selegiline transdermal (Rx)

Brand and Other Names:Emsam
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Dosing & Uses

AdultPediatricGeriatric

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

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Interactions

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            Contraindicated (56)

            • 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.

            • 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.

            • 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 (59)

            • 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.

            • 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.

            • 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.

            • 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.

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            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%)

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            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

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            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.

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            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%)

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            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.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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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.