Selegiline (Eldepryl)

• Type of Drug: Antiparkinsonian; selective monoamine oxidase inhibitor.
• Prescribed for: Parkinson’s disease.

Selegiline (Eldepryl) General Information

Selegiline is often combined with Levodopa or Carbidopa to control Parkinson’s disease. Most people who take Selegiline find that their doctor can reduce their Levodopa or Carbidopa dose within a few days.

The exact way that Selegiline works is not known. It is a very strong inhibitor of one form of the enzyme monoamine oxidase (MAO) that is found almost exclusively in the brain. Other MAO inhibitor drugs used as antidepressants work on both forms of MAO and affect the entire body. Selegiline also stimulates dopamine receptors in the brain, possibly by making the dopamine that is available in the brain last longer by interfering with its being reabsorbed into brain nerve endings. In order for any drug to work in Parkinson’s disease, it must somehow increase the activity of dopamine in the brain.

Some of Selegiline’s side effects may be caused by Meth- amphetamine and Amphetamine, 2 products of the body’s breakdown of the drug that are extremely potent stimulants.

Selegiline (Eldepryl) Cautions and Warnings

People who have had a reaction to Selegiline in the past should be very cautious about using it again.

People already taking Sinemet (which contains Levodopa and Carbidopa) who start on Selegiline may experience an increase in Levodopa side effects. Your doctor can deal with this by reducing your Sinemet dosage.

More than 10 mg of Selegiline per day may inhibit both kinds of MAO, causing unexpected reactions, including severe and possibly fatal high blood pressure.

Selegiline should not be used with Meperidine or other narcotic drugs because of the chance of severe, possibly fatal, reactions such as those seen with other MAO inhibitors.

Possible Side Effects

When Selegiline dosage is less than 10 mg per day, most of the side effects experienced are not caused by the drug itself; rather, Selegiline increases the side effects of Levodopa. That’s why it is important for your doctor to reduce your Levodopa dosage as much as possible.

• Most common: nausea, vomiting, dizziness, lightheadedness or fainting, and abdominal pains.
• Less common: tremors or uncontrolled muscle movements, loss of balance, inability to move, increasingly; slow movements (associated with Parkinson’s disease), facial grimacing, falling down due to loss of balance, stiff neck, muscle cramps, hallucinations, over-stimulation, confusion, anxiety, depression, drowsiness, changes in mood or behavior, nightmares or unusual dreams, tiredness, delusions, disorientation, feelings of ill health, apathy, sleep disturbances, restlessness, weakness, irritability, generalized aches and pains, migraine or other headaches, muscle pains in the back or legs, ringing or buzzing in the ears, eye pain, finger or toe numbness, changes in sense of taste, dizziness when rising from a sitting or lying position, blood-pressure changes, abnormal heart rhythms, heart palpitations, chest pains, rapid heartbeat, swelling in the arms or legs, constipation, appetite loss, weight loss, difficulty swallowing, diarrhea, heartburn, rectal bleeding, urinary difficulties, impotence, prostate swelling, increased sweating, increased facial hair, hair loss, rash, unusual skin sensitivity to the sun, bruising or black-and-blue marks, asthma, blurred or double vision, shortness of breath, speech problems, and dry mouth.

At doses above 10 mg per day, Selegiline may cause muscle twitching or spasms, memory loss, increased energy, a transient “high,” grinding of the teeth, decreased feeling in the penis, and inability to achieve orgasm (male).

Selegiline (Eldepryl) Drug Interactions

• Selegiline should not be used with Meperidine or other narcotics because of the chance of severe, and possibly fatal, reactions similar to those with other MAO inhibitor drugs.
• Combining Fluoxetine with MAO inhibitors other than Selegiline has been deadly. This effect has not been seen with Selegiline, but the combination should be avoided. If you are taking Fluoxetine, allow 5 weeks between the time you stop taking it and start on any MAO inhibitor. If you are already taking an MAO inhibitor, allow at least 2 weeks between stopping it and starting Selegiline.

Selegiline (Eldepryl) Food Interactions

Take with food to avoid nausea or stomach upset, but avoid the following: Chianti and red wine, vermouth, unpasteurized or imported beer, beef or chicken liver, fermented sausages, tenderized or prepared meats, caviar, dried fish, pickled herring, cheese (American, Brie, Cheddar, Camembert, Emmentaler, Boursault, Stilton, and others), avocados, yeast extracts, bananas, figs, raisins, soy sauce, miso soup, bean curd, fava beans, caffeine, and chocolate. These foods (and others) can cause severe, sudden high blood pressure to occur with Selegiline. Your doctor or pharmacist can give you more information on foods to avoid.

Usual Dose

5 mg with breakfast and lunch.

Overdosage

Selegiline overdose symptoms may include excitement, irritability, anxiety, low blood pressure, sleeplessness, restlessness, dizziness, weakness, drowsiness, flushing, sweating, heart palpitations, and unusual movements (including grimacing and muscle twitching). Serious overdoses may lead to convulsions, incoherence or confusion, severe headache, high fever, heart attack, shock, or coma. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the medicine bottle.

Selegiline (Eldepryl) Special Information

After you have taken Selegiline for 2 or 3 days, your doctor will probably reduce your Carbidopa or Levodopa dose by 10 to 30 percent. If the disease is still under control, your dose may be further reduced to find the lowest effective dose of medication to control your condition.

It is important to maintain regular contact with your doctor while taking Selegiline to allow for observation of drug effects and side effects. Headache, unusual body movements or muscle spasms, mood changes, or other unusual, persistent, or intolerable side effects should be reported to your doctor at once. Do not stop taking Selegiline or change your dose without your doctor’s knowledge.

Selegiline reduces saliva flow in the mouth and may increase the chance for cavities, gum disease, and oral infections. Use candy, ice, sugarless gum, or a saliva substitute to avoid dry mouth.

If you forget to take a dose of Selegiline, take if as soon as you remember. If it is almost time for your next dose, take 1 dose right away and another in 5 or 6 hours, then go back to your regular schedule. Do not take a double dose.

Selegiline (Eldepryl) Special Populations

Pregnancy/Breast-feeding
Pregnant women and those who might become pregnant should not use Selegiline unless its possible benefits have been carefully weighed against its risks.
It is not known if Selegiline passes into breast milk. Nursing mothers who use this drug should watch their babies for unusual reactions. Report anything unusual to your doctor at once.

Seniors
Older adults may take Selegiline without special restriction. Use the lowest effective dose to minimize side effects.