Generic name: selegiline (oral) (se LE ji leen)
Brand name: Eldepryl, Zelapar
Dosage forms: oral capsule (5 mg); oral tablet (5 mg); oral tablet, disintegrating (1.25 mg)
Drug class: Dopaminergic antiparkinsonism agents, Monoamine oxidase inhibitors
Selegiline prevents the breakdown of a chemical in your brain called dopamine (DO pa meen). Low levels of this chemical are associated with Parkinson's disease.
Selegiline is used together with other medicines to treat symptoms of Parkinson's disease.
Selegiline may also be used for purposes not listed in this medication guide.
Warnings
Serious drug interactions can occur when certain medicines are used together with selegiline. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.
Before taking this medicine
You should not use selegiline if you are allergic to it, or if you have taken fluoxetine (Prozac, Sarafem and others) within the past 5 weeks.
Some medicines can cause unwanted or dangerous effects when used with selegiline. Your doctor may need to change your treatment plan if you use any of the following drugs:
- cough medicine that contains dextromethorphan;
- cyclobenzaprine (Flexeril);
- meperidine (Demerol) or other narcotic (opioid) pain medicine;
- methadone;
- St. John's wort;
- tramadol (Ultram, Ultracet);
- an antidepressant--citalopram, desvenlafaxine, duloxetine, escitalopram, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, venlafaxine, vilazodone, vortioxetine, and others; or
- an MAO inhibitor--isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
After you stop taking selegiline, you must wait at least 14 days before taking any of the medications listed above.
To make sure selegiline is safe for you, tell your doctor if you have:
- liver or kidney disease;
- high blood pressure; or
- phenylketonuria (selegiline orally disintegrating tablets may contain phenylalanine).
People with Parkinson's disease may have a higher risk of skin cancer (melanoma). Talk to your doctor about this risk and what skin symptoms to watch for.
It is not known whether selegiline will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether selegiline passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
How should I take selegiline?
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended. Do not change your doses or medication schedule without your doctor's advice.
Selegiline capsules are usually taken twice a day, at breakfast and lunch. Follow your doctor's instructions.
The disintegrating tablet form of selegiline (Zelapar) should be taken once a day before breakfast and without any liquid.
While you are using selegiline and for 14 days after you stop, you must not eat foods listed in the "What should I avoid while using selegiline?" section of this leaflet. Eating these foods while you are using selegiline can raise your blood pressure to dangerous levels.
Foods that you MAY eat include:
- fresh meat, poultry, or fish (including lunch meat, hot dogs, breakfast sausage, and cooked sliced ham);
- any vegetables except broad bean pods (fava beans);
- processed cheese, mozzarella, ricotta, cottage cheese;
- pizza made with cheeses low in tyramine;
- soy milk, yogurt; or
- Brewer's or baker's yeast.
To take selegiline orally disintegrating tablets (Zelapar):
- Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.
- Using dry hands, remove the tablet and place it on your tongue. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves.
- Do not drink or eat anything for at least 5 minutes after taking a Zelapar orally disintegrating tablet.
Do not stop taking selegiline suddenly or you may have harmful side effects. For best results, keep taking the medicine as prescribed.
Store this medicine at room temperature away from moisture and heat.
Keep each Zelapar tablet in the foil blister pack until you are ready to take it. Throw away any Zelapar tablets not used within 3 months after you have opened the pouch containing the blister pack.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include severe headache, hallucinations, vision problems, sweating, cool or clammy skin, fast or uneven heart rate, feeling light-headed, fainting, or seizure (convulsions).
What should I avoid while taking selegiline?
Avoid drinking alcohol while you are taking selegiline.
While taking selegiline and for 14 days after you stop, you must NOT eat foods that are high in tyramine, including:
- air dried meats, aged or fermented meats, sausage or salami (including cacciatore and mortadella), pickled herring;
- any spoiled or improperly stored beef, poultry, fish, or liver;
- beer from a tap, beer that has not been pasteurized;
- aged cheeses (such as blue, Swiss, cheddar, Parmesan, or Romano cheese);
- over-the-counter supplements or cough and cold medicines that contain tyramine;
- sauerkraut, soy beans, soy sauce, tofu, fava beans; or
- yeast extracts (such as Marmite).
Eating tyramine while you are using selegiline can raise your blood pressure to dangerous levels which could cause life-threatening side effects. You should become very familiar with the list of foods to avoid while you are using selegiline.
Selegiline may impair your thinking or reactions. Some people taking selegiline have fallen asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Be careful if you drive or do anything that requires you to be alert.
Selegiline side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- trouble breathing;
- confusion, hallucinations, unusual thoughts or behavior;
- increased tremors or uncontrolled muscle movements;
- worsening side effects of your other medications;
- high levels of serotonin in the body (when taken with an antidepressant)--agitation, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting; or
- dangerously high blood pressure--severe headache, blurred vision, pounding in your neck or ears, anxiety, nausea, vomiting, severe chest pain, shortness of breath, pounding heartbeats, or seizure (convulsions).
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medicine. Talk with your doctor if this occurs.
Common side effects may include:
- dizziness;
- nausea, stomach pain, constipation;
- skin rash or other irritation;
- sleep problems (insomnia); or
- mouth sores or ulcers, pain with swallowing (while using selegiline orally disintegrating tablets).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Selegiline dosing information
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)
What other drugs will affect selegiline?
Many drugs can interact with selegiline, and some drugs should not be used together. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with selegiline. Give a list of all your medicines to any healthcare provider who treats you.