Selegiline
ELDEPRYL
Pronunciation: se-LE-ji-leen
“Elderly Seal’s gills”
Mao Zedong → MAO inhibitor
What it isSelective MAO-B inhibitor; Parkinson disease, and transdermally for depression.
Why this oneAt low oral dose it spares MAO-A so no dietary restriction is needed, and the patch bypasses gut MAO-A for depression.
What limits itSelectivity is lost at higher doses, restoring tyramine risk. Amphetamine metabolites cause insomnia; serotonin syndrome with SSRIs.
FDA-approved for
- Parkinson disease (1989)
- depression (patch) (2006)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Parkinson's disease (adjunct to levodopa/carbidopa with deteriorating response) | Adults | 5 mg BID (breakfast and lunch) | 10 mg/day (5 mg BID) | 10 mg/day |
Renal Undefined
Hepatic Undefined
No added benefit above 10 mg/day (more side effects). After 2–3 days, may try reducing levodopa/carbidopa (typically 10–30%).
Instructions
- Take 5 mg at breakfast and 5 mg at lunch
Available strengths
- cap 5 mg
- tab 5 mg
- ODT 1.25 mg
- patch 6, 9, 12 mg/24 hr
Contraindications
- Meperidine (often extended to other opioids)
Cautions
- Do not exceed 10 mg/day — loss of MAO-B selectivity; rare tyramine hypertensive reactions even at recommended dose
- Severe CNS toxicity with tricyclic antidepressants
- Serotonin-syndrome-like reactions with SSRIs; ≥14 days off selegiline before TCA/SSRI; ≥5 weeks off fluoxetine before selegiline
Adverse reactions
- Nausea
- Dizziness/lightheadedness/fainting
- Abdominal pain
- Confusion
- Hallucinations
- Dry mouth
- Vivid dreams
- Dyskinesias
- Headache
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 5 mg | cap | 30 qd | $22.69 | offered |
Other forms: Selegiline transdermal (EMSAM)
Generic entryLong generic
NO BOXED WARNINGS
No boxed warning for oral selegiline for Parkinson disease, but EMSAM, the transdermal patch for depression carries a boxed warning for suicidal thoughts and behaviors in patients under 25.
Principal riskSelectivity lost at higher doses, restoring tyramine risk
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityOrthostasis, hallucinations, dyskinesia and impulse-control symptoms; abrupt withdrawal can be hazardous.
Serotonin and MAOI
Provisional washout figures
Elevating mechanismMAO-A and MAO-B inhibitor (transdermal antidepressant formulation)
Non-elevating actionNone recorded
Exposure dependenceRoute/formulation dependent; transdermal antidepressant dosing produces clinically meaningful central MAO-A inhibition
Washout AFTER an MAOI14 days
Evidence confidenceHigh
InterpretationEMSAM should be treated as a clinically meaningful MAOI for SRI interaction screening.
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