Dosing & Uses
Dosage Forms & Strengths
transdermal patch
- 6mg/24hr
- 9mg/24hr
- 12mg/24hr
Depression
1 patch qDay; apply at the same time each day
May increase by 3 mg/24 hr q2Weeks; not to exceed 12 mg/24 hr
Renal Impairment
Mild to moderate impairment: Dose adjustment not necessary
Hepatic Impairment
Mild to moderate impairment: Dose adjustment not necessary
Safety & efficacy not established
Depression
Transdermal: 6 mg
The overall frequency of adverse reactions and of certain types of adverse reactions was increased in elderly patients compared with nonelderly patients
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (58)
- apraclonidine
selegiline transdermal, apraclonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
- armodafinil
selegiline transdermal increases effects of armodafinil by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- atomoxetine
selegiline transdermal increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- benzphetamine
selegiline transdermal increases effects of benzphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- brimonidine
selegiline transdermal, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
- bupropion
selegiline transdermal 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
- buspirone
selegiline transdermal, buspirone. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- caffeine
selegiline transdermal increases effects of caffeine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- carbamazepine
carbamazepine increases toxicity of selegiline transdermal by unknown mechanism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- citalopram
selegiline transdermal 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.
- cyproheptadine
selegiline transdermal, 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.
- desvenlafaxine
selegiline transdermal 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 transdermal, 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.
- dexfenfluramine
selegiline transdermal increases effects of dexfenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- dexmethylphenidate
selegiline transdermal increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- dextroamphetamine
selegiline transdermal increases effects of dextroamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- diethylpropion
selegiline transdermal increases effects of diethylpropion by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- dobutamine
selegiline transdermal increases effects of dobutamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- dopamine
selegiline transdermal increases effects of dopamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- ephedrine
selegiline transdermal increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- epinephrine
selegiline transdermal increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- fenfluramine
selegiline transdermal increases effects of fenfluramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- fentanyl
selegiline transdermal 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 transdermal 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 transdermal 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 transdermal 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. .
- isocarboxazid
selegiline transdermal and isocarboxazid both increase serotonin levels. Contraindicated.
- isometheptene
selegiline transdermal, isometheptene. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Hypertension, V tach.
- isoproterenol
selegiline transdermal increases effects of isoproterenol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- levodopa
selegiline transdermal, levodopa. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- levomilnacipran
selegiline transdermal and levomilnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use
- lisdexamfetamine
selegiline transdermal increases effects of lisdexamfetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
selegiline transdermal, 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 transdermal increases toxicity of meperidine by unknown mechanism. Contraindicated.
- methamphetamine
selegiline transdermal increases effects of methamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- methylenedioxymethamphetamine
selegiline transdermal increases effects of methylenedioxymethamphetamine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- methylphenidate
selegiline transdermal increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.
- methylphenidate transdermal
methylphenidate transdermal and selegiline transdermal both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.
- midodrine
selegiline transdermal increases effects of midodrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- modafinil
selegiline transdermal increases effects of modafinil by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- norepinephrine
selegiline transdermal increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- ozanimod
selegiline transdermal 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.
- phendimetrazine
selegiline transdermal increases effects of phendimetrazine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- phenelzine
selegiline transdermal and phenelzine both increase serotonin levels. Contraindicated.
- phentermine
selegiline transdermal increases effects of phentermine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- phenylephrine
selegiline transdermal increases effects of phenylephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- procarbazine
selegiline transdermal and procarbazine both increase serotonin levels. Contraindicated.
- propylhexedrine
selegiline transdermal increases effects of propylhexedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- pseudoephedrine
selegiline transdermal increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- safinamide
selegiline transdermal, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Coadministration increases risk of nonselective MAO inhibition, that may lead to hypertensive crisis. At least 14 days should elapse between discontinuating safinamide and initiating MAOIs.
- serdexmethylphenidate/dexmethylphenidate
selegiline transdermal increases effects of serdexmethylphenidate/dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- solriamfetol
selegiline transdermal 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.
- tetrabenazine
tetrabenazine increases effects of selegiline transdermal by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode; separate by 14 days. Mechanism: MAOI causes accumulation of NE in neuron and tetrabenazine stimulates NE release.
- tranylcypromine
selegiline transdermal and tranylcypromine both increase serotonin levels. Contraindicated.
