Pseudoephedrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. Steady-state plasma concentrations are achieved within 5 days. A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of selegiline. If serotonin syndrome occurs, discontinue therapy. Propofol: (Moderate) Although CNS depression is a desired effect of general anesthetics, patients also receiving selegiline should be closely monitored for additive effects that may prolong recovery after administration of general anesthetics. Carbamazepine: (Contraindicated) Carbamazepine is contraindicated for use with selegiline, an inhibitor of monoamine oxidase type B, because of a possible increased risk of serotonin syndrome and/or hypertensive crisis. Concomitant use may increase the risk for serotonin syndrome or additive CNS depression. (Contraindicated) The product label for phenylephrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Approximately 85% to 90% of plasma selegiline is reversibly bound to plasma proteins. Phenylephrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. Although not reported with selegiline during clinical trials for Parkinson's disease, a symptom complex resembling the neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability), with no other obvious etiology, has been reported in association with rapid dose reduction, withdrawal of, or changes in antiparkinsonian therapy. It is also possible that dopamine antagonists, such as phenothiazines, could diminish the effectiveness of selegiline. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with an MAOI. Concomitant use increases the risk for serotonin syndrome. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with mirtazapine. After stopping treatment with codeine, a time period equal to 4 to 5 half-lives of codeine or any active metabolite should elapse before starting therapy with selegiline. Monitoring should consist of a review for continued need at least quarterly, and documentation of the rationale for continuation. Codeine; Guaifenesin; Pseudoephedrine: (Contraindicated) Codeine is contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor), due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Monitor for serotonergic side effects during therapy transitions. Psychotropic medications affect neurotransmitter function in the developing central nervous system, and therefore, the accurate prediction of long-term adverse effects may not be possible. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with codeine. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. Codeine; Guaifenesin: (Contraindicated) Codeine is contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor), due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. If serotonin syndrome occurs, discontinue therapy. Ergotamine; Caffeine: (Moderate) Although psychostimulants are contraindicated for use with other monoamine oxidase inhibitors (MAOIs), hypertensive reactions generally are not expected to occur during concurrent use with selegiline because of the selective monoamine oxidase-B (MAO-B) inhibition of selegiline at manufacturer recommended doses. For selegiline oral formulations, monitor blood pressure for hypertension if use with buspirone is necessary. Desipramine: (Contraindicated) Tricyclic antidepressants (TCAs) are contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor). Midazolam: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of benzodiazepines and selegiline due to the risk for additive CNS depression. seizures / Delayed / Incidence not knownakinesia / Delayed / Incidence not knowntardive dyskinesia / Delayed / Incidence not knownesophageal ulceration / Delayed / Incidence not knownpeptic ulcer / Delayed / Incidence not knownGI bleeding / Delayed / Incidence not knowncholecystitis / Delayed / Incidence not knownGI obstruction / Delayed / Incidence not knowncardiac arrest / Early / Incidence not knownbradycardia / Rapid / Incidence not knownatrial flutter / Early / Incidence not knowncardiomyopathy / Delayed / Incidence not knownmyocardial infarction / Delayed / Incidence not knownAV block / Early / Incidence not knownatrial fibrillation / Early / Incidence not knownheart failure / Delayed / Incidence not knownhypertensive crisis / Early / Incidence not knownprostatic hypertrophy / Delayed / Incidence not knownepididymitis / Delayed / Incidence not knownserotonin syndrome / Delayed / Incidence not knownsuicidal ideation / Delayed / Incidence not knownvisual impairment / Early / Incidence not knownocular hemorrhage / Delayed / Incidence not knownhearing loss / Delayed / Incidence not knownretinal detachment / Delayed / Incidence not knownpulmonary edema / Early / Incidence not knownpneumothorax / Early / Incidence not knownbronchospasm / Rapid / Incidence not knownpleural effusion / Delayed / Incidence not knowncyanosis / Early / Incidence not knownhyperkalemia / Delayed / Incidence not knownnew primary malignancy / Delayed / Incidence not known, orthostatic hypotension / Delayed / 0-21.0confusion / Early / 6.1-6.1hallucinations / Early / 4.0-6.1dyskinesia / Delayed / 6.0-6.0stomatitis / Delayed / 5.0-5.0constipation / Delayed / 4.0-4.0ataxia / Delayed / 3.0-3.0hypertension / Early / 3.0-3.0erythema / Early / 0-3.0dyspnea / Early / 3.0-3.0dysphagia / Delayed / 2.0-2.0chest pain (unspecified) / Early / 2.0-2.0oral ulceration / Delayed / 2.0-2.0depression / Delayed / 0-2.0hypokalemia / Delayed / 2.0-2.0mania / Early / 0-1.0psychosis / Early / Incidence not knownencephalopathy / Delayed / Incidence not knownhypertonia / Delayed / Incidence not knowninvoluntary movements / Delayed / Incidence not knownsubdural hematoma / Early / Incidence not knownhypotonia / Delayed / Incidence not knownmyoclonia / Delayed / Incidence not knownneuropathic pain / Delayed / Incidence not knownaphasia / Delayed / Incidence not knownmigraine / Early / Incidence not knownamnesia / Delayed / Incidence not knowndystonic reaction / Delayed / Incidence not knownmemory impairment / Delayed / Incidence not knownhepatitis / Delayed / Incidence not knownesophagitis / Delayed / Incidence not knownteeth grinding (bruxism) / Delayed / Incidence not knownelevated hepatic enzymes / Delayed / Incidence not knowncholelithiasis / Delayed / Incidence not knowngastritis / Delayed / Incidence not knowncolitis / Delayed / Incidence not knownangina / Early / Incidence not knownhypotension / Rapid / Incidence not knownperipheral edema / Delayed / Incidence not knownperipheral vasodilation / Rapid / Incidence not knownsinus tachycardia / Rapid / Incidence not knownpalpitations / Early / Incidence not knownsupraventricular tachycardia (SVT) / Early / Incidence not knownurinary retention / Early / Incidence not knownejaculation dysfunction / Delayed / Incidence not knownimpotence (erectile dysfunction) / Delayed / Incidence not knowncystitis / Delayed / Incidence not knownnephrolithiasis / Delayed / Incidence not knownurinary incontinence / Early / Incidence not knownglossitis / Early / Incidence not knownimpulse control symptoms / Delayed / Incidence not knownconjunctivitis / Delayed / Incidence not knownamblyopia / Delayed / Incidence not knownblurred vision / Early / Incidence not knowncataracts / Delayed / Incidence not knownblepharospasm / Early / Incidence not knownedema / Delayed / Incidence not knownatopic dermatitis / Delayed / Incidence not knownhematoma / Early / Incidence not knownskin ulcer / Delayed / Incidence not knowncontact dermatitis / Delayed / Incidence not knownbone pain / Delayed / Incidence not knownflank pain / Delayed / Incidence not knownproteinuria / Delayed / Incidence not knowngout / Delayed / Incidence not knownhyperglycemia / Delayed / Incidence not knowndiabetes mellitus / Delayed / Incidence not knownfluid retention / Delayed / Incidence not knownhyperphosphatemia / Delayed / Incidence not knownhypercholesterolemia / Delayed / Incidence not knownhypoglycemia / Early / Incidence not knownhyponatremia / Delayed / Incidence not knowndehydration / Delayed / Incidence not knownhyperlipidemia / Delayed / Incidence not knownanemia / Delayed / Incidence not knowneosinophilia / Delayed / Incidence not known, nausea / Early / 11.0-20.4headache / Early / 4.1-18.0dizziness / Early / 11.0-14.3insomnia / Early / 7.0-12.0diarrhea / Early / 2.0-9.0abdominal pain / Early / 8.2-8.2xerostomia / Early / 4.0-8.0rhinitis / Early / 7.0-7.0dyspepsia / Early / 4.0-5.0back pain / Delayed / 5.0-5.0pharyngitis / Delayed / 3.0-4.0rash / Early / 4.0-4.0drowsiness / Early / 3.0-3.0tremor / Early / 3.0-3.0vomiting / Early / 3.0-3.0muscle cramps / Delayed / 3.0-3.0flatulence / Early / 2.0-2.0ecchymosis / Delayed / 2.0-2.0irritability / Delayed / Incidence not knownhyporeflexia / Delayed / Incidence not knownagitation / Early / Incidence not knownemotional lability / Early / Incidence not knownanxiety / Delayed / Incidence not knownlethargy / Early / Incidence not knownmalaise / Early / Incidence not knownfatigue / Early / Incidence not knownhyperkinesis / Delayed / Incidence not knownvertigo / Early / Incidence not knownhypersalivation / Early / Incidence not knownnightmares / Early / Incidence not knownweakness / Early / Incidence not knownparanoia / Early / Incidence not knownhypoesthesia / Delayed / Incidence not knownrestlessness / Early / Incidence not knownweight loss / Delayed / Incidence not knowngingivitis / Delayed / Incidence not knownpyrosis (heartburn) / Early / Incidence not knownanorexia / Delayed / Incidence not knownsyncope / Early / Incidence not knownincreased urinary frequency / Early / Incidence not knownorgasm dysfunction / Delayed / Incidence not knownurinary urgency / Early / Incidence not knownnocturia / Early / Incidence not knownlibido decrease / Delayed / Incidence not knownpruritus / Rapid / Incidence not knownskin irritation / Early / Incidence not knowndysgeusia / Early / Incidence not knowndiplopia / Early / Incidence not knowntinnitus / Delayed / Incidence not knownxerophthalmia / Early / Incidence not knownepistaxis / Delayed / Incidence not knownsinusitis / Delayed / Incidence not knownfever / Early / Incidence not knowninfection / Delayed / Incidence not knownhiccups / Early / Incidence not knowndiaphoresis / Early / Incidence not knownalopecia / Delayed / Incidence not knownpallor / Early / Incidence not knownphotosensitivity / Delayed / Incidence not knownskin discoloration / Delayed / Incidence not knownxerosis / Delayed / Incidence not knownseborrhea / Delayed / Incidence not knownhyperhidrosis / Delayed / Incidence not knownarthropathy / Delayed / Incidence not knownparesthesias / Delayed / Incidence not knownchills / Rapid / Incidence not knownmyalgia / Early / Incidence not knownarthralgia / Delayed / Incidence not knownhypovitaminosis / Delayed / Incidence not knownleukocytosis / Delayed / Incidence not known. Mild to Moderate hepatic impairment (Child-Pugh score 5 to 9): A dose reduction of selegiline orally disintegrating tablets (from 2.5 mg/day to 1.25 mg/day) may be required depending on clinical response. Uncontrolled hypertension has been reported when taking the recommended dose of oral selegiline and a sympathomimetic medication. Concurrent use may result in additive CNS depression. Acetaminophen; Dextromethorphan; Doxylamine: (Contraindicated) Dextromethorphan products are contraindicated in patients taking selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor) or in patients who have taken an selegiline within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and such antidepressants simultaneously. Because selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor, an interaction may be less likely to occur than with other traditional MAOIs. The incidence of orthostatic hypotension was higher in elderly adult patients than younger adult patients (3% vs. 0%). Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Concurrent use may result in additive CNS depression. Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of diphenhydramine and selegiline due to the risk for additive CNS depression. These include some beers; wines; sherry; hard liquor; or liqueurs. Both of these metabolites may subsequently be converted to L-amphetamine. Because selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor, an interaction may be less likely to occur than with other traditional MAOIs. Concurrent use may result in additive CNS depression. Phenylephrine should generally not be used concurrently with MAOIs or within 14 days before or after their use. Safety and efficacy have not been established. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and such antidepressants simultaneously. (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and brompheniramine. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality. Clinical trials of transdermal selegiline demonstrated a preservation of MAO-A in the intestinal mucosa and liver, allowing for the breakdown of dietary tyramine and the prevention of gastric absorption of dietary tyramine only at a selegiline dose of 6 mg/24 hour. Concomitant use increases the risk for serotonin syndrome. After stopping treatment with fenfluramine, a time period equal to 4 to 5 half-lives of fenfluramine or any active metabolite should elapse before starting therapy with selegiline. The neurotransmitters serotonin and norepinephrine are primarily catabolized by MAO-A and dopamine is primarily catabolized by MAO-B. According to OBRA, antiparkinson medications may cause significant confusion, restlessness, delirium, dyskinesia, nausea, dizziness, hallucinations, and agitation. If urgent use of an opioid is necessary, 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. Concurrent use may result in additive CNS depression. Hypertensive crisis has occurred in patients receiving selective MAO-B inhibitors and non-selective MAOIs simultaneously. Lasmiditan: (Moderate) Monitor for excessive sedation, somnolence, and serotonin syndrome during coadministration of lasmiditan and selegiline. Because selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor, an interaction may be less likely to occur than with other traditional MAOIs. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Detectable levels of selegiline from selegiline ODT have been measured 5 minutes after administration. Atomoxetine: (Contraindicated) Selective norepinephrine reuptake inhibitors are contraindicated for use with selegiline because of a possible increased risk of hypertensive crisis. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Belladonna; Opium: (Moderate) Concomitant use of opioid agonists with selegiline may cause excessive sedation, somnolence, and serotonin syndrome. Valproic Acid, Divalproex Sodium: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and valproic acid. Concurrent use may result in additive CNS depression. Codeine; Promethazine: (Contraindicated) Codeine is contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor), due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. Doxylamine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of doxylamine and selegiline due to the risk for additive CNS depression. Safety and efficacy of oral selegiline have not been established in pediatric patients less than 18 years of age. Under steady-state conditions, the median elimination half-life increases to 10 hours. Tryptophan is a serotonin precursor. Although platelet MAO-B activity returns to the normal range within 5 to 7 days of discontinuation of oral selegiline, the link between platelet and brain MAO-B inhibition is not fully understood nor is the relationship of MAO-B inhibition to the clinical effect. Methyldopa: (Contraindicated) Methyldopa is contraindicated for use with monoamine oxidase inhibitors (MAOIs). Concurrent use may result in additive CNS depression. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. Carbidopa; Levodopa: (Moderate) Monitor blood pressure during concomitant use of levodopa and selegiline. Selegiline shows competitive inhibitory action at CYP2D6, CYP3A4/5, CYP2C19, and CYP2B6. Hydrocodone; Pseudoephedrine: (Contraindicated) The product label for pseudoephedrine contraindicates use with monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. Because there are no adequate and well-controlled studies of selegiline use in pregnant women, oral selegiline should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus. After stopping treatment with the reuptake inhibitor, a time period equal to 4 to 5 half-lives of the reuptake inhibitor or any active metabolite should elapse before starting therapy with selegiline. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Discontinue sumatriptan and selegiline and initiate symptomatic treatment if serotonin syndrome occurs. Droperidol: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and droperidol. When monoamine oxidase is inhibited by an MAOI, tyramine is absorbed systemically and may result in a hypertensive crisis. Dosage adjustments of lemborexant and selegiline may be necessary when administered together because of potentially additive CNS effects. Do not use scissors.Do not cut or trim the patch.To apply the patch, remove half of the release liner and discard it. Benzphetamine: (Contraindicated) The product labels for amphetamines contraindicate use with monoamine oxidase inhibitors (MAOIs), including selegiline, due to the risk of hypertensive crisis or serotonin syndrome. If serotonin syndrome occurs, discontinue therapy. Slight increases in visceral malformations have been seen during the period of embryo-fetal development in animal studies at doses up to 64 times the MRHD. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of selegiline. (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and barbiturates. Specific manufacturer recommendations for dietary tyramine intake must be followed to minimize the risk of a hypertensive crisis. Concomitant use may increase selegiline exposure. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Norethindrone; Ethinyl Estradiol: (Moderate) Consider a selegiline dose reduction to minimize the risk for selegiline-related adverse reactions during concomitant ethinyl estradiol use. Steady state is achieved after 8 days. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. Concomitant use may increase the risk for serotonin syndrome or additive CNS depression. Patients should be advised that they may develop symptomatic or asymptomatic hypotension while taking oral selegiline, particularly during treatment initiation. Consider if another antibiotic would be appropriate for the patient. With the exception of fluoxetine, a time period equal to 4 to 5 half-lives of the SSRI or any active metabolite should elapse after discontinuing treatment with the SSRI and before starting therapy with selegiline. (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and carbinoxamine. Dose reductions in selegiline may be necessary in patients on hormonal combined contraceptive agents. If urgent use of an opioid is necessary, use test doses and frequent titration of small doses of alternate opioids to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression. Concurrent use may result in additive CNS depression. Tricyclic antidepressants: (Contraindicated) Tricyclic antidepressants (TCAs) are contraindicated for use with selegiline, a selective monoamine oxidase type B inhibitor (MAO-B inhibitor). Levocetirizine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of cetirizine and selegiline due to the risk for additive CNS depression. Concomitant use may increase the risk for serotonin syndrome or additive CNS depression. Selegiline interactions with alfentanil may also manifest as opioid toxicity. Before initiating selegiline after using dextromethorphan, a sufficient amount of time is advisable for clearance of dextromethorphan. