Selegiline

By Medically reviewed by hellodoktor

Generic Name: Selegiline Brand Name(s): Selegiline.

Uses

What is Selegiline used for?

Selegiline is used to treat movement disorders caused by Parkinson’s disease. It does not cure Parkinson’s disease, but it may improve shakiness (tremor), muscle stiffness, loss of normal movement as your dose of other Parkinson’s medication wears off (end-of-dose failure), and sudden switching between normal movement and stiffness (“on-off” problems). It may improve your range of motion and ability to walk, dress, and exercise. Selegiline is usually used in combination with other medicines (e.g., levodopa, carbidopa).

Selegiline is an enzyme blocker (MAO inhibitor) that works by slowing the breakdown of certain natural substances in the brain (neurotransmitters such as dopamine, norepinephrine, and serotonin).

How should I take Selegiline?

Take this medication by mouth, usually twice daily with breakfast and lunch. Taking selegiline late in the day may cause trouble sleeping. Dosage is based on your medical condition and response to therapy. Do not increase your dose or take it more often than directed.

After you have been taking selegiline for 2 or 3 days, your doctor may direct you to lower your levodopa dose. Follow your doctor’s instructions closely. Do not stop or change the dose of any of your medications without first talking with your doctor.

It may take a few weeks for the full benefits of the drug to be noticed. Do not stop taking this drug without first consulting your doctor. Talk with your doctor if the medication stops working well or if your condition worsens.

How do I store Selegiline?

Selegiline is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Selegiline in the bathroom or the freezer. There may be different brands of Selegiline that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Selegiline down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Selegiline?

Before taking 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 (e.g., stroke), heart problems (e.g., congestive heart failure, heart attack), bleeding problems, history of severe/frequent headaches, peptic ulcer, diabetes, personal/family history of mental/mood disorders (e.g., schizophrenia, bipolar disorder), personal/family history of high blood pressure, liver disease, overactive thyroid (hyperthyroidism).

This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

To minimize dizziness and the risk of fainting, get up slowly when rising from a sitting or lying position.

Before having surgery, tell your doctor or dentist you are taking this medication. You may need to stop taking this drug beforehand. Follow your doctor’s instructions carefully.

Selegiline should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.

It is not known if this drug passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Selegiline during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Selegiline. Selegiline is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Selegiline?

Dizziness, abdominal pain, dry mouth, nausea, stomach upset, trouble sleeping, and headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

If you are also taking levodopa, you may experience more side effects from the levodopa when taking selegiline. Tell your doctor right away if any of these side effects occur: nausea, shakiness, muscle stiffness, mental/mood changes such as hallucinations/abnormal dreams. Your doctor may need to change your medication or dose. Do not stop or change the dose of your levodopa without talking with your doctor first.

Remember that your doctor has prescribed this medication because he or she 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.

Some people taking selegiline have fallen asleep suddenly during their usual daily activities (such as talking on the phone, driving). In some cases, sleep occurred without any feelings of drowsiness beforehand. This sleep effect may occur anytime during treatment with selegiline even if you have used this medication for a long time. If you experience increased sleepiness or fall asleep during the day, do not drive or take part in other possibly dangerous activities until you have discussed this effect with your doctor. Your risk of this sleep effect is increased by using alcohol or other medications that can make you drowsy. See also Precautions section.

Tell your doctor right away if you have any serious side effects, including: fainting, loss of balance, mental/mood changes (e.g., agitation, confusion, depression, hallucinations), unusual strong urges (such as increased gambling, increased sexual urges), worsening muscle stiffness/twitching, changes in sexual ability/interest, increased shaking (tremor), swollen ankles/legs, difficulty urinating, unusual weight gain, easy bleeding/bruising, black/tarry stools, vomit that looks like coffee grounds.

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. Get medical help right away if any of these 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, vision changes (e.g., double/blurred vision), 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.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Selegiline?

Some products that may interact with selegiline include: antidepressants (including bupropion, maprotiline, mirtazapine), other MAO inhibitors (isocarboxazid, linezolid, 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, 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 narcotic 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.

To prevent a very serious high blood pressure reaction, it is very important that you follow a special diet recommended by your doctor or dietician in order to limit your intake of tyramine while you are taking this medicine. Avoid foods and beverages that are high in tyramine, including: aged cheeses (e.g., bleu, cheddar, parmesan), dried/aged/fermented meats and sausages (e.g., salami, liverwurst), preserved fish (e.g., pickled herring), products containing large amounts of yeast (e.g., concentrated yeast extract, bouillon cubes, powdered soup/gravy, homemade or sourdough bread), fermented foods (e.g., sauerkraut, kim chee), most soybean products (e.g., soy sauce, tofu), broad/fava beans, red wine, sherry, tap beers, vermouth. Limit or avoid foods that are moderate in tyramine, including: avocados, bananas, eggplant, green beans, raisins, raspberries, red plums, spinach, tomatoes, chocolate, cultured dairy products (e.g., buttermilk, yogurt, sour cream), fish eggs, pate, peanuts, coffee, cola, alcohol-free beer, bottled beer, distilled spirits, port, white wine. Consult your doctor or dietician for more details and a complete list of other tyramine-containing foods you should limit or avoid. Seek immediate medical attention if you notice symptoms of very high blood pressure such as unusually fast/slow heartbeat, vomiting, unexplained sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, slurred speech.

This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson’s disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Selegiline may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Selegiline?

Selegiline may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Selegiline?