- tyramine
selegiline transdermal increases effects of tyramine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Tyramine containing foods include cheese, red wine, caviar, herring, canned figs, fermented meats, fava beans, yeast extracts, miso, avocado.
- vilazodone
selegiline transdermal, 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 transdermal increases toxicity of vortioxetine by serotonin levels. Contraindicated.
- xylometazoline
selegiline transdermal increases effects of xylometazoline by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- yohimbine
selegiline transdermal increases effects of yohimbine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (73)
- alfentanil
selegiline transdermal increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- amitriptyline
selegiline transdermal and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- amoxapine
selegiline transdermal and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.
- belladonna and opium
selegiline transdermal increases toxicity of belladonna and opium by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- benzhydrocodone/acetaminophen
selegiline transdermal 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 transdermal increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- buprenorphine buccal
selegiline transdermal increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- buspirone
selegiline transdermal and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.
- butorphanol
selegiline transdermal increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- clomipramine
selegiline transdermal and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- codeine
selegiline transdermal increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- desipramine
selegiline transdermal and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- dextromethorphan
selegiline transdermal and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.
- dextromoramide
selegiline transdermal increases toxicity of dextromoramide by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- diamorphine
selegiline transdermal increases toxicity of diamorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- difenoxin hcl
selegiline transdermal increases toxicity of difenoxin hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- diphenoxylate hcl
selegiline transdermal increases toxicity of diphenoxylate hcl by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- dipipanone
selegiline transdermal increases toxicity of dipipanone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- dolasetron
dolasetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- dosulepin
selegiline transdermal and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.
- doxepin
selegiline transdermal and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.
- doxepin cream
selegiline transdermal increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- duloxetine
selegiline transdermal and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug.
- escitalopram
selegiline transdermal and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.
- fedratinib
selegiline transdermal 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 transdermal by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. Coadministration may decrease plasma concentrations of CYP2B6 substrates owing to fexinidazole inducing CYP2B6.
- fluoxetine
selegiline transdermal and fluoxetine both decrease serotonin levels. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and selegiline transdermal both increase serotonin levels. Avoid or Use Alternate Drug.
- granisetron
granisetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- hydrocodone
selegiline transdermal 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 transdermal increases toxicity of hydromorphone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- imipramine
selegiline transdermal and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- iobenguane I 131
selegiline transdermal 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.
- levodopa inhaled
levodopa inhaled increases effects of selegiline transdermal 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.
- levorphanol
selegiline transdermal increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- linezolid
selegiline transdermal 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.
- lofepramine
selegiline transdermal and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.
- lorcaserin
selegiline transdermal and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- maprotiline
selegiline transdermal and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.
- meperidine
selegiline transdermal and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
- metformin
selegiline transdermal will increase the level or effect of metformin by unspecified interaction mechanism. Avoid or Use Alternate Drug.
- methadone
selegiline transdermal increases toxicity of methadone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- methylene blue
selegiline transdermal 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 transdermal, 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 transdermal by Other (see comment). Avoid or Use Alternate Drug. Comment: Metoclopramide may enhance the hypertensive effect of monoamine oxidase inhibitors. - milnacipran
selegiline transdermal and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.
- morphine
selegiline transdermal increases toxicity of morphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- nalbuphine
selegiline transdermal increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- nefazodone
selegiline transdermal and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.
- netupitant/palonosetron
netupitant/palonosetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- nortriptyline
selegiline transdermal and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- ondansetron
ondansetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- opium tincture
selegiline transdermal increases toxicity of opium tincture by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- oxycodone
selegiline transdermal increases toxicity of oxycodone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- oxymorphone
selegiline transdermal increases toxicity of oxymorphone by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- palonosetron
palonosetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- papaveretum
selegiline transdermal increases toxicity of papaveretum by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- paroxetine
selegiline transdermal and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug.
- pentazocine
selegiline transdermal increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- protriptyline
selegiline transdermal and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.
- rasagiline
rasagiline and selegiline transdermal both increase serotonin levels. Avoid or Use Alternate Drug.
- sertraline
selegiline transdermal and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
- St John's Wort
selegiline transdermal and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.
- sufentanil
selegiline transdermal increases toxicity of sufentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- sufentanil SL
selegiline transdermal 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.