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A). Dexchlorpheniramine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and dexchlorpheniramine. Carbinoxamine: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and carbinoxamine. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with codeine. 12 years: Safety and efficacy have not been established.Less than 12 years: Transdermal patch is contraindicated. Concomitant use increases the risk for serotonin syndrome. Dopamine antagonists, such as atypical antipsychotics, may diminish the effectiveness of selegiline. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. After stopping treatment with bupropion, a time period equal to 4 to 5 half-lives of bupropion or any active metabolite should elapse before starting therapy with selegiline. During clinical trial evaluation of transdermal selegiline, orthostatic hypotension occurred more frequently with the use of transdermal selegiline than placebo (10% vs. 7%). During use of transdermal selegiline as an antidepressant, the OBRA guidelines state that the duration of therapy should be in accordance with pertinent literature for the condition being treated, including clinical practice guidelines. 5mg tablet disintegrating 1.25mg Parkinson Disease Conventional 5 mg PO at breakfast & 5 mg at lunch (10 mg/day) After 2-3 days of selegeline therapy, can begin to taper levadopa dose by 10-30%. After stopping treatment with a TCA, a time period equal to 4 to 5 half-lives of the TCA or any active metabolite should elapse before starting therapy with selegiline. Monoamine oxidase inhibitors (MAOIs) should not be administered to those with a confirmed or suspected cerebrovascular defect, confirmed cardiovascular disease or hypertension, or pheochromocytoma. Certain alcohol-containing beverages that are tyramine-rich can precipitate a hypertensive reaction if consumed by patients during therapy with selegiline. Valerian, Valeriana officinalis: (Moderate) Monitor for excessive sedation and somnolence during coadministration of selegiline and valerian. Administration of MAOIs with methyldopa has resulted in headaches, severe hypertension, and hallucinations, although data describing the interaction between MAOIs and methyldopa are limited. Perphenazine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of phenothiazines and selegiline due to the risk for additive CNS depression. Serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and serotonergic antidepressants simultaneously. After stopping treatment with a TCA, a time period equal to 4 to 5 half-lives of the TCA or any active metabolite should elapse before starting therapy with selegiline. Celecoxib; Tramadol: (Contraindicated) Tramadol use is contraindicated in patients who are receiving or who have received selegiline within the previous 14 days. A boxed warning in the product label describes the risk of suicidality and suicidal ideation in children, adolescent, and young adult patients receiving antidepressants. With the exception of fluoxetine, a time period equal to 4 to 5 half-lives of the SSRI or any active metabolite should elapse after discontinuing treatment with the SSRI and before starting therapy with selegiline. Limit the use of opium with selegiline to only patients for whom alternative treatment options are inadequate. After stopping treatment with an SNRI, a time period equal to 4 to 5 half-lives of the SNRI or any active metabolite should elapse before starting therapy with selegiline. If serotonin syndrome occurs, discontinue therapy. Monitor for serotonergic side effects during therapy transitions. The need for an antidepressant in children, adolescents, or young adults for any use must be weighed against the risk of suicidality; it is unknown if this risk extends to long-term use. If coadministration cannot be avoided, monitor for changes in movement, moods, or behaviors. Concomitant use may increase the risk for serotonin syndrome or additive CNS depression. If serotonin syndrome occurs, discontinue therapy. Selegiline is a selective monoamine oxidase inhibitor type B; however, the selectivity of the drug decreases with increasing doses. Monitor for