Selegiline – Oral, Eldepryl

Medication Uses: This medication is used to treat movement disorders caused by Parkinson’s disease. It does not cure Parkinson’s disease, but it may improve shakiness (tremor), muscle stiffness, loss of normal movement as a dose of other Parkinson’s medication wears off (end-of-dose failure), and sudden switching between normal movement and stiffness ("on-off" problems). It may improve range of motion and ability to walk, dress, and exercise. Selegiline is usually used in combination with other medicines (levodopa, carbidopa). Selegiline is an enzyme blocker (MAO inhibitor) that works by slowing the breakdown of certain natural substances in the brain (neurotransmitters such as dopamine, norepinephrine, and serotonin).

HOW TO USE: Take this medication by mouth, usually twice daily with breakfast and lunch. Taking selegiline late in the day may cause trouble sleeping. Dosage is based on your medical condition and response to therapy. The usual highest dose is 5 milligrams twice a day. Do not increase your dose or take it more often than directed. After you have been taking selegiline for 2 or 3 days, your doctor may direct you to lower your levodopa dose. Follow your doctor’s instructions closely. Do not stop or change the dose of any medications without first talking with your doctor. It may take a few weeks for the full benefits of the drug to be noticed. Do not stop taking this drug without consulting your doctor. Talk with your doctor if the medication stops working well or if your condition worsens.

SIDE EFFECTS: Dizziness, abdominal pain, dry mouth, nausea, stomach upset, trouble sleeping, and headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. If you are also taking levodopa, you may experience more side effects from the levodopa when taking selegiline. Tell your doctor immediately if any of these side effects occur: nausea, shakiness, muscle stiffness, mental/mood changes such as hallucinations/abnormal dreams. Your doctor may need to change your medication or dose. Do not stop or change the dose of your levodopa without talking with your doctor first. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these unlikely but serious side effects occur: fainting, loss of balance, mental/mood changes (agitation, confusion, depression, hallucinations), worsening muscle stiffness/twitching, changes in sexual ability/interest, increased shaking (tremor), swollen ankles/legs, difficulty urinating, unusual weight gain. Tell your doctor immediately if any of these rare but very serious side effects occur: easy bleeding/bruising, black/tarry stools, vomit that looks like coffee grounds. This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk. (See also Drug Interactions section.) Seek immediate medical attention if any of these serious side effects occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, vision changes (double/blurred), sudden sensitivity to light (photophobia). A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before taking selegiline, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: a certain kind of adrenal gland tumor (pheochromocytoma), cerebrovascular disease (stroke), heart problems (congestive heart failure, heart attack), high blood pressure, history of severe/frequent headaches, peptic ulcer. Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, diabetes, personal/family history of mental/mood disorders (schizophrenia, bipolar disorder), family history of high blood pressure, heart disease (coronary artery disease, history of chest pain), liver disease, history of peptic ulcer, overactive thyroid (hyperthyroidism). This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages. To minimize dizziness and the risk of fainting, get up slowly when rising from a sitting or lying position. Before having surgery, tell your doctor or dentist you are taking this medication. You may need to stop taking this drug beforehand. Follow your doctor’s instructions carefully. Selegiline should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known if this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval. Some products that may interact with selegiline include: antidepressants (bupropion, maprotiline, mirtazapine, SSRIs fluoxetine/paroxetine, SNRIs duloxetine/venlafaxine, TCAs amitriptyline/doxepin), other MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, tranylcypromine), appetite suppressants (diethylpropion), drugs for attention deficit disorder (atomoxetine, methylphenidate), apraclonidine, buspirone, carbamazepine/oxcarbazepine, cyclobenzaprine, dextromethorphan, certain herbal products (ephedra/ma huang, St. John’s wort), cold medications/nasal decongestants (phenylephrine, phenylpropanolamine, pseudoephedrine), certain narcotic medications (fentanyl, meperidine, methadone, propoxyphene, tapentadol), street drugs (MDMA/"ecstasy", LSD, mescaline), stimulants (amphetamines, ephedrine), supplements (tryptophan, tyramine), tetrabenazine, tramadol, certain "triptans" used to treat migraine headaches (rizatriptan, sumatriptan, zolmitriptan). Tell your doctor or pharmacist if you are using any of these medications before, during, or within 2 weeks after treatment with selegiline. Tell your doctor or pharmacist if you have taken fluoxetine during at least 5 weeks before starting selegiline. Discuss with your doctor how much time to wait between starting or stopping any of these drugs and taking selegiline. Check the labels on all your medicines (including allergy, cough-and-cold products, diet pills) because they may contain dextromethorphan, decongestants, or stimulants. Ask your pharmacist about the safe use of these products. To prevent a very serious high blood pressure reaction, it is very important that you follow a special diet recommended by your doctor or dietician to limit your intake of tyramine while taking this medicine. Avoid foods and beverages that are high in tyramine, including: aged cheeses (bleu, cheddar, parmesan), dried/aged/fermented meats and sausages (salami, liverwurst), preserved fish (pickled herring), products containing large amounts of yeast (concentrated yeast extract, bouillon cubes, powdered soup/gravy, homemade or sourdough bread), fermented foods (sauerkraut, kim chee), most soybean products (soy sauce, tofu), broad/fava beans, red wine, sherry, tap beers, vermouth. Limit or avoid foods that are moderate in tyramine, including: avocados, bananas, eggplant, green beans, raisins, raspberries, red plums, spinach, tomatoes, chocolate, cultured dairy products (buttermilk, yogurt, sour cream), fish eggs, pate, peanuts, coffee, cola, alcohol-free beer, bottled beer, distilled spirits, port, white wine. Consult your doctor or dietician for more details and a complete list of other tyramine-containing foods you should limit or avoid. Seek immediate medical attention if you notice symptoms of very high blood pressure such as unusually fast/slow heartbeat, vomiting, unexplained sweating, headache, chest pain, sudden vision changes, weakness on one side of the body, slurred speech. This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson’s disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

QUESTION

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may not appear for up to 12 hours and may include excitement, irritability, restlessness, dizziness, weakness, drowsiness, flushing, sweating, fast heartbeat, headache, confusion, and seizures. NOTES: Do not share this medication with others. People with Parkinson’s disease may have an increased risk for developing skin cancer (melanoma). Tell your doctor promptly if you notice a change in the appearance or size of moles or other unusual skin changes. Ask your doctor if you should have regular skin exams. MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up. STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details on how to safely discard your product. Information last revised December 2013. Copyright(c) 2013 First Databank, Inc.