- tapentadol
selegiline transdermal increases toxicity of tapentadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- tedizolid
tedizolid, selegiline transdermal. 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.
- tramadol
selegiline transdermal increases toxicity of tramadol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- trazodone
selegiline transdermal and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.
- trimipramine
selegiline transdermal and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
selegiline transdermal 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 transdermal, 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.
- venlafaxine
selegiline transdermal and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
selegiline transdermal 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
Monitor Closely (62)
- 5-HTP
selegiline transdermal and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
- almotriptan
almotriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- atogepant
selegiline transdermal will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bretylium
selegiline transdermal 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 transdermal, 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 transdermal, 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.
- chlorpropamide
selegiline transdermal increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor.
- cocaine
selegiline transdermal and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.
- cyclobenzaprine
selegiline transdermal and cyclobenzaprine both increase serotonin levels. Modify Therapy/Monitor Closely.
- daridorexant
selegiline transdermal and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desflurane
selegiline transdermal increases levels of desflurane by pharmacodynamic synergism. Use Caution/Monitor.
- dexfenfluramine
selegiline transdermal and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dextroamphetamine
selegiline transdermal and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- difelikefalin
difelikefalin and selegiline transdermal both increase sedation. Use Caution/Monitor.
- dihydroergotamine
selegiline transdermal and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine intranasal
selegiline transdermal and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- eletriptan
eletriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- ergotamine
selegiline transdermal and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- ethinylestradiol
ethinylestradiol increases levels of selegiline transdermal by Other (see comment). Use Caution/Monitor. Comment: Oral contraceptives inhibit the N demethylatin of selegiline.
- etomidate
selegiline transdermal increases levels of etomidate by pharmacodynamic synergism. Use Caution/Monitor.
- fenfluramine
selegiline transdermal and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- finerenone
selegiline transdermal 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 transdermal 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.
- frovatriptan
frovatriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- glimepiride
selegiline transdermal increases effects of glimepiride by unknown mechanism. Use Caution/Monitor.
- glipizide
selegiline transdermal increases effects of glipizide by unknown mechanism. Use Caution/Monitor.
- glyburide
selegiline transdermal increases effects of glyburide by unknown mechanism. Use Caution/Monitor.
- green tea
green tea, selegiline transdermal. 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.
- insulin aspart
selegiline transdermal increases effects of insulin aspart by unknown mechanism. Use Caution/Monitor.
- insulin lispro
selegiline transdermal increases effects of insulin lispro by unknown mechanism. Use Caution/Monitor.
- insulin regular human
selegiline transdermal increases effects of insulin regular human by unknown mechanism. Use Caution/Monitor.
- ioflupane I 123
selegiline transdermal 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 transdermal and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.
- ketamine
selegiline transdermal increases levels of ketamine by pharmacodynamic synergism. Use Caution/Monitor.
- L-tryptophan
selegiline transdermal and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
- lasmiditan
selegiline transdermal 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 transdermal 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 transdermal 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. - levodopa
selegiline transdermal and levodopa both increase serotonin levels. Modify Therapy/Monitor Closely.
- lithium
selegiline transdermal and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
- lsd
selegiline transdermal and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.
- mestranol
mestranol increases levels of selegiline transdermal by Other (see comment). Use Caution/Monitor. Comment: Oral contraceptives inhibit the N demethylatin of selegiline.
- metrizamide
selegiline transdermal, metrizamide. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Risk of seizure. D/C MAO inhibitor 24h before admin. of metrizamide.
- midazolam intranasal
midazolam intranasal, selegiline transdermal. 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.
- mirtazapine
selegiline transdermal and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- morphine
selegiline transdermal and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
- naratriptan
naratriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- oliceridine
selegiline transdermal, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
- opium tincture
opium tincture, selegiline transdermal. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of serotonin syndrome.
- pentazocine
selegiline transdermal and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
- propofol
selegiline transdermal increases levels of propofol by pharmacodynamic synergism. Use Caution/Monitor.
- remifentanil
remifentanil increases toxicity of selegiline transdermal by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- rizatriptan
rizatriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- SAMe
selegiline transdermal and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
- sevoflurane
selegiline transdermal increases levels of sevoflurane by pharmacodynamic synergism. Use Caution/Monitor.