Selegiline may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Selegiline.

What is the dose of Selegiline for an adult?

Usual Adult Dose for Parkinson’s Disease

Oral tablet:

Recommended dose: 5 mg orally twice a day

Maximum dose: 10 mg orally per day

Oral disintegrating tablet:

Initial dose: 1.25 mg orally once a day for at least 6 weeks. After 6 weeks, the dose may be increased to 2.5 mg orally once a day if needed.

Maintenance dose: 1.25 to 2.5 mg orally once a day

Maximum dose: 2.5 mg orally once a day

Comments:

-After two to three days of treatment, an attempt may be made to reduce the dose of concomitant levodopa-carbidopa by 10% to 30%. Further reductions may be possible during continued selegiline therapy.

Use: Adjunct in the management of Parkinson’s disease patients being treated with levodopa-carbidopa who exhibit deterioration in the quality of their response to this therapy.

Usual Adult Dose for Depression

Initial dose: Apply one 6 mg/24 hours transdermal patch to intact skin once every 24 hours

Maintenance dose: One 6 mg/24 hours to 12 mg/24 hours transdermal patch applied to the skin once a day

Maximum dose: 12 mg/24 hours transdermal patch applied to the skin once a day

Comments:

-Episodes of depression may require several months or more of sustained pharmacologic therapy

-If dose adjustments are necessary, they should be made in increments of 3 mg/24 hours at intervals of at least 2 weeks

-Full antidepressant effect may be delayed

Use: Treatment of major depressive disorder (MDD)

Renal Dose Adjustments

Orally disintegrating tablets:

-Mild to moderate renal dysfunction (CrCl 30 to 89 mL/min): No adjustment recommended

-Severe renal dysfunction and end-stage renal disease (CrCl less than 30 mL/min): Use is not recommended

Transdermal patch:

-Mild to severe renal dysfunction (CrCl 15 to 89 mL/min/1.73 m3): No adjustment recommended

-End-stage renal disease (CrCl less than 15 mL/min/1.73 m3): Data not available

Liver Dose Adjustments

Orally disintegrating tablets:

-Mild to moderate liver dysfunction (Child-Pugh 5 to 9): 1.25 mg orally once a day

-Severe liver dysfunction (Child-Pugh greater than 9): Use is not recommended

Transdermal patch:

-Mild to moderate liver dysfunction (Child-Pugh 5 to 9): No adjustment recommended

Other Comments

Administration advice:

-Oral tablet: Doses should be taken with food, at breakfast and lunch

-Orally disintegrating tablets: Patients should avoid ingesting food or liquids for 5 minutes before and after taking a dose

-Transdermal patch: Follow the detailed instructions in the medication guide. Patches should be applied to dry intact skin on the upper torso, upper thigh, or the outer surface of the upper arm. Rotate application sites; avoid reapplication to the same site on consecutive days.

Storage requirements:

-Orally disintegrating tablet: Once opened, unused tablets must be disposed of after 3 months.

General:

-Treatment should be periodically reevaluated

-This drug interacts with other drugs; prescribers should be aware for the potential for interactions. A washout period may be required between ceasing selegiline and commencing other medicines and vice versa.

-Dietary modifications are recommended in patients taking either selegiline transdermal 9 mg/24 hours or 12 mg/24 hours patches. Tyramine-rich foods and beverages should be avoided beginning on the first day of the 9 mg/24 hours or 12 mg/24 hours patch and for 2 weeks after either a dose reduction to 6 mg/24 hours or following discontinuation of the higher strength patches. Foods and drinks containing little to no tyramine are acceptable; the manufacturer product information should be consulted.

Monitoring:

-Cardiovascular: Blood pressure, tyramine-induced hypertensive crisis

-Nervous system: Exacerbation of dyskinesia (if used concomitantly with levodopa)

-Oncologic: Melanoma

-Psychiatric: Impulse disorders, falling asleep during activities of daily living, somnolence, emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior

Patient advice:

-Tell your healthcare provider about all of the medicines that you take, including prescription and non-prescription medicines.

-This medicine may increase the risk of suicidal thoughts and behavior. Be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Report any behavior of concern to your healthcare provider as soon as possible.

-There have been reports of patients experiencing intense urges to gamble, increased sexual urges, and other intense urges, and the inability to control these urges while taking one or more of the medicines used to treat Parkinson’s disease. Be alert for the emergence of these urges. Report any behavior of concern to your healthcare provider as soon as possible.

-Tyramine-rich foods, beverages, and nutritional supplements should be avoided when using the 9 mg/24 hours or 12 mg/24 hours patch.

-Immediately contact your doctor if you experience severe headache, neck stiffness, heart racing or palpitations, or other sudden unusual symptoms.

-Avoid exposing the selegiline transdermal patch application site to external sources of direct heat, such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, and prolonged direct sunlight.

-This medicine may cause drowsiness, impaired judgment, thinking, or motor skills; do not drive a car or operate dangerous machinery until you know how this drug affects you. Contact your doctor if you experience daytime sleepiness or episodes of falling asleep during activities that require participation (e.g., eating).

-Concomitant ingestion of alcohol is not advised.

What is the dose of Selegiline for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Selegiline available?

Selegiline is available in the following dosage forms and strengths:

  • Oral tablet,
  • Oral tablet, disintegrating,
  • Oral capsule,
  • Compounding powder,
  • Transdermal film, extended release.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Selegiline, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 26, 2018 | Last Modified: September 12, 2019

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