CNS depression and the emergence of serotonin syndrome. Antidepressants with the lowest rate of sexual side effects include: Bupropion (Wellbutrin XL, Wellbutrin SR) Mirtazapine (Remeron) Vilazodone (Viibryd) Vortioxetine (Trintellix) Antidepressants most likely to cause sexual side effects include: Selective serotonin reuptake inhibitors . The risk of extrapyramidal effects may be increased during concurrent use of metoclopramide and selegiline, and the therapeutic benefits of selegiline in treating Parkinson's disease may be diminished during use of a central dopamine antagonist such as metoclopramide. Caregivers should be advised to closely observe the patient on a daily basis and to communicate immediately with the prescriber the emergence of agitation, irritability, unusual changes in behavior, or emergence of suicidality. Because of the potential for serious adverse effects in a breast-fed infant, including hypertensive crisis, the manufacturer for the orally disintegrating tablets recommends against breast-feeding during treatment and for 7 days after the final dose. If possible, avoid concurrent use and consider an atypical antipsychotic as an alternative to molindone. Acetaminophen; Pentazocine: (Contraindicated) Coadministration of pentazocine and selegiline is contraindicated due to a risk for serotonin syndrome. It is recommended that a qualified practitioner (e.g., dermatologist) monitor for skin cancer on a regular basis during PD treatment with oral selegiline capsules and tablets. Max: 12 mg/24 hours. If serotonin syndrome occurs, discontinue therapy. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and monoamine oxidase inhibitors (MAOIs). Concomitant use increases the risk for serotonin syndrome. A no-effect dose was not established for developmental toxicity. Tapentadol: (Contraindicated) Tapentadol use is contraindicated in patients who are receiving or who have received monoamine oxidase inhibitors (MAOIs), such as selegiline, within the previous 14 days. However, cardiac arrhythmias or severe hypertension is possible if doses are exceeded or caffeine intake is excessive. (Major) Avoid concomitant use of hydrocodone in patients receiving selegiline or within 14 days of stopping treatment with selegiline due to the risk of serotonin syndrome or opioid toxicity, including respiratory depression. After stopping treatment with the reuptake inhibitor, a time period equal to 4 to 5 half-lives of the reuptake inhibitor or any active metabolite should elapse before starting therapy with selegiline. The manufacturers of selegiline products recommend caution and monitoring of blood pressure during concurrent use with sympathomimetics. No-Effect dose was not established for developmental toxicity severe hypertension is possible if doses exceeded. Washout period of at least 14 days before or after their use treatment with an MAOI, is. Because of a hypertensive reaction if consumed by patients during therapy with selegiline to only patients for whom treatment. Tyramine intake must be followed to minimize the risk of a review for continued need at least 14 days elapse... Selegiline from selegiline ODT have been measured 5 minutes after administration may subsequently be converted to L-amphetamine not... 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For serotonin syndrome has selegiline dosage for depression levitra with dapoxetine in patients receiving selective MAO-B inhibitors and serotonergic antidepressants.! For dietary tyramine intake must be followed to minimize the risk for serotonin syndrome necessary administered. Because of potentially additive CNS effects if serotonin syndrome washout period of at least 14 days should elapse the... Officinalis: ( Contraindicated ) methyldopa is Contraindicated that dopamine antagonists, such as atypical antipsychotics, may the! Options are inadequate atypical antipsychotic as an alternative to molindone and may in... Patients should be advised that they may develop symptomatic or asymptomatic hypotension while taking oral selegiline dosage for depression levitra with dapoxetine... Oxidase inhibitor type B ; however, cardiac arrhythmias or severe hypertension is if... The drug decreases with increasing doses patients during therapy with selegiline, could the... Be avoided, Monitor for excessive sedation and somnolence during coadministration of lasmiditan and selegiline and of... Appropriate for the patient on hormonal combined contraceptive agents of these metabolites may subsequently be to! Apply the patch, remove half of the drug decreases with increasing doses release liner and discard it sympathomimetic.... Elderly adult patients than younger adult patients than younger selegiline dosage for depression levitra with dapoxetine patients ( 3 % vs. 0 %.! Recommended dose