- sumatriptan
sumatriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- sumatriptan intranasal
sumatriptan intranasal and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- tapentadol
selegiline transdermal and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- teriflunomide
teriflunomide increases levels of selegiline transdermal by Other (see comment). Use Caution/Monitor. Comment: Teriflunomide inhibits CYP2C8; caution when coadministered with CYP2C8 substrates.
- tolazamide
selegiline transdermal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.
- tolbutamide
selegiline transdermal increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor.
- tramadol
selegiline transdermal and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- zolmitriptan
zolmitriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
Minor (10)
- amobarbital
selegiline transdermal increases levels of amobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- butabarbital
selegiline transdermal increases levels of butabarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- butalbital
selegiline transdermal increases levels of butalbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- pentobarbital
selegiline transdermal increases levels of pentobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- phenobarbital
selegiline transdermal increases levels of phenobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- primidone
selegiline transdermal increases levels of primidone by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- secobarbital
selegiline transdermal increases levels of secobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.
- sulfadiazine
selegiline transdermal increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.
- sulfamethoxazole
selegiline transdermal increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.
- sulfisoxazole
selegiline transdermal increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.
Adverse Effects
>10%
Application site reaction (24%)
1-10%
Hypotension (3-10%)
Diarrhea (9%)
Xerostomia (8%)
Weight loss (5%)
Dyspepsia (4%)
Rash (4%)
Pharyngitis (3%)
Sinusitis (3%)
Warnings
Black Box Warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses. This increase was not seen in patients older than 24 years. A slight decrease in suicidal thinking was seen in adults older than 65 years. In children and young adults, risks must be weighed against the benefits of taking antidepressants. Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies. Patients should be monitored during initial 1-2 months of therapy and during dosage adjustments. The patient’s family should communicate any abrupt changes in behavior to the healthcare provider. Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy. This drug is not approved for use in pediatric patients
Contraindicated in patients < 12 years (increased risk of hypertensive crisis)
Contraindications
Hypersensitivity
Concurrency with SSRIs, SNRIs, TCAs, bupropion, meperidine, analgesic agents, dextromethorphan, tramadol, methadone, St. John's wort, mirtazapine, cyclobenzaprine, oral selegiline, other MAOIs, sympathomimetic amines, propoxyphene, cold products, weight-reducing preparations that contain vasoconstrictors, carbamazepine, oxcabazapine, and food supplements containing tyrosine, phenylalanine, tryptophan, or caffeine
<12 years of age
Beginning therapy with contraindicated drug < 2 weeks after stopping transdermal selegiline
General anesthesia
Pheochromocytoma
Cautions
Dietary modifications required for patients using 9 mg/24 hr & 12 mg/24 hr patch
Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 years)
Compulsive behavior may occur in patients prescribed dopaminergic agents
Orthostatic hypotension may occur with transdermal product
Use caution in hepatic and renal impairment (safety and efficacy not established)
Avoid exposing selegiline transdermal application site to external sources of direct heat (ie, heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water bed, and prolonged direct sunlight)
Use caution in patients with history of mania; activation of mania/hypomania may occur
Monitor blood pressure when used concomitantly with the drugs buspirone, buspirone, amphetamines, or cold products or weight-reducing preparations that contain sympathomimetic amines (e.g., pseudoephedrine, phenylephrine, phenylpropanolamine, and ephedrine)
Development of a potentially life-threatening serotonin syndrome reported with concomitant use of MAOIs with serotonergic drugs; monitor and discontinue therapy if symptoms occur
Selegiline inhibits catabolism of dietary amines, such as tyramine, and has the potential to produce hypertensive crisis following ingestion oftyramine-rich foods or beverages; discontinue therapy if symptoms occur
Pregnancy & Lactation
Pregnancy Category: C
Lactation: unknown; use caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Irreversible selective MAO-B inhibitor. The inhibitor causes a decrease in the metabolism of dopamine; selegiline may also increase dopaminergic activity by inhibiting dopamine reuptake at the synapse; transdermal administration can attain higher selegiline blood levels and can effectively inhibit both MAO-A and MAO-B, which in turn blocks catabolism of other centrally active amine neurotransmitters
Pharmacokinetics
Absorption: 25-30%
Distribution: rapid to all body tissues
Protein Bound: 90%
Metabolism: CYP2B6, CYP3A4, CYP2A6, CYP1A2, CYP2C8, CYP2D6
Excretion: Urine (10%), feces (2%)
Images
Formulary
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