selegiline (Rx)

Brand and Other Names:Eldepryl, Zelapar
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Dosing & Uses

AdultPediatricGeriatric

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

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Interactions

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            Contraindicated (58)

            • 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

            • 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.

            • 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.

            • 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.

            • 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.

            • vortioxetine

              selegiline increases toxicity of vortioxetine by serotonin levels. Contraindicated.

            Serious - Use Alternative (43)

            • abametapir

              abametapir will increase the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP2B6 substrates. If not feasible, avoid use of abametapir.

            • 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.

            • 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.

            Monitor Closely (104)

            • 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).

            • 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

              selegiline and cocaine 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.

            • 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.

            • 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.

            • 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).

            • 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.

            • 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.

            • 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.

            • 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 (1)

            • ruxolitinib

              selegiline will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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            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

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            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
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            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.

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            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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Emsam transdermal
            -
            12 mg/24 hr transdermal system
            Emsam transdermal
            -
            9 mg/24 hr transdermal system
            Emsam transdermal
            -
            6 mg/24 hr transdermal system

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            Patient Handout

            Patient Education
            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: Selegiline is an antidepressant (monoamine oxidase inhibitor) that treats depression by restoring the balance of certain natural substances (neurotransmitters) in the brain. Selegiline can improve your mood and feelings of well-being. This medication is a patch for use on the skin.

            HOW TO USE: Read the Medication Guide available from your pharmacist before you start using selegiline and each time you get a refill. If you have any questions, consult 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. Usually, your daily dose will not be more than 12 milligrams. 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 persists or worsens.

            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 persist or worsen, notify your doctor or pharmacist promptly.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 (e.g., agitation, confusion), muscle stiffness/twitching, changes in sexual ability/interest, shaking (tremor), shivering, swollen ankles/legs, unusual weight gain/loss, eye pain/swelling/redness, vision changes (e.g., double/blurred vision), severe stomach/abdominal pain, persistent nausea/vomiting, seizures, dark urine, yellowing eyes/skin.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: See also Warning section.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 (e.g., stroke), heart problems (e.g., congestive heart failure, heart attack), personal or family history of high blood pressure, history of severe/frequent headaches, personal/family history of mental/mood disorders (e.g., 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).To minimize dizziness and the risk of fainting, get up slowly when rising from a sitting or lying position.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 you are on this medication. You may need to stop using this drug beforehand. Follow your doctor's instructions carefully.Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the effects on blood pressure.This medication should be used only when clearly needed during pregnancy. 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, breast-feeding is not recommended while using this drug and for 5 days after the last dose. Consult your doctor before breast-feeding.

            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, 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 (e.g. 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.Tell your doctor or pharmacist 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 (e.g., doctor, pharmacist, dietician) for more information, including recommendations for your diet.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.

            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 their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., blood pressure) should be performed periodically to monitor your progress or check for side effects. 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 How to Use section).

            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 August 2021. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.