct heat sources such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, or prolonged direct sunlight while wearing your selegiline patch. Heat sources may cause more drug to be released into your body, increasing the chance of side effects.If you are going to have an MRI test, tell testing personnel that you are using this patch. Some patches may contain metals that can cause serious burns during an MRI. Ask your doctor whether you will need to remove your patch before the test and apply a new patch afterward, and how to do so properly.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). You may need to stop using selegiline before surgery. Follow your doctor's instructions carefully.Older adults may be more sensitive to the side effects of this drug, especially the effects on blood pressure.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Since untreated mental/mood problems (such as depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breastfeeding is not recommended while using this drug and for 5 days after the last dose. Consult your doctor before breastfeeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with selegiline include: antidepressants (including bupropion, maprotiline, mirtazapine), other MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, tranylcypromine), appetite suppressants (such as diethylpropion), drugs for attention deficit disorder (such as atomoxetine, methylphenidate), apraclonidine, buspirone, carbamazepine/oxcarbazepine, cyclobenzaprine, deutetrabenazine, certain herbal products (such as ephedra/ma huang), cold medications/nasal decongestants (such as phenylephrine, phenylpropanolamine, pseudoephedrine), fentanyl, metoclopramide, street drugs (such as LSD, mescaline), stimulants (such as amphetamines, ephedrine), supplements (such as tryptophan, tyramine), tetrabenazine, certain "triptans" used to treat migraine headaches (such as rizatriptan, sumatriptan, zolmitriptan), valbenazine.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, dextromethorphan, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine, TCAs such as amitriptyline/doxepin), certain opioid medications (such as meperidine, methadone, pentazocine, propoxyphene, tramadol, tapentadol), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Tell your doctor or pharmacist if you are using any of these medications before, during, or within 2 weeks after treatment with selegiline. Tell your doctor or pharmacist if you have taken fluoxetine during at least 5 weeks before starting selegiline. Discuss with your doctor how much time to wait between starting or stopping any of these drugs and taking selegiline.Check the labels on all your medicines (such as allergy, cough-and-cold products, diet pills) because they may contain dextromethorphan, decongestants, or stimulants. Ask your pharmacist about the safe use of those products.It is very important that you follow special dietary restrictions in order to limit the amount of tyramine in your diet if you are using the higher strength patches (9 or 12 milligrams). Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate. Caffeine can increase the side effects of this medication. Foods and beverages high in tyramine should be avoided while you are using this medication and for at least 2 weeks after you stop using this medication.Foods high in tyramine include: aged cheeses (cheddar, camembert, emmenthaler, brie, stilton blue, gruyere, gouda, brick, bleu, roquefort, boursault, parmesan, romano, provolone, liederdranz, colby, edam), aged/dried/fermented/salted/smoked/pickled/processed meats and fish (includes bacon, summer sausage, liverwurst, hot dogs, corned beef, pepperoni, salami, bologna, ham, mortadella, pickled or dried herring), banana peel, beef/chicken liver (stored, not fresh), bouillon cubes, commercial gravies, concentrated yeast extracts, fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread, kim chee (Korean fermented cabbage), orange pulp, overripe or spoiled fruits, packaged soups, red wine, sauerkraut, sherry, snow pea pods, sourdough bread, soy sauce, soybeans, soybean paste/miso, tofu, tap beer and ale, vermouth.Moderate-to-low tyramine content foods include: alcohol-free beer, avocados, bananas, bottled beer and ale, chocolate and products made with chocolate, coffee, cola, cultured dairy products (such as buttermilk, yogurt, sour cream), distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.Get medical help right away if you notice symptoms of high blood pressure such as fast/slow heartbeat, vomiting, sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, or trouble speaking.Contact your healthcare professionals (such as doctor, pharmacist, dietician) for more information, including recommendations for your diet.This medication may interfere with certain medical/lab tests (such as brain scan for Parkinson's disease), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: This medication patch may be harmful if chewed or swallowed. If someone has overdosed, remove the patch if possible. For serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood pressure) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, use it as soon as you remember unless it is close to the time for your next dose. In that case, skip the missed dose. Use your next dose at the regular time. Do not apply 2 doses to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not open the foil pouch until you are ready to use the patch. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed (See also How to Use section). Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised May 2024. Copyright(c) 2024 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