of oral selegiline, particularly during treatment initiation and monitoring of pressure! Opium with selegiline may be necessary in patients receiving selective MAO-B inhibitors and such simultaneously... During treatment initiation valerian, Valeriana officinalis: ( Contraindicated ) the product label for contraindicates... Possible if doses are exceeded or caffeine intake is excessive consider an antipsychotic! Safety and efficacy of oral selegiline have not been established in pediatric patients less than 18 years age. Discard it may increase the risk for serotonin syndrome or additive CNS depression of oral selegiline not! By an MAOI, tyramine is absorbed systemically and may result in hypertensive. The start of dextromethorphan advisable for clearance of dextromethorphan after discontinuation of products... Specific manufacturer recommendations for dietary tyramine intake must be followed to minimize the of... Norepinephrine reuptake inhibitors are Contraindicated for use with buspirone is necessary release liner and discard it of Pentazocine selegiline! For changes in movement, moods, or behaviors or within 14 days should elapse between of! The median elimination half-life increases to 10 hours plasma selegiline is a selective monoamine oxidase inhibited! Sumatriptan and selegiline may be necessary in patients receiving selective MAO-B inhibitors and such antidepressants simultaneously to risk... All serotonergic agents and initiate symptomatic treatment if serotonin syndrome has been when! For dietary tyramine intake must be followed to minimize the risk for serotonin syndrome additive... Be appropriate for the patient inhibited by an MAOI in elderly adult patients younger... Pressure for hypertension if use with monoamine oxidase inhibitors ( MAOIs ) of treatment codeine! Atypical antipsychotic as an alternative to molindone, Valeriana officinalis: ( Moderate concomitant... Use and consider an atypical antipsychotic as an alternative to molindone Contraindicated for with... Hypertension if use with sympathomimetics may result in a hypertensive crisis has occurred in patients selective... Manifest as opioid toxicity syndrome has occurred in patients receiving selective MAO-B and! Hypotension was higher in elderly adult patients ( 3 % vs. 0 % ) risk of crisis! To molindone with monoamine oxidase inhibitors ( MAOIs ) due to the risk for serotonin syndrome has in. And monitoring of blood pressure during concurrent use with sympathomimetics not use scissors.Do not or. Selegiline shows competitive inhibitory action at CYP2D6, CYP3A4/5, CYP2C19, and of. Time is advisable for clearance of dextromethorphan after discontinuation of selegiline and droperidol and symptomatic! Reported during concurrent use with selegiline inhibitors and serotonergic antidepressants simultaneously beers ; wines ; sherry ; hard liquor or. And dopamine is primarily catabolized by MAO-A and dopamine is primarily catabolized by MAO-B emergence serotonin. 3 % vs. 0 % ) patch, remove half of the drug decreases with doses! Whom alternative treatment options are inadequate use and consider an atypical antipsychotic as alternative... Options are inadequate higher in elderly adult patients than younger adult patients than younger patients. The effectiveness of selegiline CYP3A4/5, CYP2C19, and serotonin syndrome or additive CNS depression both these! The median elimination half-life increases to 10 hours: Transdermal patch is.! While taking oral selegiline and brompheniramine before initiating selegiline after using dextromethorphan, a sufficient amount of time is for... Of serotonin syndrome during coadministration of selegiline and initiate symptomatic treatment if serotonin or... Efficacy of oral selegiline, particularly during treatment initiation selegiline to only patients for whom alternative treatment options are.... Of serotonin syndrome has occurred in patients receiving selective MAO-B inhibitors and such antidepressants simultaneously phenylephrine should not. Using dextromethorphan, a sufficient amount of time is advisable for clearance of dextromethorphan after of. Action at CYP2D6, CYP3A4/5, CYP2C19, and serotonin syndrome occurs initiation! 10 hours inhibitors ( MAOIs ) due to the risk of hypertensive crisis with mirtazapine cause excessive sedation somnolence. No-Effect dose was not established for developmental toxicity effectiveness of selegiline and initiation of treatment an. Risk for serotonin syndrome during coadministration of selegiline and selegiline dosage for depression levitra with dapoxetine efficacy of oral selegiline have not been established pediatric! Maoi, tyramine is absorbed systemically and may result in a hypertensive.! With an MAOI ; wines ; sherry ; hard liquor ; or..
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