Why Is Selegiline Prescribed For Parkinson’s Disease

Does Selegiline Raise Serotonin

Selegiline is definitely an irreversible inhibitor of monoamine oxidase , an enzyme that catabolizes norepinephrine, serotonin, and dopamine. The blockage of the enzyme prevents the reuptake of those neurotransmitters within the CNS, conferring elevated quantity of a biologically active monoamines in the synaptic cleft.

What Should I Avoid While Taking Selegiline

Avoid drinking alcohol while you are taking selegiline.

While taking selegiline and for 14 days after you stop, you must NOT eat foods that are high in tyramine, including:

• air dried meats, aged or fermented meats, sausage or salami , pickled herring

• any spoiled or improperly stored beef, poultry, fish, or liver

• beer from a tap, beer that has not been pasteurized

• over-the-counter supplements or cough and cold medicines that contain tyramine

• sauerkraut, soy beans, soy sauce, tofu, fava beans or

• yeast extracts .

Eating tyramine while you are using selegiline can raise your blood pressure to dangerous levels which could cause life-threatening side effects. You should become very familiar with the list of foods to avoid while you are using selegiline.

Selegiline may impair your thinking or reactions. Some people taking selegiline have fallen asleep during normal daytime activities such as working, talking, eating, or driving. You may fall asleep suddenly, even after feeling alert. Be careful if you drive or do anything that requires you to be alert.

Can Selegiline Cause Problems

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with selegiline. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common selegiline side-effects	What can I do if I experience this?
Sore mouth
Let your doctor know about this
Sleeping problems, feeling confused or depressed, hallucinations, blocked nose, sore throat, sweating	If any of these become troublesome, speak with your doctor

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

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What Are Side Effects Associated With Using Selegiline

Common side effects or health problems may include:

Other side effects of selegiline include:

• Irregular heartbeats
• Extrapyramidal symptoms
• Generalized pain
• Mouth sores or ulcers
• Pain with swallowing

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Are There Any Other Precautions Or Warnings For This Medication

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Antidepressant medication: Severe reactions are possible when selegiline is combined with tricyclic antidepressants or serotonin reuptake inhibitors, medications used to treat depression. The combination of selegiline and antidepressants from these groups must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are also possible.

If you take any of these medications or have taken antidepressants recently, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Headache: If you experiencing a severe headache or other unusual symptoms while taking selegiline, report them to a doctor immediately.

Levodopa: Some people who take selegiline may experience a worsening of levodopa-associated side effects, such as unusual movements of the body. Report these effects to your doctor as soon as possible. Your doctor may help with these effects by reducing the dose of levodopa.

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Selegiline For Parkinson’s Disease

OverviewSelegiline is a prescription drug approved by the U.S. Food and Drug Administration to treat motor symptoms in people with Parkinsons disease. Selegiline may be prescribed as a monotherapy to people with early Parkinsons disease, or as an adjunctive treatment in those who are taking levodopa/carbidopa and are experiencing reductions in its effectiveness. Selegiline is also referred to by its brand names, Eldepryl and Zelapar.

Selegiline is a member of a class of antidepressant drugs called monoamine oxidase inhibitors . In cases of Parkinsons disease, selegiline is believed to work by preventing the breakdown of dopamine in the brain, thereby increasing the amount of dopamine available.

Some medications are available both as generic and branded products. Although generic and branded formulations of a drug contain the same active ingredients at the same concentrations, your body may react differently to different formulations. Check with your doctor before switching between drug brands or between generic and branded drugs.

How do I take it?Selegiline is taken orally, either as a capsule or a disintegrating tablet. As a capsule, selegiline is taken twice a day with meals. As a disintegrating tablet, selegiline is taken once daily on an empty stomach, before breakfast. Do not eat or drink five minutes before or after taking selegiline as a disintegrating tablet.

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Selegiline Daily Med

Symptomatic Treatment Of Parkinson Disease

Many types of medications are available for symptomatic treatment of PD: anticholinergics, amantadine, LD, MAO inhibitors , catechol-O-methyltransferase inhibitors , and DAs . Anticholinergics such as trihexyphenidyl and benztropine antagonize the effects of acetylcholine at muscarinic receptors postsynaptic to striatal interneurons. They reduce tremor and rigidity but have no effects on bradykinesia. Toxicity relates to antagonism of acetylcholine at central receptors, causing confusion, and peripheral receptors, causing blurred vision, dry mouth, constipation, and urine retention. Although amantadine has been available for nearly 4 decades , its antiparkinsonian mechanisms have been poorly understood. It has been thought to stimulate release of endogenous dopamine stores, block reuptake of dopamine from the synaptic cleft, and have anticholinergic properties. However, amantadine has been found to have antiglutamatergic properties and as such is the only antiparkinsonian drug that improves LD-induced dyskinesia. Extended release formulation of amantadine has been found to improve not only dyskinesia but also motor fluctuations .

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Important Information About All Medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.

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How Should I Use This Medication

Take this medication by mouth in the morning. Follow the directions on the prescription label. Do not push the tablet through the foil backing. Peel back the foil with dry hands, gently remove the tablet, and immediately place the tablet on your tongue. It will dissolve in seconds. Do not swallow it. Wait about 5 minutes after taking your medication before ingesting any food or liquid. Take your doses at regular intervals. Do not take your medication more often than directed. Do not stop taking except on the advice of your care team.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

Where Should I Keep My Medication

Keep out of the reach of children and pets.

Store at room temperature between 15 and 30 degrees C . Keep this medication in the original packaging until you are ready to take it. Protect from moisture. Get rid of any unused medication 3 months after opening a pouch. Get rid of any unopened, unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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What Is This Medication

SELEGILINE treats the symptoms of Parkinson disease in people who are taking the medication Levodopa. It works by increasing the amount of dopamine in your brain, a substance which helps manage body movements and coordination. This reduces the symptoms of Parkinson, such as body stiffness and tremors. It belongs to a group of medications called MAOIs.

This medicine may be used for other purposes ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME: Zelapar

Why Is This Medication Prescribed

Selegiline is used to help control the symptoms of Parkinson’s disease in people who are taking levodopa and carbidopa combination . Selegiline may help people with Parkinson’s disease by decreasing the dose of levodopa/carbidopa needed to control symptoms, stopping the effects of levodopa/carbidopa from wearing off between doses, and increasing the length of time that levodopa/carbidopa will continue to control symptoms. Selegiline is in a group of medications called monoamine oxidase type B inhibitors. It works by increasing the amount of dopamine in the brain.

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Before Taking This Medicine

You should not use selegiline if you are allergic to it, or if you have taken fluoxetine within the past 5 weeks.

Some medicines can cause unwanted or dangerous effects when used with selegiline. Your doctor may need to change your treatment plan if you use any of the following drugs:

• cough medicine that contains dextromethorphan

After you stop taking selegiline, you must wait at least 14 days before taking any of the medications listed above.

To make sure selegiline is safe for you, tell your doctor if you have:

• liver or kidney disease

• high blood pressure or

• phenylketonuria .

People with Parkinson’s disease may have a higher risk of skin cancer . Talk to your doctor about this risk and what skin symptoms to watch for.

It is not known whether selegiline will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether selegiline passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

What Should I Watch For While Using This Medication

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse. Do not stop taking except on your care team’s advice. You may develop a severe reaction. Your care team will tell you how much medication to take.

This medication can interact with certain foods that contain high amounts of tyramine. The combination may cause severe headaches, a rise in blood pressure, or irregular heartbeat. Foods that contain significant amounts of tyramine include aged cheeses, meats and fish , beer and ale, alcohol-free beer, wine , sherry, hard liquor, liqueurs, avocados, bananas, figs, raisins, soy sauce, miso soup, yeast/protein extracts, bean curd, fava or broad bean pods, or any over-ripe fruit. Ask your care team for a complete listing of tyramine-containing foods.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can interfere with the effect of this medication. Avoid alcoholic drinks.

When taking this medication, you may fall asleep without notice. You may be doing activities like driving a car, talking, or eating. You may not feel drowsy before it happens. Contact your care team right away if this happens to you.

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Does Selegiline Cause Weight Gain

From the three MAOIs in the above list, phenelzine is easily the most prone to lead to putting on weight, based on a 1988 review. However, a more recent formulation of the MAOI referred to as selegiline continues to be proven to lead to weight reduction during treatment. Emsam is really a transdermal medication thats put on your skin having a patch.

What Are Warnings And Precautions For Selegiline

Warnings

• In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for major depressive disorders and other psychiatric illnesses.
• This increase was not seen in patients aged over 24 years a slight decrease in suicidal thinking was seen in adults over 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 this should be done during initial 1-2 months of therapy and 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.
• This medication contains selegiline. Do not take Eldepryl or Zelapar if you are allergic to selegiline or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity to drug or other ACE inhibitors
• Concomitant meperidine, possibly other opioids, many other drugs

Effects of Drug Abuse

• See “What Are Side Effects Associated with Using Selegiline?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Selegiline?”

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Study Design And Patient Selection

Patients included in this retrospective casecontrol study were selected using the Parkinson Institute research database, which contains detailed demographic, clinical and lifestyle information on all patients assessed at the Parkinson Institute. Data from all patients seen between 1st October 2009 and 31st October 2015 and suffering from idiopathic PD diagnosed according to UK Brain Bank criteria were reviewed . Patients with vascular parkinsonism were excluded on the basis of magnetic resonance brain imaging evaluation . Patients treated with advanced-stage therapies, such as deep brain stimulation, continuous apomorphine infusion and levodopa duodenal infusion at baseline or during follow-up were also excluded.

Information on consecutive patients who were prescribed therapy with selegiline or rasagiline between 1st October 2009 and 31st October 2012 and had a follow-up assessment at 3 years was extracted. Patients with PD who had been treated with selegiline for at least 3 years were selected and matched on a 1:1 ratio with patients with PD who had been treated with rasagiline for at least 3 years matching was performed by gender, disease duration and age at initiation of MAO-B inhibitor therapy. Finally, the same matching procedure was applied to extract a group of patients with PD who had never received a prescription for a MAO-B inhibitor . A patient flow diagram is presented in Fig. 1.

Fig. 1

What Side Effects Are Possible With This Medication

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal or stomach pain
• burning of lips, mouth, or throat
• dizziness or lightheadedness, especially when rising from a lying or sitting position
• high or low blood pressure
• inability to move
• increased sensitivity of skin to light
• increased sweating
• numbness of fingers or toes
• pounding or fast heartbeat
• ringing or buzzing in ears
• slowed movements
• urination changes

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• difficulty breathing
• increase in unusual movements of body
• irregular heartbeat

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How To Use Selegiline Oral

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. 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 of your 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 first consulting your doctor. Talk with your doctor if the medication stops working well or if your condition worsens.